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Painting the portrait of athlete health: a call for interconnected health information systems
  1. Dustin Nabhan1,
  2. David Taylor2,3,
  3. Jonathan T Finnoff3,4
  1. 1 Sports Medicine, US Olympic Committee, Colorado Springs, Colorado, USA
  2. 2 Sports Medicine, US Olympic & Paralympic Training Center, Colorado Springs, Colorado, USA
  3. 3 US Coalition for Prevention of Illness & Injury in Sport, Colorado Springs, Colorado, USA
  4. 4 Sports Medicine, United States Olympic & Paralympic Committee, Rochester, Colorado, USA
  1. Correspondence to Dr Dustin Nabhan, Sports Medicine, US Olympic Committee, Colorado Springs, CO 80909, USA; nabhandc{at}gmail.com

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Athlete health promotion programmes depend on accurate and complete sport epidemiology data.1 Many methods are used for health surveillance in elite athletes: research registries, medical records, screening questionnaires for clinical and research use and athlete monitoring systems designed for high performance management teams.2–4 In this clinical commentary, we describe our theory that the true incidence and prevalence of health conditions may be best described by interconnected data systems that aggregate the information from each of these inputs into one live data table. We then introduce a system developed by a National Olympic & Paralympic Committee that is used to help document medical records of individuals for clinical athlete management, while also contributing to knowledge of athlete cohorts for population-based health promotion programmes.

Importance of the issue

The best predictor of future injury is prior injury; however, systems that categorise an athlete’s previous injury, track new conditions and maintain records of risk factors are not readily available for use in the clinical setting.5 Analysis of existing injury surveillance systems provide examples of common flaws with current systems (eg, inconsistent definitions, poor data hygiene, failure to report conditions by medical staff or inaccurate and incomplete reporting) that must be addressed in order to improve the state of injury prevention research.6–8 In this editorial, we describe how integrated health information systems may potentially help sports medicine clinicians and researchers understand the true health risks associated with sport participation.

Abstract art: incongruent health information systems paint a fuzzy picture

In elite sports settings, there are many stakeholders who share the goal of optimising athlete health; however, the methods each group uses to accomplish this goal are often incongruent. Clinicians use medical records to document the care provided to an athlete as required by regional regulations and standards of care. Researchers create injury surveillance systems and patient registries to quantify and analyse injury trends, risk factors and outcomes. High performance teams use health reports to monitor biomarkers of health and performance of athletes, direct training plans and allocate science and medical resources. Federations use surveillance tools to monitor athlete health and promote safety through equipment and policy change. In our experience, despite shared intent of these stakeholders to improve athlete health, successful integration and/or planning of these programmes into one system is rare.

Important information may be lost when systems do not communicate, use disparate coding languages, or fail to record all events.

A proposed solution

The United States Olympic & Paralympic Committee (USOPC) developed a programme that systematically records each component of the athletes’ health information (figure 1). This system includes electronic medical record (EMR) data for over 10 000, electronic health history questionnaires for over 1000 and sport science and health monitoring data for over 500 athletes. Security and privacy are cornerstones to this programme. Athletes who consent to the use of their data by their health and performance providers are entered into the health information system. On receipt of consent, data from the EMR and sport science data are combined into an aggregated data set to be used for heath and performance management. User roles (eg, physician, strength and conditioning coach) are used to define access to user-specific reports.

Figure 1

The USOPC Health Information System.

During periodic health evaluations, we use electronic health history questionnaires followed by structured patient interviews to capture historical health information. We re-code data from these tools into our EMR using the Orchard Sports Injury and Illness Classification System (OSIICS), a publicly available sport injury surveillance coding system—an important step to organise health information from multiple sources for meaningful use.

When an athlete seeks healthcare from the USOPC, medical consultations are recorded in an EMR customised for elite sport. If athletes receive care from outside our health system, we enter records from this care into the EMR to ensure no important information is lost.

We invite elite athletes training with the USOPC to participate in Athlete 360, an athlete management system that communicates with the EMR. When athletes self-report an injury or illness through the Athlete 360 messaging system, a USOPC healthcare provider is alerted and asked to investigate and act on the issue. Once a diagnosis is rendered by the healthcare team, it is documented in the EMR with an appropriate OSIICS code. This process ensures health information is maintained in one centralised system.

We generate reports from this system designed for each end user. Athletes can access their historical health information via individualised, infographic-style dashboards that live in their athlete management system user interface. Clinicians and scientists are granted access to discipline specific reports and, when appropriate, to detailed medical records in the EMR. Aggregate injury report dashboards are created for communication with high performance teams. All data are coded for research use according to IOC consensus recommendations, reducing the time required for population-level reporting and research use.

A call to action

Sport organisations must prioritise the development of interconnected health information systems that combine medical histories, electronic medical records and athlete management systems for the true burden of health problems on athletes to be known. These systems should use diagnostic coding systems designed for sport, allow for athlete self-report of health problems and provide aggregate, de-identified data for development of future athlete health promotion programmes.

Ethics statements

References

Footnotes

  • Twitter @nabhansportsmed

  • Contributors DN, DT and JTF are responsible for all aspects of this work, including development of the idea, writing the manuscript and approving the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.