Tomorrow's operating room to harness Net, RFID

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to the system and track their whereabouts. The OR display will show a complete list of staff expected for a surgery, and when a doctor or nurse enters the room the name will become brightly lit. That way, unfamiliar faces can be met with assurance.

Sandberg said that in the ORF at Massachusetts General, doctors were reluctant to use the RFID tags, but have grown accustomed to the system and find it valuable.

There's been much to overcome to provide this sort of bird's eye view. Individual technology providers such as General Electric, Siemens and Philips have yet to develop industry-wide standards for their medical gear. LiveData stepped in about five years ago and created a unified interface and system for the disparate gear.

Hospitals reluctant
Still, hospitals are reluctant to adopt this technology for numerous reasons.

For one, if the system goes down, a nurse or doctor would need an information technology specialist to help. During surgery, that won't do. The system could also add fuel to the litigiousness of patients, providing detailed, archived data on surgery and doctors' whereabouts when something went wrong. During the workshop, at least one physician also expressed concern about the learning curve of hospital staff as it adapted to the new system and its impact on old-fashioned communication.

"There's a natural tendency to rely on technology, but you have to be mindful of human interaction," Leonard said.

Doctors and LiveData have already learned that people in the OR move around a lot in order to see different computer screens and check vital signs. Having one point that brings all that information together saves time.

Sandberg said that they also plan to create alarm settings so the system can alert medical staff to take necessary actions in the operating room. For example, if a patient is not getting ventilation and his or her heart rate is rising, the system could send a warning.

LiveData's CEO said the company is talking informally with lawyers and the Food and Drug Administration about integrating alarms into the system. Such capability, although extremely helpful, could add liability to the company.

Other ideas for improvements include combining RFID tag capabilities with automatic sign-ons to the computer system. The system recognizes a physician with an RFID tag within 30 seconds, but the doctor still must log on to other data systems when in the room, which can take two minutes or more, according to executives.

Aileen Killen, the director of nursing in perioperative services at the Memorial Sloan-Kettering Cancer Center, showed pictures of her hospital's "wall of knowledge" on Monday to illustrate a design for a safer OR. It consists of four large computer screens with much of the same data from LiveData, with audio and video feeds, and pathology reports. "We wanted everything off the floor," Killen said.

At Massachusetts General, the ORF is a standard clinical care environment, and no data is collected personally for use in the research. The ORF takes up to 20 cases a week, and according to Sandberg, the efficiency of the system lets the staff care for more people in a day but spend the same amount of time with each patient.

"We're not replacing people, we're adding a layer of decision support," Sandberg said. "We're way out there on the cutting edge."

[jamie.p.walsh]

A few thoughts

"The system could also add fuel to the litigiousness of patients, providing detailed, archived data on surgery and doctors' whereabouts when something went wrong. "

It could make the case more reviewable. It would also streamline the review process itself. The alerts that could be built in would safegaurd against a lot of situations that occur during surgery. Stripped of identifying material, the transcripts could then also be compiled for use in surgical research.

In terms of the litiginousness of patients, that should be handled by legislation that uses a system like this as a basis for reducing what is and isn't litigated.

Operationally, there should always be a backup plan in case the system goes down. In fact, this system should be supplemental to the information that is communicated by the staff anyway.

In short, the medical benefits this could bring should not be argued against by presenting the legal ramifications that may increase with its use.

[jamie.p.walsh]

A few thoughts

"The system could also add fuel to the litigiousness of patients, providing detailed, archived data on surgery and doctors' whereabouts when something went wrong. "

It could make the case more reviewable. It would also streamline the review process itself. The alerts that could be built in would safegaurd against a lot of situations that occur during surgery. Stripped of identifying material, the transcripts could then also be compiled for use in surgical research.

In terms of the litiginousness of patients, that should be handled by legislation that uses a system like this as a basis for reducing what is and isn't litigated.

Operationally, there should always be a backup plan in case the system goes down. In fact, this system should be supplemental to the information that is communicated by the staff anyway.

In short, the medical benefits this could bring should not be argued against by presenting the legal ramifications that may increase with its use.