The Future of O&P: A Practitioner's Perspective

"You can't learn in school what the world is going to do next year." With this clear and prescient statement, Henry Ford summed up the challenges that we face in a world of constant change. Driven by computer technology, the pace of change has only quickened, and at times just keeping up can seem exhausting. But change also provides great opportunities for those willing to move with the trends. Historically, new technologies have been developed in response to specific problems, only to find much greater applications once people put them to use. For example, the radio was initially seen as a wireless telegraph system and was used to great benefit in the maritime industry for transmission of vital meteorological information. Only later did it become a means for mass communication and eventually entertainment. I believe that in many ways, the future of O&P is here, and we are already looking at the technology, systems, and concepts that will drive our industry over the next several decades. It is the methods of adaptation and the particular uses of these emerging tools that will determine the direction of our industry. Scanners One of the more recent technological advancements in O&P is the 3-D scanner. Systems such as Biosculptor's BioScanner", Hanger's Insignia", and Ohio Willow Wood's OMEGA® Tracer® indicate a clear shift toward digital casting. Although scanners have been available for some time now, their use is becoming more widespread, possibly due to a combination of lower cost and increased practitioner trust. There are several advantages to using scanners: A reduction in the time, cost, and mess associated with traditional casting. Elimination of shipping costs and faster turnaround times with electronic data transmission. Long-term storage of cast data without significant cost. Improved accuracy and consistency of shape capture across practitioners, resulting in fewer errors. The adoption of scanning has a "pull" effect on the industry as a whole. Central fabrication facilities will need to develop their systems and readily accept all computer-aided design (CAD) file formats. Those that do not will probably find their business diminishing over time. Information Technology Beyond fabrication, information technology is playing a major role in how practitioners work, interact, and treat their patients. The widespread use of electronics and electronic communications, including cell phones, Blackberries, laptop computers, and e-mail, allows practitioners to be more available. In the years to come, patients will expect quickand at times instantaccess to O&P professionals. These patients also have access to the web, where they can research their own diagnoses and remedies. While this can be beneficial, it can also be a hindrance if the patient challenges the experience and education of certified caregivers. Using information technology, practitioners may be more productive and capable of dealing with a heavier patient load; however, this does lend itself to the problem of "always-on" 24-hour access, which can be overwhelming. I believe part of the formula for success in the future depends on practitioners being able to control their communication flow. Likewise, back-office functions, such as the processing of claims and medical-records, are increasingly moving into the digital realm. The Internet has also begun to change how the profession communicates. The O&P listserv ( www.oandp-l.org ) is a good example, as are the continuing-education credits that are being offered online, and the distance-learning modules and webinars. It is not a stretch to say that the practitioners of the next few decades will be tech savvy and niche focused. The team approach to healthcare will require full collaboration with an array of other professionals. Success will depend on providing high value-added outcomes, evidence-based results, and possibly specialization in either patient care or fabrication. Beyond technology, there are new concepts of biomechanics and physical medicine that will undoubtedly emerge. Those concepts will provide us with opportunities to reconsider treatment options for our patients. This is already obvious with recent advances in myoelectrics, neuroprosthetics, and dynamic gait-analysis systems. Bestselling author John Naisbitt said, "In a world that is constantly changing, there is no one subject or set of subjects that will serve you for the foreseeable future, let alone for the rest of your life. The most important skill to acquire now is learning how to learn." In that vein, the future's most successful practitioners will learn to use all of these tools to benefit their patients. These tools offer tremendous potential for increased productivity, which will be necessary if costs are to be containedespecially in an environment where reimbursements are likely to be limited. The coming generations of O&P graduates will easily adopt these technologies as they become the practice managers, product developers, and business owners of the 21st century. While I can't predict the future, I am certain of two things: change is inevitable, and speed in adapting to it is preferable! CAD/CAM Technology The adaptation of computer-aided design and manufacturing (CAD/CAM) systems has been increasing in O&P for several decades. CAD is the use of computers to draw and model physical components in 2-D and 3-D. These programs were originally used by engineers and architects to augment the work of drafting artists. They automated the process of drawing plans, elevations, and sections of anythingfrom skyscrapers to engine parts. CAM was a separate development that took spatial location data and translated it into travel paths for rotating machine tools. CAM allowed complex and one-off pieces to be milled from almost any material. It had tremendous applications in many industries, such as aerospace and automotive. The marriage of CAD/CAM took these technologies and allowed designers to create a plan or model on the computer screen and then seamlessly machine the exact part with great precision. This had a natural application for the prosthetics industry. The introduction of both the surface-touch wand and the laser scanner allowed practitioners to capture the topography of residual limbs. Once set up in 3-D, the software allows the operator to shave and shape the model to his or her specifications. The main restrictions to widespread adoption of this technology are its high initial cost; a steep learning curve to master the software; and a reluctance, or inertia, to change from traditional fabrication methods. However, according to Moore's Law regarding the exponential increase in integrated-circuit capacity and processing speed, it is inevitable that costs will continue to fall. In addition, software upgrades will make CAD/CAM systems very user friendly. I have always believed in the use of technology as a way to make businesses more productive and scalable. More than ten years ago, and with great promise, we at Hersco purchased a CAD/CAM system to make foot orthotics. Unfortunately, the package was oversold, and the resulting products were costly and non-uniform. We spent a lot of time trying to optimize the system and eventually wrote off the entire investment. We survived the ordealbruised but intact. This did not stop us from continuing to look at new and emerging ideas. Earlier this year, we bought a new CAD/CAM system that we are using with great success to manufacture foot orthotics. Recent developments in software, machining, and scanning technology have made this possible. Going forward, we will accept scans and digital files directly for manufacture, which will eliminate inbound shipping time and costs. Meanwhile, mainstream engineering is developing a next-generation technology called 3-D rapid prototyping, the automatic construction of physical objects using solid freeform fabrication, which may well end up in the O&P industry too. Séamus Kennedy, BEng (Mech), CPed, is president and co-owner of Hersco Ortho Labs, New York, New York. He can be contacted via e-mail at seamus@hersco.com or visit www.hersco.com

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