Tackling head trauma in the NFL

Aiming to prevent head injuries, NFL turns to Mass. firm’s databasing for players’ medical files

As criticism mounts over the National Football League’s failure to do enough to prevent repeat head injuries and their lasting cognitive effects, the NFL was expected to announce Monday that the league would convert to an electronic health record system next season with software provided by Westborough-based eClinicalWorks.

Under a 10-year contract, the NFL will pay $7 million to $10 million for a system that would store X-rays, blood test results, physical exam notes, medications — even video clips documenting a game injury — in one online server that players and physicians could access from anywhere in the country.

“It brings a continuity of care to players regardless of whether they switch teams or move to another state,’’ said Dr. Anthony Yates, president of the NFL Physicians’ Society and head team physician for the Pittsburgh Steelers.


The technology will also allow researchers to tap into the medical records with names removed to analyze a vast treasure trove of data and learn more about field conditions that raise the likelihood of ankle injuries or the types of concussions that are likely to lead to early dementia.

“In recent years there’s been a much sharper focus on concussions in football and other sports,’’ Roger Goodell, the NFL commissioner, said during a lecture he delivered last Thursday at Harvard School of Public Health. Researchers have made advances in understanding how critical it is for players to avoid multiple severe head impacts in close succession, but Goodell added, “there are still unanswered questions.’’

At the moment, each team relies on its own medical records system, with some using paper records and others electronic systems that do not necessarily allow players to have access to their records when they switch teams or see doctors for second opinions.

“The NFL wanted an electronic health record that was usable across the entire system,’’ said Girish Navani, chief executive of eClinicalWorks. “This system will allow physicians to send prescriptions electronically to the pharmacy or an order for an X-ray or MRI. It can hold a workout regimen for rehabilitation and will allow trainers to examine X-rays from previous injuries to compare with new ones.’’


Although electronic health records have come under scrutiny for privacy concerns and computer hackers, security has improved tremendously on these systems in recent years.

“It’s more secure than online banking,’’ Navani said, “and 10 times more secure than records we keep in a drawer.’’

The company utilizes cloud computing to store records rather than keeping them on individual servers in doctors’ offices or team locker rooms. In addition to a password, a user needs an identifying authentification tool, such as a fingerprint or electronic chip, with a password that keeps changing.

And, unlike paper records, which can be read surreptitiously, electronic records track who accesses the file and which files have been seen.

“We have a full audit of everything any user does to a medical record,’’ said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center, “and employees know they can be fired for unauthorized access.’’

Beth Israel Deaconess adopted eClinicalWorks for 3,000 doctors affiliated with the hospital in more than 80 locations five years ago; Halamka described his experience with the software as “very positive.’’ The system has not had any security breaches, he said, and is compatible with the hospital’s own electronic records system, used on the hospital campus.

“If there’s anything doctors grouse about, it’s that it takes them more time to write a prescription,’’ said Halamka, who is cochairing a federal committee to set compatibility standards for electronic health records. “Where it used to take them two seconds to scrawl illegibly, it now takes them several clicks to get to the appropriate form, but the downstream benefit is that patients can have a history of every X-ray they’ve every had, a complete medication list, and an avoidance of unnecessary testing and dangerous drug interactions.’’


NFL players will also have access to a system that alerts their team physician when they are due for a vaccination or cholesterol screening and will keep track of how many players are complying with their health screening.

The system will also have firewalls in place to prevent team trainers and others from accessing health information that players may not want to reveal to all medical staff, like treatment for depression or a sexually transmitted disease.

“I think the NFL switch to electronic records is a terrific idea,’’ said Dr. Ashish Jha, an associate professor of health policy at the Harvard School of Public Health. “The new technology could also be useful in the future to measure the impact of head injuries with technology embedded in helmets, so it’s not a judgment call whether a player has actually suffered a concussion.’’

With all the attention placed on the seriousness of repeat head injuries and mandatory time off from play, he said, some trainers may be tempted to raise the threshold for when they call an injury a concussion. An electronic system measuring the impact could help take judgment calls out of that decision making.

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