“In the past 20 years, the Internet has been probably the number-one place that people go for medical information,” says Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine and co-author of the study. “I haven’t yet heard from any patients who have used ChatGPT or other chatbots in this way, but it’s definitely where we see things going. The same way that people use search engines to look for medical information now, we expect they will use chatbots in the future, including in their decision-making process.”

For this study a team of investigators identified nine frequently asked questions about cervical spine surgery, which they considered to be of particular clinical relevance. Question topics ranged from the benefits and drawbacks of different surgical approaches to side effects and recovery after surgery. The questions were inputted one at a time into ChatGPT version 3.5.

Two experts in cervical spine surgery who were not involved in designing the questions rated the chatbot’s responses on accuracy, appropriateness, and readability. On average, the responses received a score of 8.1/10, with a 3.9/5 for accuracy and a 2.2/3 for appropriateness. The main drawback the reviewers noted was that ChatGPT failed to provide comprehensive responses, often omitting important factors. For example, it described a particular procedure as being more challenging without mentioning that the level of challenge depended on patient indications as well as the surgeon's overall practice, training and comfort with the technique. 

The experts noted that the responses were easier for people to understand than research literature, which can be complicated for non-experts. Flesh-Kincaid Grade Level analysis determined that ChatGPT's responses were at the level of a junior in high school, compared with primary literature, which is aimed at scholars working in the field. They also appreciated that responses from ChatGPT were always prefaced with a statement regarding consulting an expert for medical advice.

Dr. Qureshi explains that one serious concern with using a chatbot versus a web search is that it’s not clear where the information is being sourced from. “Most people know not to blindly trust everything they find on the Internet,” he says. “If a search takes you to the webpage for HSS or another well-established medical center, you can feel confident that the information has been vetted by experts.”

The researchers plan to continue studying this topic to better understand how patients are using AI tools. Ultimately, their hope is to identify opportunities to ensure that when AI is responding to medical queries it is prioritizing the most reliable and credentialed information.

This innovative surgery revolutionizes conventional anatomical stemmed total shoulder replacement, using an elliptical-shaped head which is anatomically matched to the ovoid shape of the ball-and-socket joint in the human shoulder. The stemmed elliptical head enables surgeons to readily convert an anatomic total shoulder replacement prosthesis to a reverse shoulder replacement prosthesis, should a revision surgery ever be needed in the future. Dr. Blaine is the first surgeon in the world to use this advanced technology, placing an elliptical head on a stemmed implant.

Anatomic total shoulder replacement arthroplasty is often advised for patients with osteoarthritis. This surgery replaces the ball and socket with artificial components, allowing younger patients to stay active and play sports. Reverse shoulder replacement is advised when patients have both arthritis and a deficient rotator cuff. The natural positions of the ball and socket are switched. A metal ball implant is placed where the patient's own natural socket was, and a plastic socket implant is placed on the top of the humeral head.

For the past 50 years, since they were first introduced by Dr. Charles Neer in the 1970s, the heads of the prostheses used in shoulder replacement surgeries have been spherically shaped. In the last several years however, two manufacturers have introduced elliptical heads which may improve range of motion and healthy shoulder functionality over spherical heads, according to some biomechanical and clinical studies.

“The main reason for implanting a convertible prosthesis in a patient’s shoulder is that an anatomic shoulder replacement provides a more normal shoulder than a reverse prosthesis in active patients.  However, if a patient ever had an injury or tear of the rotator cuff in the future, we now have better options with a stemmed prosthesis,” explains Dr. Blaine. “Up until now, we haven’t had convertibility from a standard ball-and-socket prosthesis to a reverse prosthesis. The stemmed elliptical head prosthesis for anatomic replacement gives us the ability to make this conversion in a more expedient way without having to remove the stem.”

“One of our primary goals at HSS is to reproduce or recapitulate the human anatomy,” Dr. Blaine adds. “The normal anatomy of the shoulder joint is an egg-shaped head, not a sphere. This new approach allows us to get closer to replicating the normal function of the human shoulder so patients can remain active well into their later years.”

These first procedures using elliptical head prostheses at HSS Stamford have been successful, and the technology is now being used at multiple centers throughout the U.S. Dr. Blaine also reports that HSS will soon be conducting a motion analysis study in conjunction with other institutions to compare shoulder replacement patients who received oval-shaped heads versus those who received spherical heads.

As HSS performs approximately 32,000 surgeries a year, it is important for physicians to get high-priority messages as fast as possible.

With a pager, there was no way to discern whether the call was coming from a patient with a question, a patient who urgently needed treatment or from someone else. Nick Wirth, director of operational excellence at HSS, explains how pagers only lend themselves to a one-way communication and come with a high retrieval time. Under the new cell phone system, physicians can triage three messages and the system has built-in protocols so that high-priority calls are returned within five minutes.

With this change, HSS has created a higher level of patient safety for postoperative patients.

According to Wirth, if a patient calls the hospital after hours, the staff person who answers the phone can route the call directly to the on-call person with a generated text or secure voicemail.

Wirth has already seen some very positive results from this transformation.

Read the full article at HealthcareITNews.com.