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Maximizing the Internet in Your Orthopaedic Practice

  • Authors: Christopher W. Oliver, DM, FRCS
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This activity is intended for orthopaedic surgeons and pharmacologists.

The goal of these activities is to define "state-of-the-art" treatment protocols and clinical strategies for the diagnosis and management of bone and joint disorders, to enhance the care of patients with arthritis and degenerative diseases and to support quality clinical practice of orthopaedic surgeons involved in their care.

Upon completion of this activity, participants will be able to:

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  4. Review the current etiologic theories for increased incidence of ACL injury in females.

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Maximizing the Internet in Your Orthopaedic Practice

Authors: Christopher W. Oliver, DM, FRCSFaculty and Disclosures


Getting Along With the Internet

Physician-centered decision making is now evolving into patient-physician shared decision making by the use of the Internet. Panelist J. Sybil Biermann, MD, of Ann Arbour, Mich, indicated that patients are now becoming more autonomous in their health care decision making. She estimated that about one third of the US population is online and this figure may approach one half by the end of 2001. Therefore, more patients will become seekers of quality information health care from the Internet. Dr. Biermann described her own study, which showed that 74% of patients whose physicians recommend a Web site, subsequently access the site. Twenty-four percent of patients subsequently search the Internet for the diagnosis given by the physician for health information on their own condition. From this information, 42% of patients subsequently raised further questions to ask the doctor about their condition.

Increasingly, patients are using e-mail to communicate with their physician. The physician needs to develop strategies to cope with the growing number of patients who gather information from the Internet before consultation. An automatic reply to incoming messages to say the message has been received and will be dealt with later can be used. Patients posing complex questions should be advised to make a clinic visit, as problems cannot always be dealt with by e-mail. Dr. Biermann observed that electronic communication with patients may be nonreimbursable, but could be seen by some physicians as an added value service.


Orthopaedic Web sites Ranked for Content, Ease of Use

Christopher W. Oliver, MD, FRSC, of Edinburgh, Scotland reported on a study performed in his surgical unit. Sixteen major established orthopaedic sites were reviewed in 1999, with respect both to their content and their usefulness.[1] It was not intended to be a comprehensive or individual review of all trauma and orthopaedic sites, but rather a 'snapshot' of the orthopaedic Internet. The chosen sites were easily accessed by the professional and public alike and in this writer's opinion, represented the better quality end of the orthopaedic Internet. Dr. Oliver noted that there is inherent subjectivity in the method as use of the Internet is easier and quicker at certain times of day.

The Web sites were:


  1. American Academy of Orthopaedic Surgeons  
  2. AO-ASIF  
  3. Belgian Orthoweb  
  4. British Orthopaedic Association  
  5. Canadian Orthopaedic Association  
  6. Department Of Orthopaedics University of Edinburgh  
  7. Egyptian Orthopaedic Association  
  8. Institute of Orthopaedics Oswestry  
  9. Internet Society of Orthopaedics and Trauma Surgery  
  10. Journal of Bone and Joint Surgery UK  
  11. Orthogate  
  12. Orthogate Patient Information  
  13. Orthopaedic Product News  
  14. Orthopaedic Trauma Association  
  15. Organising Medical Networked Information

A summary of results is shown in Table 1.


Table 1. Summary Results of Snapshot of the Quality of the Orthopaedic Internet

  • Most of the chosen sites had some kind of academic affiliations.  
  • Most sites showed a clear source for the information and were qualified to give such information.  
  • Half of the Web sites did not clearly state the aims of the material posted.  
  • Half of the Web sites had apparently not been updated within the last month.  
  • Half of the Web sites were not clearly referenced.  
  • Almost seventy five percent did not clearly state the intended audience (ie, lay or professional).  
  • Just under half of the Web sites had commercial sponsorship but in only 2 Web sites did there appear to be a conflict of interest.  
  • Just over half had no Web site disclaimer.  
  • Three-quarters gave no statement of the Web site's limitations.

Most had an attractive layout with useful hyperlinks, which worked and were of good quality. Dr. Oliver and colleagues rated 12 of the 16 sites as suitable for a lay audience. These results suggest that, despite purporting to be sources of quality, reliable information, many sites do not adhere to the standards expected in printed texts and journals. While this may be seen to allow freedom of expression of opinions from individuals and organizations across the globe, it also provides potentially misleading interpretations of established or experimental practice. The points on which the Web sites failed are ranked below:


  1. Not stating any limitations of the Web site.  
  2. Not stating the intended audience.  
  3. Not posting a disclaimer.  
  4. Not stating the sources interests.  
  5. Not stating time of last update.  
  6. Not stating references or sources.

"Internet Portals" are the Future of Interaction

Ira Kirschenbaum, MD, of Lennox Hill Hospital, New York, described how the Internet would extend education beyond residency and that education would evolve into "edutainment." He opined that the common usage of Internet search engines would decline, as "Internet Portals" continue to develop information.

Specialist medical Web sites enable greater access to education through CME, web-updates of topics, "access to leading thoughts," and next-day conference summaries to make information available to surgeons and remote communities.


Copious Data Creates Its Own Problems

Dr. Oliver described his experiences and strategies for dealing with information overload. To avoid further information overload in this review, his article can be found in the AAOS Bulletin.[2]


Web-based Knowledge Management

Jonathan L. Schaffer, MD, of Chestnut Hill, Mass, described the trend to the fully electronic office and the methods of controlling and being creative with knowledge management. He described his experiences with maintaining large Web sites by using distributed authoring, where no whole Web site is maintained by a single person. He described how each section of a Web page[3] was driven by a database that was then used to create the whole Web page for a specific aspect of the hospital. His own hospital experienced considerable financial savings by using in-house Web publishing and Web-based job publishing.


Office-based Internet Tools Create Infrastructure

Randale C. Sechrest, MD, of Missoula, MT, described Internet-savvy patients who are demanding greater interaction with their health care providers. He said that attempts need to be made to negotiate the "data smog" of the Internet in relation to information overload and search engines. He attributed the information revolution to be the tool to cross the chasm to ePractice and eServices.[4]

Dr. Sechrest's vision for the future "change agents" of the orthopaedic Internet were:


  1. Unlimited bandwidth -- giving a much greater amount of information to be transmitted across a telecommunication connection.  
  2. "Always on" connectivity -- giving an immediate access online.  
  3. Wireless connectivity -- will act to extend a network and make the computer more portable.  
  4. Connected devices -"smart" devices that can act independently in their own environment if required.  
  5. Growth of services -- the creation of an infrastructure in which information services can be provided as an eService.


  1. Oliver CW, Auld J. A snapshot of orthopaedic Internet quality [Orthopaedic Product News site]. October 1999. Available at: Accessed March 18, 2000.
  2. Oliver CW. How to avoid drowning in e-mail. American Academy of Orthopaedic Surgeons Bulletin. April 1999;47(2). Available at: Accessed March 18, 2000.
  3. Enterprise Wide Web-Based Information Services [Brigham and Women's Hospital site]. Available at: Accessed March 18, 2000.
  4. Sechrest RC. The Orthopedist's Guide to the Internet: The Four Critical Steps to an ePractice [Orthopaedic Internet Consortium site]. Available at: Accessed March 18, 2000.


Suggested Web sites:

Edinburgh Orthopaedic Trauma Unit:

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