October 2000 Bulletin

The AAOS in 2005

Data Accrual

Information Management

Knowledge Transmission

The AAOS is developing a dynamic program to become the leading musculoskeletal knowledge-based organization by 2005. It’s an ambitious undertaking that both recognizes and capitalizes on the changes sweeping through the profession and society.

The AAOS mission will remain basically unchanged, but the organization will be reshaped and streamlined to function efficiently and effectively in the Information Age.

By year 2005, the core activities of the AAOS will be data accrual, information management and knowledge transmission.

What triggered the initiative? Richard Gelberman, MD, AAOS first vice president, lists three fundamental changes in the world in which AAOS operates: Health care reform, the Internet and a new generation of orthopaedists who aren’t like their predecessors.

In the last few years, managed care has swept through the profession, toppling traditional fee-for-service, eroding reimbursements and cutting down the time that orthopaedists can volunteer to organizations such as the AAOS. Few expect the "good old days" to return.

At the same time, the information revolution took hold of the economy and daily lives of Americans. The widespread use of computer technology is lauded for increasing productivity and giving millions access to oceans of digitized information. But computer technology also presents daunting challenges to professional organizations with book publishing operations and lecture-rooted education services.

No less important are the attitudes and needs of young orthopaedists—the future of the AAOS. Far different from their older counterparts, the younger orthopaedists are computer reliant; value time more than money; and count every dollar and debate every purchase, including membership in professional societies. They’re not "joiners" and don’t volunteer for projects that take long periods of time. Not a good sign for professional organizations like the AAOS that depend on volunteers.

More than a year of study, workshops and discussion have elapsed since the idea for the initiative was born at a meeting of the Academy officers line in the summer of 1999.

Dr. Gelberman recalls that the participants focused on "what are we compelled to do now to be a leader in the future in education, research, practice and governance?"

The officers recognized the changes in the environment and that the AAOS imprimatur on a product or service was not enough—that the AAOS had to have a value to the member "customer," says Lawrence E. Rosenthal, PhD, deputy executive vice president. Working closely with Dr. Gelberman on the 2005 initiative, Rosenthal also observes that competition is building from companies offering products and services and vying for the time and intellectual knowledge of the members.

The Board of Directors approved a 15-month initiative, known as "The AAOS in 2005," to be led by Dr. Gelberman, then second vice president.

Dr. Gelberman brings to the initiative a vision of the AAOS of the not-too-distant future as an organization dedicated to "improving the care of the population, education of orthopaedic surgeons and efficiency and effectiveness of orthopaedic practices."

The Academy has conducted two workshops, aptly named "Meeting the Needs of the Upcoming Generation of Orthopaedists in the Information Age," and brought together orthopaedists of all age groups, consultants and staff to develop the concept.

The initiative is still in the formative stage. At a future workshop, the Board of Directors will examine what is being done in each of the four target areas—education, research, practice and governance. But here’s where the planning stands at this time.

Education

The AAOS already is moving forward in preparing for the future in education with its Just-in-Time Surgery Online and Online Reference and Review programs. Just-in-Time Surgery Online is a web-based educational program designed to meet the needs of the busy orthopaedic surgeon who wants information when he or she needs it. Orthopaedic surgeons with only a few minutes to get needed information about a procedure will be able to visit the Academy’s online Orthopaedic Campus in the Medical Education section of the AAOS home page at www.aaos.org. The Just-in-Time component will provide indications, approach, technical aspects, postoperative course, etc. for a number of procedures. The Online Reference and Review component is for the orthopaedist who has more time. It links the orthopaedist with information in AAOS journal articles, texts, monographs. There also will be new material and audiovisual features with interactivity.

"The two work in tandem to be the most ambitious comprehensive education program offered anywhere for the orthopaedic office, clinic and home," says Dr. Gelberman.

The AAOS Board of Directors approved a $500,000 allocation from the Academy’s unrestricted reserves to support the initial phase of the online program. Solicitation for Editors-in-Chief of each component has resulted in replies from excellent candidates for each program, says Dr. Gelberman.

Research

The 2005 objective is to be the primary information resource on musculoskeletal care, says Dr. Gelberman. That means continually collecting data on the incidence, outcome and cost. The AAOS will use this data and the expertise of the fellowship to identify the most significant musculoskeletal conditions—such as osteoarthritis, osteoporosis and back disorders. The AAOS will identify the unmet health care needs associated with the conditions. The research, health policy, education and communication activities of the AAOS will be directed to meet the needs of the targeted conditions and to improve the quality of care provided by orthopaedic surgeons.

The initiative will come under the rubric of Improving Musculoskeletal Care in America. The starting point is the current Burden of Disease effort of the department of research and scientific affairs, which has been collecting data on the most common musculoskeletal conditions and treatments. As a first step, the Clinical Quality Improvement Initiatives Task Force, headed by James N. Weinstein, DO, MS, has developed a number of recommendations to be reviewed at the December Board of Directors workshop. These include development of evidence-based models for osteoarthritis of the knee. The task force recommends development of a guideline and performance measures in osteoarthritis of the knee, a shared decision-making video for patients, development of a computer adapted test instrument for osteoarthritis and a pilot test to collect outcomes using the new test instrument. The task force also recommends establishment of a task force to develop, implement and evaluate a "Sign Your Site" campaign; and an AAOS/NIH workshop.

Practice

Research conducted in preparation for the 2005 initiative showed that practice management is one of the three most important areas of interest and concern among orthopaedists. While AAOS members find the organization a primary source of quality educational products and services for the practice of orthopaedics—the diagnosis and treatment of musculoskeletal conditions—there is a need for more information on the business of orthopaedics— the day-to-day dollar and cents of it. The AAOS has developed seminars, symposia and Instructional Course lectures, and has made practice management a focus of the bimonthly Bulletin. But many orthopaedists individually turn to personal contacts or local or national consultants for advice on how to manage their practice.

The 2005 objective is to become the definitive core knowledge resource in practice management, says David Halsey, MD, chair-elect of the Board of Councilors, who heads the 2005 practice management project team. Dr. Halsey, assisted by the marketing department, is conducting market research to determine the specific practice management services and needs of orthopaedic practices. "I envision reference materials in print and electronic media forming the foundation of this project," says Dr. Halsey. An Internet-based version of the reference material may be housed in the AAOS online Orthopaedic Campus. He expects a panel of experts from the AAOS, BONES Society and selected commercial partners will be created to develop opportunities to assist and inform orthopaedists.

Governance

It’s clear to Dr. Gelberman that the AAOS should be restructured to facilitate its core abilities. He believes the AAOS should move from a constituency-based to a competency-based operation, utilizing talent and expertise in the membership to quickly identify needs and develop programs and services to meet those needs.

The AAOS’s organizational structure of four councils for activities in education, research, health policy and communications—sometimes characterized separate "silos" of activity—may give way to a flattened, horizontally integrated organization. Dr. Gelberman says committee activities may be handled by project teams created to accomplish specific tasks and then go out of business.

The Board of Directors also may be competency-based, not constituency-based, says Dr. Gelberman. There may be fewer "slotted" directors representing certain constituencies and more at-large members with competencies and talents in areas that are needed at a particular time. The restructuring proposals may go to the board next year and, if approved, would need membership approval through Bylaws changes.


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