Jan 29, 2015
Cyber Structure

By Chad Kinart, MS, ATC

Chad Kinart, MS, ATC, Athletic Trainer for ESPN Sports Medicine in Omaha, Neb., provides his perspective on progressing toward a Web-based injury tracking application within a collegiate athletic training room setting. Kinart served as an Assistant Athletic Trainer at the University of Nebraska-Omaha from 2000 to 2006.

As all athletic trainers know, treating athletes is only a part of the job. One of the more time-consuming elements of the day-to-day work is capturing and managing athlete health information.
Lacking a gold standard within the profession, each athletic training room follows its own protocol–some record the name of a player and injury date, others record treatment information relevant to their role, and a few collaborate with external medical teams to create a holistic health record. Regardless of the approach, the information captured is usually placed into paper files and in some cases a mix of paper and a homegrown computer system. The latter was the case at the University of Nebraska-Omaha.

When I came to Omaha, we were managing athlete health information with a combination of paper and customized Microsoft Access databases. This approach facilitated the management and delivery of athlete health information, but lacking centralization, the data could not be easily accessed. In addition, keeping records up to date and organized was a labor-intensive process.

Recognizing this, Head Athletic Trainer Tom Frette, MA, ATC, EMT, championed the idea of a single electronic health information management system. Hospitals and clinics have utilized these systems for years. However, our needs required a system tailored to sports medicine applications–one that would also avoid the complexity and cost of traditional electronic health record/billing systems.

As athletic trainers, we require flexible access in both the athletic training room and on the field. We must also be able to quickly and securely share information with other members of the sports medicine team. In addition, our central role in athletes’ recoveries means we must facilitate the overall care process. This involves knowing athlete health histories well enough to recommend and ensure prompt, appropriate treatments that minimize downtime and maximize full recovery potential. The system had to reflect these and other needs.

When seeking a system, it is important to list your program’s essential requirements before looking at the available products on the market. These requirements will most likely be modified as you view and become familiar with different products. Frette led the search for a system to meet our athletic training requirements. In the end, he chose Presagia Sports (also known as Injury-Zone). Some important criteria identified during the search process were:

• The ability to finitely control access for multiple users and user types in order to protect the security of health information in accordance with HIPAA. The system we selected supported a role-based access structure. This allowed us to easily define the information each user type could see, access, and modify. For instance, a coach might see the current health status for all athletes on one team while an athletic trainer might view and modify entire health records for all athletes across the organization.

• The system needed to adapt to the university’s existing environment. We chose a Web-based, HTML-coded software. Working with the vendor and making changes to the system based on our needs was not only possible, but also very easy. This contrasted with other “out of the box” local computer/server-based programs tested, which lacked the same level of customizability. In addition, our experience with “out of the box” programs and our university’s computer/server system was not a pleasant one. The system that needed to host the program did not mesh well and we were constantly having problems.

• The system needed to be capable of being utilized in smaller pieces as opposed to one large program. Smooth implementation was a key component. At the time of purchase, some products forced you to use certain and/or all sections for the overall program to operate. We found this cumbersome and time consuming, particularly if a section of the program didn’t fit with our current policies and practices. The product we chose allowed us to use the sections we wanted and to either implement later or hide the sections we did not want to use. This facilitated a much-improved implementation process.

• The system needed superior customer service. Unfortunately, it does not matter how good the product you choose is, eventually you are going to have problems with it. The pace of work at colleges and universities cannot tolerate long amounts of downtime due to product failures. Having outstanding customer service and support is the icing on the cake. This facet takes a great product and makes it outstanding.

One element critical to our success, while introducing the new system into our current processes, was to devise an implementation plan. Technology-related projects often meet with some resistance, usually due to a natural fear of the unknown. To overcome this, we developed an implementation plan prior to purchase.

We spent a considerable amount of time working with the vendor and our own staff to create a plan that would decrease user stress and frustration at the early stages of implementation. The plan stretched several years, calling for minimal system use at the start and branching out from there as staff and students became more comfortable with various features. Taking this approach, we had the basic system fully up and running about a month after purchase, with additional components being phased in strategically.

A few of the outcomes we immediately noticed as system use ramped up included: • The athletic training workflow was improved, with access to information outside the training room. • The ability to centrally track documents increased administrative efficiency. • The building of more comprehensive, accessible health records for student athletes improved the level of care provided.

Armed with experience working within a technology-supported athletic training environment, I have become a strong advocate of this approach. Centralizing record keeping and managing information electronically allows athletic trainers to spend more time evaluating and treating athletes. Using a standardized format to capture information greatly reduces the chance of human error and redundant data entry. As the information contained within the system grows, so too does the potential to identify injury trends and establish best-practice treatment processes.

For athletic trainers looking to change their athlete health information management process, my biggest recommendation is to make sure that whatever route you take (paper, computerized, or Web-based), you are 100-percent committed to detailed and comprehensive record keeping. If you are not, it will not matter which method you choose and you simply will not be satisfied with the results. If you do commit to the Web-based approach, it is an outstanding way to improve athletic training processes and provide a higher level of care to your athletes.

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