By Andrew M. Wong, MD
As the demands and pace of society continue to increase, technology has kept pace by creating newer and more sophisticated ways of communicating electronically. From the basic home computer to the WiFi-enabled personal digital assistant (PDA), the transfer of text and images via the Internet has become more portable and faster with each new generation of hardware and software.
Surprisingly, in a profession characterized by on-going technological advances, the AAOS fellowship has not embraced electronic media and communication with the same enthusiasm seen in other organizations of similar scope and size.
Reluctance to go electronic
The American Association of Neurological Surgeons (AANS) currently communicates with three-quarters of its members via electronic mail (e-mail), whereas just 60 percent of AAOS members are willing to communicate electronically. Granted, the AANS is a smaller society (6,500 versus 26,000 members) but the Academy’s 2002 Biennial Physician Census demonstrated that interest in electronic media is actually declining, despite evidence that members’ access to computers and high-speed Internet access is increasing.
There has been an ongoing reluctance by AAOS members over the past several years to provide usable e-mail addresses that would allow direct contact from the AAOS. Several techniques have been attempted, including the introduction of on-line registration for the Annual Meeting, Orthopaedic Learning Center and CME courses, and cooperative efforts with the Bones Society to obtain physicians’ e-mail addresses from their office managers.
Timely communication with orthopaedic surgeons will become a higher priority as legislative and patient care issues evolve. As budgets continue to tighten, electronic mail allows for cost-effective, faster and more comprehensive communication and enables members to provide rapid feedback on important issues.
Arrangements are already in place to convert some print publications, such as the Board of Councilors Report, into electronic formats in 2004 to save mailing and printing costs. With this conversion, it’s important that access be maintained for individuals and groups who wish to continue receiving these publications and materials. However, those without an e-mail point of contact will inevitably be disenfranchised.
What are the barriers?
At the Board of Councilors fall meeting, the Communications Committee focused on this issue. We attempted to determine what factors were preventing members from participating in electronic communication. We made suggestions for improving our current AAOS e-mail system and proposed future changes that would better integrate and involve our fellowship. The broad-based access of e-mail and its ease of use create the potential for abuse, and therein lay one of the main drawbacks to e-mail participation. The number of unsolicited and inappropriate messages (spam) is already overloading our electronic in-boxes.
The difficulty comes in trying to separate the “wheat from the chaff”—what e-mail messages are important and require immediate attention versus those that are deletable junk. This problem is compounded by the fact that orthopaedic surgeons are a very mobile group traveling from the hospital to the office multiple times during a given day. The amount of time necessary to review e-mail correspondence can become a daunting waste of time and energy. Inadequate identification of AAOS as the sender of electronic mail creates further difficulties in determining the relative value of a message.
Patient Safety is the key
Those members who feel that the inconvenience and hassles of e-mail justify their decision to hold steadfast against the electronic future must understand that they will be missing an important link in the maintenance of adequate patient safety. Providing the AAOS with an e-mail address is vital to keeping informed on urgent issues that affect your practice and the health of your patients.
An excellent example is the recent Patient Safety Member Alert on prescription errors for oral morphine (Roxanol). Potential over-dosages may have been avoided by the timely dissemination of this information, but it was only received by the 60 percent of members who have an e-mail address listed with the Academy. Other drug issues such as the rash of counterfeit Epogen (Procrit) and product recalls such as the Sulzer acetabular shell several years ago could be widely and urgently communicated to practicing physicians via e-mail and prevent patient harm and potential litigation.
At the same time, measures must be taken to protect the safety and privacy of fellows’ e-mail addresses as well as avoid AAOS spam. Some suggestions for future action include the development of customized e-mail in-boxes so that members could specify which e-mail topics they would be willing to accept. This would ensure that all Academy communication would be of value and importance to each individual. Better identifying AAOS documents for ease of recognition would help to differentiate high priority notifications from other announcements. The development of an opt-out system would benefit members, preserve the effectiveness of electronic communication over time and prevent the bombardment of members by unnecessary and unwanted messages.
Overcoming members’ resistance to online activities also requires that such online experiences proceed smoothly and with relative ease. Online registration and Web site use must be routinely monitored, and continuous improvements in these areas will make their use a mainstay of the Academy.
What’s on your mind?
The goal of making electronic communication as popular and acceptable as hard-copy mailings can only be achieved through interaction. Instead of sending information in one direction, electronic media allows for ongoing interactive commentary and instruction, which greatly broaden the appeal and usefulness of this form of communications.
Our committee has proposed creating a discussion page that would be devoted to addressing the daily concerns and struggles of orthopaedic practice. As opposed to the current topic-related discussion pages that typically focus on questions regarding management of specific orthopaedic surgical problems, this page would emphasize the economic, medico-legal, emotional and psychological challenges of our specialty. We hope that it will serve as a conduit to the Academy leadership to help them understand the practical struggles of the physician “in the trenches” and identify problem trends early.
By linking the discussion page to other online resources, we hope that it can also assist in conflict resolution and information gathering. To facilitate discussions, we have also considered sending periodic topics of interest to the members that would solicit immediate feedback and hopefully prompt further dialogue.
Electronic communication holds tremendous promise for the future, but the key lies in careful planning and execution. Most important is your participation — send us your e-mail address! To ensure that the AAOS has your current e-mail address on file, contact Member Services at (847) 384-4258 or check the “My Profile” section of the AAOS Web site at www.aaos.org.
Andrew M. Wong, MD, is chair of the Board of Councilors Communications Committee and a member of the Bulletin Editorial Advisory Board.