Musculoskeletal care - at the confluence of data science, sensors, engineering, and computation

Use of electronic patient records and encrypted email patient communication among Swiss chiropractors: a population-based cross-sectional study

BACKGROUND

The implementation of electronic health information technologies is a key target for healthcare quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking.

OBJECTIVES

To estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland.

METHODS

Population-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the associations between clinician and practice characteristics and (1) EPR use, and (2) encrypted email use.

RESULTS

Among 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). Among respondents, 47% (95% confidence interval [CI], 40-54%) reported using an EPR in their practice, while 60% (95% CI, 54-67%) endorsed using encrypted email technology. Chiropractors aged ≥ 60 (versus those ≤ 39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants.

CONCLUSIONS

As of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland - just under 50% of responding Swiss chiropractors used an EPR system in clinical practice, while 60% used encrypted email technology. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and encouraged for the purpose of musculoskeletal healthcare quality improvement.

Digital health in musculoskeletal care: where are we heading?

BMC Musculoskeletal Disorders launched a Collection on digital health to get a sense of where the wind is blowing, and what impact these technologies are and will have on musculoskeletal medicine. This editorial summarizes findings and focuses on some key topics, which are valuable as digital health establishes itself in patient care. Elements discussed are digital tools for the diagnosis, prognosis and evaluation of rheumatic and musculoskeletal diseases, coupled together with advances in methodologies to analyse health records and imaging. Moreover, the acceptability and validity of these digital advances is discussed. In sum, this editorial and the papers presented in this article collection on Digital health in musculoskeletal care will give the interested reader both a glance towards which future we are heading, and which new challenges these advances bring.

A Semi-Automated 3D-Printed Chainmail Design Algorithm with Preprogrammed Directional Functions for Hand Exoskeleton

The problem of computerising the design and development of 3D-printed chainmail with programmed directional functions provides a basis for further research, including the automation of medical devices. The scope of the present research was focused on computational optimisation of the selection of materials and shapes for 3D printing, including the design of medical devices, which constitutes a significant scientific, technical, and clinical problem. The aim of this article was to solve the scientific problem of automated or semi-automated efficient and practical design of 3D-printed chainmail with programmed directional functions (variable stiffness/elasticity depending on the direction). We demonstrate for the first time that 3D-printed particles can be arranged into single-layer chainmail with a tunable one- or two-directional bending modulus for use in a medical hand exoskeleton. In the present work, we accomplished this in two ways: based on traditional programming and based on machine learning. This paper presents the novel results of our research, including 3D printouts, providing routes toward the wider implementation of adaptive chainmails. Our research resulted in an automated or semi-automated efficient and practical 3D printed chainmail design with programmed directional functions for a wrist exoskeleton with variable stiffness/flexibility, depending on the direction. We also compared two methodologies of planning and construction: the use of traditional software and machine-learning-based software, with the latter being more efficient for more complex chainmail designs.