Every one of the 32 NFL teams has 60 players that often receive medical care from hospitals or other facilities they've never visited before.
So imagine how difficult it might be to share an electronic medical record (EMR) when you're a player on the visiting team and you need treatment at an out-of-region facility or specialist.
That's what the NFL has had to deal with for the past 90-plus years of its existence. While the healthcare industry as a whole is today grappling with interoperability of EMR systems, even within the same hospital system, the NFL has already solved the issue industry-wide.
And, not too surprisingly, "technology is not the problem," said NFL CIO Michelle McKenna-Doyle, who led the NFL's EMR rollout in a way that would provide continuity of care across the league.
In a report issued last week, the Office of the National Coordinator for Health Information Technology (ONC) said that EMR vendors make sharing patient information too expensive and complicated for hospitals and doctors.
McKenna-Doyle and Matthew Matava, a doctor and recent past president of the NFL Physicians Society, spoke at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago this week on how integration has improved player healthcare.
McKenna-Doyle pointed out that integrating disparate EMRs was more about a healthcare facility's willingness to put the time into enabling data sharing, a decision that often had little to do with technology's ability to meet the challenge.
As McKenna-Doyle explained, if you're a hospital treating a famous football player, you don't want to be the one that couldn't properly treat him because his EMR wasn't available.
Even then, hospital executives sometimes needed a little persuading -- often from a team owner. In one case, NFL Commissioner Roger Godell called the CEO of a hospital, "and things started moving in the next couple of days," McKenna-Doyle said. "They're very aware of the publicity.
"Making sure your technology people have a seat at the table and are listened to can't be discounted," she added.
Imaging the greatest challenge.
Imaging, as it turns out, wound up being one of the biggest problems with EMR integration for the NFL, she said.
"Our goal was to provide a comprehensive record, medical history and images without delay, meaning it needed to be available immediately when treating injuries," McKenna-Doyle said. "Storing images in a centralized location would not have solved the problem, as the images would have to be accessible in multiple places at multiple times."
The NFL deployed a league-wide Picture Archiving and Communication System (PACS) from Infinitt Healthcare. The system is a web-based service that maintains digital copies of images across a network of data centers.
The NFL chose eClinicalworks for its EMR, which was able to integrate with all hospital, pharmaceutical, imaging and video systems used to diagnose and treat injuries.
The League also rolled an X2 Concussion Assessment tool from X2 Biosystems. The head injury management software is used on the sidelines during games via Microsoft Surface tablets. The system works through sensor modules in a player's helmet that wirelessly notify athletic trainers, coaches, and physicians in real time about impacts to player's heads. The data is also recorded in a secure Windows Azure cloud database.
Physicians need to be able to determine in "a very rapid fashion" if a player has gotten a concussion, Matava said. "Our teams are very proactive using GPS to track players," he said. "The technology allows us to do this, which we had never been able to do previously in the field of sports medicine."
During the season, virtually everything that happens to a player is recorded. Players even wear GPS trackers in their shoulder pads, allowing their speed and position on the field to be recorded.
If a player was injured in a previous game, for example, medical staff might use the GPS to determine if he's running too many fast routes and should back off.
Data mobility is a key component of tracking that health information, including being able to immediately view any video that may offer a physician insight into how an injury occurred.
EMRs begin at The Combine
A player's EMR integration begins at "The Combine," the annual, week-long evaluation of 320 NFL prospects from colleges around the country. Players perform physical and mental tests in front of NFL coaches, general managers, and scouts.
"Unlike your own personal medical record, the players' medical records become part of their employment," McKenna-Doyle said.
That means the information in those records could -- and probably will -- directly affect a player's career, the average length of which is just 3.5 years.
Every part of a player's medical care, such as whether they can get a second opinion from a physician on the team's dime, is part of their collective bargaining through the NFL Players Association.
An NFL EMR must be able travel not only with a player from game to game, but also when they are traded or, with free agency, they choose a new team. And a player's EMR will contain not only their college medical data, but information dating back to their grade school years, Matava said.
When a player moves between teams, firewalls keep his data from being seen by other team physicians.
"I may do 120 checkups on players per year. [A player] may not remember all his surgeries. With this new EMR, I can track him all the way to grade school. If he leaves and goes to the Bears, I no longer have access because of the firewall," Matava said.
The way the NFL has gone about integrating systems is important, because healthcare facilities and hospitals around the U.S. face the same kind of barriers to sharing patient information. Experts agree, even on a larger scale, the problems are less about technology and more about removing business barriers.
Nationwide, EMR data sharing between disparate vendor platforms, geographically dispersed facilities and unassociated medical institutions remains at a virtual standstill. Hospital departments are frustrated because they can't get laboratory reports on time, they can't get radiological images or they don't get complete records.
Being able to exchange healthcare data promises far greater benefits than just the convenience of data mobility. Patient data can be anonymized and used in accelerating scientific research and tracking health trends.