Celebrating 10 Years of Service

CTSNet: 10 Years of the Global Cardiothoracic Surgery Network

In 2007, CTSNet celebrated its 10^th anniversary as a global, Web-based community of cardiothoracic surgeons. Founded in 1997 by The Society of Thoracic Surgeons, The American Association for Thoracic Surgery, and The European Association for Cardiothoracic Surgery, CTSNet provides a dynamic portal for surgeons to collaborate and exchange information. Thoracic surgeons and trainees throughout the world use CTSNet extensively to interact with fellow surgeons, learn about meetings and events, and stay up-to-date with the latest biomedical research. Every community participant has a home page and a secure user ID and password that allow access to secure or personal resources within CTSNet. During the past 10 years, cardiothoracic surgeons and medical professionals have become increasingly dependent upon this community’s unique resources and for current information and news about the cardiothoracic surgery community.

Developing Relationships with Specialty Organizations

The strength of CTSNet can be found in its relationships with the CTSNet Participating Organizations. More than partners, the Participating Organizations form the backbone of the CTSNet network. In return, CTSNet provides a long list of benefits in terms of technology infrastructure to content development and archiving that is vital to the cardiothoracic surgery community. Also, CTSNet recognizes that the community exists internationally and that it includes related medical professionals. Currently, 52 organizations participate in the CTSNet community.

New participating organizations in 2007 include the Accreditation Committee - Perfusion Education, Association of Physician Assistants in Cardiovascular Surgery, Indian Association of CardioVascular-Thoracic Surgery, and Polish Society of Cardio-Thoracic Surgeons.

Outreach to Serve an International Community

In 2007, CTSNet attempted to reach out more directly to the international community of cardiothoracic surgeons. A large effort was made to bring into the community participants from Asia. A special incentive was provided by the European Journal of Cardiothoracic Surgery to provide subscriptions to surgeons from Asia. In addition, CTSNet was represented at professional meetings throughout Europe.

Membership Increases during the Past Year

CTSNet membership increased slightly more than 13% during 2007. Currently, 34,421 medical professionals participate in CTSNet. Of these medical professionals, 27,301 identify themselves as cardiothoracic surgeons (an increase of 10% over 2006). CTSNet continues to expand its international reach with membership representative of 165 countries.

 

CTSNet Member Count by Category
Surgeons	27,301
Perfusionists	2,939
Associates	1,305
Physician Assistants	909
Data Managers	773
Cardiologists	330
Anesthesiologists	265
Industry Representatives	256
Staff	203
Program Coordinators	129
Surgical Assistants	11
TOTAL	34,421

 

CTSNet Member Count by Country
United States	13,121
Italy	1,797
Japan	1,841
Germany	1,454
United Kingdom	1,336
Turkey	1,224
Brazil	1,050
India	1,048
China	788
Spain	769
France	722

How the Community Uses CTSNet

CTSNet Is Heavily Used by the Community

A typical week of activity in November 2007 on CTSNet looked like this:

Total Sessions: 239,250

Average Sessions per Day: 34,179

Total Page Views: 239,250

Average Page Views per Day: 34,179

Average Page Views per Session: 6.67

Average Length of a Session: 5 minutes and 50 seconds

This activity adds up over the course of a year. In 2007, CTSNet experienced the following total activity:

Total Sessions: 11,736,010

Average Sessions per Day: 32,153

Total Page Views: 81,630,009

Average Page Views per Day: 223,644

Average Page Views per Session: 6.86

Average Length of a Session: 5 minutes 14 seconds

The sections most visited on CTSNet are the following:

• Journals
• Job Center
• Videos
• CTSNet Member Web Pages
• Events

The CTSNet community uses the Website to submit and review abstracts for annual meetings, create oplog entries, order SESATS, upload SESATS applications, earn Journal CME credit, earn CME credit through online learning, and more. Some of these activities are summarized below.

Abstracts Submitted: 28,226

Abstract Reviews Submitted: 348,718

Jobs Posted: 2,634

Resumes Posted: 1,760

Total Oplog Entries: 761,536

ABTS Oplog Entries: 615,325

EBTCS Oplog Entries: 52,202

In April, CTSNet supported the American Board of Thoracic Surgery In-Training Exam, with more than 350 residents participating.

Highlights of New Features Released During the Past Year

CTSNet Safety Reporting System

With financial support and input from the Society of Thoracic Surgeons, CTSNet developed and launched the first-ofits-kind Cardiothoracic Safety Reporting System in June 2007. The system reports vignettes submitted anonymously by medical professionals that recount safety incidents and near-miss events in the operating theater. In addition to reporting on incidents and events, a team of safety experts provides an analysis of the reported event and presents recommendations to prevent the event from occurring in the future. The anonymity of the reporting process creates an environment that focuses less on blame and more on improving performance through an open discussion and straightforward review of the event. Our goal is to create an archive of case vignettes that describe real errors and events occurring around the care of adult and congenital cardiac surgical patients and general thoracic surgical patients.

CTSNet Professional Portfolio

A major programming effort during the past year has been the development of a Professional Portfolio for cardiothoracic surgeons. The Professional Portfolio provides a centralized, Web-based resource for surgeons and their certifying boards that helps surgeons assess their ongoing educational activities and facilitates the gathering, assessment, and reporting of competency activities to certification boards. By the end of 2007, there were 357 active portfolios, indicating that this new feature is being well-received by the CTSNet community. One goal of Maintenance of Certification (MOC) is to encourage lifelong learning and practice improvement for all medical specialties. The CTSNet Professional Portfolio provides a simple, user-friendly Web system for surgeons to track and reflect upon their learning and practice improvement activities.

The Professional Portfolio is a highly collaborative effort that involves many of the organizations that already participate in CTSNet. Also the Portfolio provides important education and competency programs for members of Participating Organizations. The Portfolio leverages CTSNet’s existing collaborative Web infrastructure, including a shared central portal, authentication system, and database infrastructure. It will also leverage CTSNet’s data exchange capabilities with its many participating organizations and other partners, including Stanford’s HighWire Press for journal-related resources.

The Portfolio provides tools to collect educational content, to participate in competency activities, to assess competency goals and objectives, and to report accomplishments and relevant information to certification boards. The Portfolio can help to aggregate information about a wide variety of CME and other activities, not just those that are available online. For example, it is possible to track CME credit information for in-person professional society meetings. The Portfolio will not supplant the need for certification organizations to provide their own online capabilities for receiving updated certification information collected in the Portfolio. CTSNet does not intend to define scope or requirements of educational or competency-related activities, this being the province of certification boards and other regulatory authorities. Instead, the CTSNet Professional Portfolio provides an administrative role for collecting and reporting information that is relevant to certification. Through its membership in the MedBiquitous Consortium, a nonprofit organization developing technology standards for medical education, CTSNet can leverage an emerging data exchange standard for reporting of CME and MOC activities. This Activity Report data exchange standard, which is written in XML, was originally developed by the American Board of Pediatrics and the American Academy of Pediatrics to facilitate exchange of information for the Pediatric Competency Portfolio and the American Board of Pediatric’s MOC program. It is currently being implemented by a wide variety of CME providers.

CTSNet worked closely with the American Board of Thoracic Surgery (ABTS) in the development of the portfolio. ABTS has been an important contributor of ideas and has provided in-depth feedback.

CTSNet Launches Revamped e-Learning Center

The CTSNet e-Learning Center is the result of a 3-year effort of the Joint Council for Thoracic Surgery Education, the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the European Association for Cardio-Thoracic Surgery (EACTS), and the Children’s Memorial Hospital (Chicago, IL) to identify and implement an online Learning Management System to deliver innovative e-learning modules for cardiothoracic surgeons. The goals of the project were:

• To deliver effective e-learning modules on specific topics for target audiences of thoracic surgeons
• To enable the thoracic surgery community (including learners, educators, and organizational leaders) to acquire experience with developing and supplying effective e-learning
• To gain from a knowledge transfer from experts in instructional design and e-learning delivery, and
• To minimize and coordinate the risks of e-learning program development across several thoracic surgery organizations.

 

Currently, two modules are available publicly. The first module, “Off Pump Coronary Artery Bypass: Positioning and Stabilization,” was developed by John D. Puskas, M.D., and Joseph F. Sabik III, M.D. The purpose of the module is to educate cardiothoracic surgeons and residents on the techniques and devices used in cardiac positioning and stabilization during the performance of off-pump coronary revascularization. The module is sponsored by the American Association for Thoracic Surgery and awards CME credit and certificate for successful completion. Almost 400 users have completed the module for CME credit.

A second module is “Off Pump Coronary Bypass Debriefing,” by Paul Sergeant, M.D. In this module, the Off Pump Coronary Bypass Team of the Katholieke Universiteit of Leuven presents a debriefing exercise of the learner’s OPCAB procedures versus their Standard Operating Procedures. The module is sponsored by the European Association for Cardio-Thoracic Surgery.

Additional modules are under development and will be available soon.

As part of the e-learning project, CTSNet has developed templates for use by Participating Organizations and the CTSNet community for effectively developing sophisticated e-modules for delivery through the CTSNet Learning Management System.

Access the CTSNet e-Learning Center from the left menu (under Clinical Resources) of the CTSNet home page, or in the New Community Tools box at the top of the right gutter.

Cardiac Portal

CTSNet released an innovative new specialty portal, the Cardiac Portal, under the editorship of Edward Savage, M.D. The top of the portal has streaming announcements, similar to those on the main page, and provides direct access to many of the content areas relevant to adult cardiac surgery with highlights of new additions as they are posted. In addition, the portal creates an innovative framework for the development of future content in an organized fashion. Special features include the ability of editors to annotate the content selections they make as a way to draw special attention to them.

OpLog Revision

Toward the end of 2007, CTSNet released a new version of its heavily used Resident’s tool, the CTSNet Operative Log. The revision provides significantly enhanced functionalities that make the entry of cases more streamlined and intuitive. Also, the update reflects the latest revisions required for reporting cases to program directors. There is an enhanced program director view and reporting function that enables a more sophisticated overview and administration of oplog reports.

Image Database

The increase in digital images and video in the past decade has provided a great opportunity for cardiothoracic surgeons to create and share spectacular images of surgical techniques. CTSNet has configured an Image Library catalogs images by keyword topic and photographer. Each contributor will have his or her own area in which to collect images. Images can also be collected into Topic Albums. Images will be freely available for educational use only.

CTSNet e-Commerce System

SESATS is one example of the use of the CTSNet e-Commerce system that was implemented in 2007. An online e-commerce system was developed by CTSNet for the American Board of Thoracic Surgery to collect dues payments and other payments online. The CTSNet e-Commerce system now enables organizations to set up their own online “stores” and define the types of items or events that are available for online transactions. Intuitive interfaces lead organization staffs through the process of setting up online transaction systems for multiple uses. A sophisticated administrative interface enables staff to oversee, manage, and report on transactions.

The CTSNet e-commerce system is available for use by all Participating Organizations for membership renewals, meeting registration, and online purchases.

New Toolkit for Organization Editors

CTSNet completely revamped the interface and functionality of the Organization Editors toolkit in 2007. Many new features are available to make the management of documents and committees more effective and efficient than previously. The new interface reorganizes tasks and features so that administrators can easily navigate through the tasks they need to do.

Implementing a Wiki Format for CT Notes

The heavily used CT Notes in the Residents section received a reformatting of content. The notes now appear in a Wiki format. The Wiki format enables residents and surgeons to contribute and edit content more easily. In this way, the CT Notes are highly interactive and constantly evolving to reflect best and latest practices.

Video File Conversions

All video files in CTSNet were reformatted to Flash from Real Media. The reason for the change in format was to enable the videos to run on a broader set of platforms and to increase the efficiency of downloads. The overall quality of videos as a result has also improved.

CTSNet Transitions to New Colocation Facility

In late June 2007, CTSNet transitioned its contracted colocation services from Savvis to DataPoint. There were several reasons for the transition. Over the past year, charges at Savvis had increased dramatically, almost 45%. During the same period, support services had not been as responsive to CTSNet requests as they once were and had been generally unresponsive to inquiries about the lowering service levels and escalating costs. Logistically, the travel time to the Savvis facility has notably increased as traffic in the Washington, DC, area has become heavier. In short, Savvis was no longer adequately meeting the needs of CTSNet.

After a thorough search and evaluation, we identified a facility that will better meet our needs and is located nearby to CTSNet. The new facility is called DataPoint, a Baltimore-based colocation facility. Founded as Toad Computers and ToadNet, DataPoint has been providing infrastructure services to companies for 10 years. DataPoint appears to be profitable and stable; however, we fully acknowledge that consolidation is a longstanding trend in the colocation industry (as we have experienced with Savvis and its many previous iterations). However, we are confident that DataPoint better meets our needs, financially and technically, and will serve the CTSNet community with outstanding service and support, guaranteed through service agreements. The agreement we are negotiating is currently undergoing legal review through our attorney. For informational purposes, we have attached the Service Level Agreement portion of the agreement.

Rob Oberteuffer, CTSNet's Chief IT Architect, developed a detailed plan for the transition. Our goal was to minimize downtime and to inform the community ahead of time about the transition and its possible effects on CTSNet services through a series of announcements on the CTSNet home page. The transition occurred within a traditionally low-traffic time and without incident.

CTSNet used the transition to upgrade and improve hardware and security.

CTSNet looks forward to continuing to provide greater than 97% uptime and consistently outstanding connectivity to the CTSNet community.

Ongoing Highlights of CTSNet Community Features and Services

Journal CME

Launched in December 2005, Journal CME continues to gain interest by the CTSNet community. Activities are compiled and prepared by the journal editorial staffs, processed by CTSNet, and made available through the CTSNet Journal program on Highwire Press.

This release of journal CME was the culmination of a project spearheaded by Dr. Henry Edmunds. Currently, each journal designates three articles (one in each major subject category, cardiovascular, thoracic, and congenital) as CME activities. Readers earn up to 1 hour of CME credit for each article. Time, expense, availability, and relevance limit opportunities for busy cardiothoracic surgeons to earn CME credits. Specialty Journal CME on CTSNet overcomes these barriers, costs the learner nothing currently, and is available 24 hours a day.

Self-Education Self-Assessment in Thoracic Surgery (SESATS)

This was the second year for CTSNet to provide online transaction, data collection services, and exam upload for the latest version of the Self-Education Self-Assessment in Thoracic Surgery (SESATS) examination. CTSNet has worked closely with the American Board of Thoracic Surgery (ABTS) and the developer of the latest version of SESATS to integrate transactions, databases, and reporting to be as seamless as possible. Since the release of SESATS in late July, CTSNet has conducted more than 450 online transactions through the CTSNet e-Commerce system. Several new enhancements were made to provide a more-detailed reporting of transactions, orders and shipments, and uploading of testing results. An agreement was made in 2007 with FedEx that sharply reduces shipping expenses. A sample version of SESATS was distributed to a European organization for assessment and for use of SESATS on a larger scale internationally.

CTSNet Benefits Industry

CTSNet has prided itself on its innovations in creating an environment where industry can appropriately—and effectively— participate in the CTSNet community. Industry receives an additional benefit of participating in the CTSNet community. In more than 95% of the cases where industry has a product listing on CTSNet, we discovered that when a Google search is performed on that product, the CTSNet listing is in the top two search results. In almost all cases, the CTSNet product listing occurs higher than a company’s own listing for the same product. This provides industry with a tremendous amount of exposure because of their relationship with CTSNet. As important, the Google results provide CTSNet with important exposure as a major source not only for product information, but related medical information as well.

Another project underway this year is the development of a more sophisticated Industry Forum section on CTSNet. The purpose of the project is to network relevant medical content on CTSNet into the industry space. This has required a new look for Industry Forum. Higher level of sponsors will enjoy a new set of features that allow industry representatives to develop product launch campaigns and to focus on specific products and services. This is a need that has been long-requested by industry participants in CTSNet. Also, the new format is designed to allow CTSNet members a more efficient means of navigating industry material.

CTSNet Blogs Cover Varied Topics

From global warming to a medical professional’s experience as a patient, the CTSNet Blogs have provided an interesting additional dimension to information presented on CTSNet. There are currently five active blogs, with five blogs coming soon.

Abstract Management System Enhancements

While CTSNet considers the viability of a major product enhancement, many smaller— though significant—enhancements have been to the CTSNet Abstract Management System. Many of the enhancements resulted from detailed feedback and requests from Participating Organizations using the system. Also, approximately two dozen fixes have been made, tested, and released into the production version of the abstracts system. The new enhancements provide a greater search capability, a more stable reviewer assignment process, and an improved way of filtering errant abstracts. The system is currently being used by seven organizations. The main value of the system is that it provides smaller organizations an affordable system for the management of abstract submissions.