NFL enlists health IT in injury battle

PACS, EHRs, telehealth and more find their place on the sidelines
By Mike Miliard
12:00 AM

Football season is now in full swing, and the hits keep coming. Now, more than ever, football is a dangerous game. That's why the National Football League has finally embraced a full array of health information technology and radiology tools to help diagnose and track the litany of injuries that could afflict even the luckiest guy on the gridiron.
The Buffalo Bills announced in August that they'd partner with nearby Rochester, N.Y.-based Carestream Health to develop new imaging technology aimed at early detection of brain injuries. It's just the latest development for a league that's deploying health IT in football stadiums nationwide.
The Bills will work with Carestream and Johns Hopkins University to research and develop new 3D imaging systems, including a cone beam CT system developed for musculoskeletal radiology and orthopaedic imaging of extremities, with applications ranging from traumatic injury to arthritis and osteoporosis, officials say.
This partnership seeks to develop new technology not just to drive earlier diagnosis and assessment of injuries, but to develop medical standards that indicate if an athlete can return to play. It will also study long-term degenerative medical conditions of the head and brain.
"The NFL supports initiatives that will help us better understand the impact of traumatic brain injuries and the effect on players' health, with the goal of advancing sports medicine to provide better care for all athletes," said Russ Brandon, president and CEO of the Buffalo Bills. "This collaboration is an important step that will help with this effort."
Carestream has installed a new CARESTREAM DRX-Ascend System and a DIRECTVIEW CR System at Ralph Wilson Stadium to enable Bills medical staff to instantly access X-ray images and determine whether a player can return to a game or a practice session, or if further treatment is necessary.
"By working with clinicians and sports medicine experts to obtain information that will aid in our development of advanced medical imaging solutions for head and other injuries, we have an opportunity to apply our expertise to help improve the lives of athletes and people in our communities," said Diana L. Nole, president of digital medical solutions at Carestream.
"The prevalence and severity of TBI has come dramatically to light in the last decade," said Jeffrey H. Siewerdsen, a professor in the Department of Biomedical Engineering at Johns Hopkins University. "Our work will create a system capable of detecting TBI at the point of care, leveraging a major advance in imaging capability to confidently diagnose subtle brain injury and direct patients to appropriate therapy, avoid repeat injury and stem the debilitating effects of undetected disease."
On Aug. 27, INFINITT North America announced the signing of a 10-year agreement with the NFL to enable on-demand access to players' medical images. INFINITT's Smart-NET, a Web-based PACS, maintains digital copies of images across a network of data centers and will allow instant viewing of both new and historical images from any stadium, team facility or physician's office as long as the user has proper credentials for image access, officials say.
"Currently, most healthcare providers copy the players' images to CD/DVD, but these aren't always on hand when and where you need them," said INFINITT CEO David Smarro. "With the INFINITT system, digitized images can be transmitted electronically over the Internet, and viewed in multiple locations simultaneously. This is particularly valuable when two or more physicians need to consult on the player's condition or diagnosis."
Beyond imaging technology, the NFL will also be using electronic health records league-wide this fall. Healthcare IT News reported in 2012 that it had contracted with Westborough, Mass.-based eClinicalWorks to serve its 32 teams
"The health and safety of our players continues to be our number one priority," Brian McCarthy, NFL's vice president of communications, told Healthcare IT News in November 2012. "We want to provide team medical staff with the latest technology that will help with their care and treatment of players in real time at the team facility, in the locker room (and) on the sidelines."
In fact, the NFL was required to move to digital records, thanks to the 2011 collective bargaining agreement with the players union, which called on the league to "develop and implement an online, 24-hour electronic medical record system" and implement it before August 2013.
Owners initially opposed the move, but the union pressed the case that electronic records were critical protecting players' health and safety.
In July, the USA Today reported that iPad-based EHRs may soon be coming to the sidelines, enabling team docs to have players' entire medical record - imaging files, injury data and more - within easy reach.
Eight teams will participate in the iPad pilot program: Baltimore Ravens, Denver Broncos, Houston Texans, New England Patriots, New York Giants, New York Jets, Pittsburgh Steelers and San Francisco 49ers.
Each iPad will be loaded with software that includes the Sideline Concussion Assessment Tool (SCAT-3) a neurocognitive test that can determine whether a player has a concussion, according to the paper.
"If we can just sit him down and say, 'Look, here's your balance test and your cognitive skills, your memory, your reaction time,' now they've got a visual of that, which is a very positive step forward with the players accepting that they have an issue and wanting to get it resolved," James Bradley, the Pittsburgh Steelers' head orthopedic surgeon and chairman of the league's medical research committee, told USA Today's Tom Pelissero.
As this flurry of health IT activity happing at the professional level, even local and high school football teams are starting to embrace technology as a key to player safety.
With more and more states passing laws mandating medical clearance by a qualified healthcare provider, such as a neurologist, before concussed athletes can return to play, this past year the Mayo Clinic published a study, "Teleconcussion: An Innovative Approach to Screening, Diagnosis, and Management of Mild Traumatic Brain Injury," which studied student athletes in rural communities.