Tomorrow's operating room to harness Net, RFID

SAN FRANCISCO--It's hard to do most jobs without talking to your peers, but in the operating room, poor communication can cost a life.

In the operating room of the future, however, telling a doctor he or she is making a mistake could be as easy as pointing to a computer screen or "wall of knowledge"--a thoroughgoing summary of background data, vital signs and strategic information designed to prevent mistakes during surgery.

To best understand this so-called operating room of the future, which experts discussed at the "OR of the future" medical conference here on Monday, imagine a football video game. It would show players' backgrounds, injuries, vital statistics, real-time video, milestones and progress logs. It would keep track of the players, the coaches and give the gamers options for play calling.

In surgery, the "wall of knowledge" presents a similar "team huddle," translating the big picture, minute by minute, of the patient and surgical events from various data. That's a big change for nurses, doctors, assistants, surgeons and anesthesiologists who are typically so focused on their specific tasks and specialized computer feeds that they might sometimes miss the patient's overall health.

"We see the acceleration of technology coming into the OR and nurses are having to keep up with the 'data burden,'" said Dr. Warren Sandberg of the center for Integration of Medicine and Innovative Technology at Massachusetts General Hospital in Boston. "We think there's room to convert all that information into knowledge...With this system, anybody can see a snapshot of everything that's happening."

Giving doctors and other medical staff that big picture can be important, because human error and poor communication are the most common reasons one in 25 patients experience avoidable injury under the knife, according to the National Institutes of Health.

Of course, Sandberg has a stake in this particular future. He's part of a pilot "OR of the Future" (ORF) at Massachusetts General that has been using advanced technology for the last three years. He demonstrated ORF technology here at the one-day conference.

The ORF computer system is an integration system with a single, secure Web interface for many different data sources. With technology from LiveData, based in Cambridge, Mass., the ORF takes high-speed data streams from hospital databases and various networks, synchronizes them and then time-stamps them for display onto a Web portal, which can be transmitted on an Internet-connected PC in the room.

Vital stats displayed
The digital display includes the patient's name, weight, age, gender and the procedure he or she is undergoing. It includes a detailed list of medical staff on duty and where they are according to RFID tags they're wearing. It lists critical information such as allergies, precautions and special needs, followed by charts on the patient's heart rate, ventilation, fluids, body temperature and so on. That information is documented before, during and after the surgery.

In most hospitals, that information would be held on clip boards and white boards, and within the computer systems and minds of medical staff. In most cases, it's hard to get all of that in one spot.

"As you sit in the OR you get bits of information from different places. Rarely does the group have the big picture on the individual," said Michael Leonard, the physician leader for patient safety at Kaiser Permanente and former director of anesthesia at Colorado Permanente Medical Group.

One of the most progressive--and controversial--elements of the system involves location tracking technology for medical staff and patients. Doctors and nurses wear radio frequency identification (RFID) tags, similar to key chains, which are synchronized

[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.