By the start of the 2014 season, NFL physicians could have a player’s entire medical history at their fingertips the moment he comes to the sideline with an injury.
The data — X-rays, imaging studies, notes and more, regardless of where the player may have been examined in the past — would be stored on iPads, which every NFL medical staff will begin using this season as part of the league’s ongoing efforts to improve concussion assessment.
“Now, it’s a visual to the player. That’s the important thing,” James Bradley, the Pittsburgh Steelers’ head orthopedic surgeon and chairman of the league’s medical research committee, told USA TODAY Sports.
“If we can just sit him down and say, ‘Look, here’s your balance test and your cognitive skills, your memory, your reaction time.’ Now they’ve got a visual of that, which is a very positive step forward with the players accepting that they have an issue and wanting to get it resolved.”
Each iPad in use this season will be loaded with X2 software that includes the Sideline Concussion Assessment Tool (SCAT-3), the most advanced version yet of the neurocognitive test to determine if a player has a concussion.
The results for most teams will get printed and placed into a physical chart. Eight teams — the Steelers, Baltimore Ravens, Denver Broncos, Houston Texans, New England Patriots, New York Giants, New York Jets and San Francisco 49ers — will participate in a pilot program that allows the results to be shot through the Internet into a player’s electronic medical record (EMR).
If all goes well, as it did with beta testing of the iPads last season, complete electronic medical records (including baseline concussion assessments) could be in use and transferable between all 32 teams as a player moves via trades or free agency beginning next year.
“Let’s say he starts out with the Rams, and then he’s either cut or traded or leaves as a free agent, goes to the Denver Broncos, then the information will be portable,” said Matthew Matava, head team physician for the St. Louis Rams and president of the NFL Physicians Society.
“The Denver doctors will then have any information that was accrued while he was in St. Louis. Like any other electronic medical record, it will be portable with the player and therefore very accurate.”
Article 40, Section 3 of the collective bargaining agreement reached by the league and players in July 2011 provided for such a system, stating that the league “shall develop and implement an online, 24-hour electronic medical record system within 24 months of the effective date of this Agreement or such longer period as the parties may agree.”
The same conversion is taking place in hospitals and doctors’ offices across the country in compliance with the Patient Protection and Affordable Care Act — better known as Obamacare — which was signed into law in March 2010.
But there remains some level of concern among some players, agents and the NFL Players Association about how those records will be handled and when they would become available to a new team, particularly if certain disclosures could work against a player in free agency or grievance hearings.
“We are still discussing how to handle free agent medical records with the union,” the NFL said in a statement to USA TODAY Sports. “It is a work in progress. We will not use the EMR to share records between teams until after the pilot stage of the program.”
Several messages from USA TODAY Sports to the NFLPA were not returned.
“They’re just trying to do what they can to protect teams,” said free agent receiver Laurent Robinson, who suffered four concussions last season and has filed a grievance against the Jacksonville Jaguars over an injury guarantee following his March release.
“They want to make sure that if a player gets dinged up, they check him right away. Teams are going to know about every injury you have anyway, just based on the medical records. Every time you go in the training room, they write it down for something small.
“The more information, I guess, the better for them. It might cause less people to get picked up, but ...”
Players sign disclosure forms each year that allow teams to share medical information, a practice which has been commonplace for years. Some teams have already been making electronic conversions on their own.
The difference now is that information can be shared, behind password-protected firewalls designed to prevent hacking or teams gaining access to medical records of opponents’ players.
“The league itself is not allowed to have (the records). There’s a HIPAA violation there,” Bradley said, referring to the Health Insurance Portability and Accountability Act of 1996.
“The importance of it for us — so we’re on the sideline and we have an injury, we can look on the iPad and pull up his old X-rays, pull his old notes, pull up his whole medical history and all of his imaging studies on the sideline, and then, when the player leaves us and goes to somebody else, he can take that entire record with him.”
In separate interviews, Bradley and Matava said their understanding is those records wouldn’t be available to a new team until the acquisition of a player is finalized but referred the matter to the league office.
That would mean a player such as Kansas City Chiefs quarterback Alex Smith, who lost his starting job in San Francisco last season after self-reporting concussion symptoms, would still be responsible for disclosing his own medical history during a physical to finalize a trade.
“For me, I obviously want my doctors and trainers to know my history,” Smith said. “I can’t always verbalize that to them. We’re not doctors as players, and we know our injuries to a certain extent. But you hope there’s good communication from the training staff and the doctors that I just left to my new trainers and doctors.
“You hope there is some transparency there. You hope they talk and communicate. The more they know, the better.”
To NFL doctors, the use of iPads and the electronic medical records program are, in Bradley’s words, “a very positive step in the treatment of concussions in the NFL. Very positive. The league was very proactive with this.”
There are more eyes than ever on players, including an observer in the press box, the game officials and an independent neurology specialist on each sideline. Each team’s head physician and athletic trainer no longer are restricted in where they can move along the sideline. If there’s any question about how a player was injured, they can view a replay on a dedicated TV monitor.
More technology for studying brain injuries could be in common use soon, such as the infrascanner — a portable screening device that uses near-infrared technology to screen patients for intracranial bleeds that could help players avoid unnecessary CT scans — and high-definition fiber tractography to trace nerve fibers.
The NFL continues to implement rules changes as well, citing the drop in concussions on kickoffs since they were moved up to the 35-yard line in 2011. It all comes against the backdrop of ongoing concussion litigation, with a federal judge this week ordering the league and about 4,200 former players to negotiate how their case will be resolved.
“I think the NFL has led the way of all four pro sports as far as doing research and trying to make the game safer,” Matava said. “Obviously, it’s a collision sport. There are going to be injuries. I think everyone accepts that and understands that. We’re just trying to make the injuries less serious and then try to make them less frequent.”