Determining surgical outcomes and quality of patient care are some of the primary forces that shape which surgical procedures and medical protocols are ultimately utilized. As insurers and patient-consumers demand more of an evidenced-based approach to medical care to contain costs and provide proven treatments, those technologies that facilitate this measurement are particularly worthy of consideration.
Cleft lip and palate is a devastating congenital deformity affecting nearly 1 in 700 of children born in the United States and nearly 1 in 300 in children born in developing Asian countries. The treatment of this deformity requires a team approach utilizing the skills of surgeons, nursing personnel, speech pathologists, social workers, and orthodontists. Each team member contributes uniquely to the care of the individual patient, and must accurately record their observations and treatments. After this data is then entered into a master database, patient progress may be followed and the efficacy of treatments determined.
Provider compliance in acquiring data is enhanced by capture systems that facilitate this process, leading to more complete outcomes measures. To this end, I developed a Palm OS database that incorporates the text descriptors specific for Cleft Lip and Palate surgery and a unique diagram that graphically records the anatomic side and site of the cleft lip and/or palate deformity. The utility of this handheld system was presented at the American Cleft Palate Cranio-Facial Association annual meeting on May 3, 2002 in Seattle, WA.
System Hardware
The Palm OS was utilized primarily because of the superior availability of user modifiable database software. Because of the higher screen resolution, a Sony Clie T615 was preferred, although the Palm Vx served adequately.
System Software
Pendragon Forms v.3.2 was used to construct the text database portion of the Palm OS database. In this database, over 50 individual fields were required to accurately describe patient demographics, surgical personnel, type of defect according to a new classification system, ICD diagnosis and CPT procedure classifications, and primary and revision repair types.
The graphics portion of the database utilized either TealPaint v.4.95 or the paint program provided with the Clie handheld (CliePaint). Using either of these programs allowed the user to modify a standardized multiple-use template reflecting the cleft deformity. The modified diagram may then be combined with the text database and subsequently stored as part of the patient's database record.
The desk or laptop database was either FileMaker Pro or Microsoft Access. Data on both the handheld and desktop was encrypted secure with PDASecure and GoldSecure software.
XXXXXXXDatabase Operation
The handheld is quite easy to use in either the clinic or abroad during surgical missions. The physician provider first enters the text data rapidly, being facilitated using "pick lists" or other standardized "pop-up" menus. After entering this text data, the physician then modifies the diagram template to indicate the anatomic deformity of the cleft lip and/or palate. After data transfer to the desk or laptop workstation by cable or IR transmission, both the patient specific text and graphic image information is integrated into the desktop database.
From the desktop database, multiple patient records can be easily accessed, data analyzed and treatment protocols and outcomes determined.
Summary
The data from over 40 patients was collected on the handheld text and graphic database and then transferred to the desktop database, encrypted secure and with no loss of integrity. Specific information regarding the demographic and operative details was easily queried and analyzed. Likewise, rapid comparison of the diagrammatic representation was performed allowing practitioners to more accurately determine the anatomic side, site, and difficulty of the cleft operation. Further studies will incorporate the handheld as a primary capture device in developing outcomes measures.
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www.pdamd.com/vertical/forums/read.php?f=5&i=530&t=530Howard S. Kotler, M.D., FACS is a Board Certified Otolaryngologist - Head and Neck Surgeon in private practice in Chicago and Clinical Assistant Professor of Otolaryngology - Head and Neck Surgery at The University of Illinois College of Medicine in Chicago. Dr. Kotler is also Director of Surgical Services for Operation Sunrise, a not-for-profit organization providing free reconstructive surgery and related services to children and young adults with cleft lips and palates in medically under-served areas of the world. He has a strong interest in Medical Informatics; performing research involving handheld applications in medicine, serving on the Informatics Committee of the American Academy of Otolaryngology - Head and Neck Surgery and pursuing a graduate degree in Medical Informatics.