Going paperless isn't just better for the environment: It may also reduce healthcare costs and produce better outcomes for your patients, according to a new study.

Researchers compiled data from 41 urban hospitals in Texas and developed an assessment tool to measure the "success of the interface between technology and healthcare professionals" at each facility, according to senior author Neil Powe, MD, MPH, MBA, of Johns Hopkins University School of Medicine in Baltimore.

The study, published in the Jan. 26 issue of the Archives of Internal Medicine, surveyed physicians about their use of clinical information technologies and assigned number scores to each hospital.

Those that ranked high in the automation of notes and records showed a 15 percent reduction in the risk of hospital fatalities. Similarly, facilities that were in the top tier of use for decision support systems, which provide physicians with clinical information to help them make treatment decisions, showed a 21 percent reduction in the risk of patient complications.

The authors conclude that "hospitals with automated notes and records, order entry and clinical decision support had fewer complications, lower mortality rates and lower costs" than those with lower automation scores.

Irene Tsikitas

The post-op pain that patients undergoing foot and ankle surgery experience might be a question of mind over matter, according to research conducted at Stanford University Medical Center in California.

A team led by Loretta B. Chou, MD, an orthopedic surgeon at Stanford, used questionnaires to evaluate the pre-op and post-op pain experiences of 98 patients - a mix of men and women with an average age of 46.5 years - who were undergoing inpatient and outpatient foot and ankle surgeries.

In their study, which appeared in the November 2008 issue of the journal Foot & Ankle International, the researchers report that patients' actual pre-op pain and anticipated post-op pain were predictive of the pain intensity they experienced at three days and six weeks post-op.

Dr. Chou says optimistic patients suffered less post-op pain than patients with expectations of post-op discomfort, although her research was unable to pinpoint the exact cause for the discrepancy. "To make a long story short, we found that believing there will be pain after surgery leads to just that, pain," she explains. "This result may demonstrate that patients are good at predicting pain, or that their expectation of greater pain may contribute to its subsequent occurrence."

This study may help surgeons select appropriate pain management regimens for typically painful orthopedic procedures, notes Dr. Chou. She warns, however, that further research is needed to relate patients' post-op discomfort to the type of pain medications used and the specific procedure performed. Follow-up studies focusing on patients' pain experiences following ankle fracture surgery and the removal of painful hardware from the foot and ankle have begun, she says.

Daniel Cook

In a move toward greater transparency among its members, the North American Spine Society is requiring researchers to disclose exactly how much money they have received from device manufacturers and drug makers over the preceding 12 months.

"The goal is to create an environment of scientific validity, in which learners can trust [that] the information they receive is objective and unbiased," says the society's ethics committee. The mandatory disclosure rule urges members to be "forthright in their dealings with one another and with their colleagues and patients."

The violation of this rule may result in membership suspension, expulsion and public letters of censure, says the society.

That hasn't always been the case with spine surgeons, who have been the subject of occasional federal scrutiny. Last year, the FDA investigated several spine surgeons who had conducted clinical trials that led the agency to approve of a surgical device, and who had also invested in the device's development.

In another case, Thomas Zdeblick, MD, a spine surgeon and researcher at the University of Wisconsin, disclosed that a device manufacturer had paid him $20,000 or more each year, when he had actually received $19 million over five years, according to a published report.

Kent Steinriede