Educational Resources
What is operating room integration?
Historical Focus:
Within the past few decades, surgical procedures have been driven towards the use of Minimally Invasive (MI) techniques to reduce patient stays, speed recovery times, and improve overall clinical outcomes. These techniques have concentrated on the use of the video “endoscope” for visualization and manipulation of internal organs and structures without large incisions. Because of adoption by Minimally Invasive surgeons, primarily endoscopists, laparoscopists, and arthroscopists, the market for these technologies has predominantly been supplied through video endoscopy equipment manufacturers. As a result, design of the Integrated Operating Room has historically been focused on routing of inter-operative video images to multiple display monitors within the MI operating room, and centralized control of selected endoscopic equipment.
Today’s Integrated Operating Room:
The Healthcare industry continues driving technology based advances in surgical techniques. These advances emphasize improving clinical outcomes, providing higher levels of patient safety, and more efficient utilization of the operating room as a financial asset.
Introduction of advanced diagnostic imaging modalities, increased adoption of the electronic medical record (EMR), and increased reliance on access to other critical patient information inter-operatively, has caused a strong shift in design of the Integrated Operating Room from “inter-operative video”, to “inter-operative video and patient information.”
Thus far, the primary clinical application for "patient information" revolves around PACS images. PACS images (archived radiological images and other diagnostic image studies) now need to be accessed for inter-operative review in order to provide the surgeon and his/her team with an immediate comparative study with live images. In addition, other forms of information (both clinical and non-clinical) are now required at the sterile field. Examples of these information types are physiological monitor information, previous medical history data and studies, patient post-op condition and vitals, surgical scheduling information, etc.
Furthermore, there is an emerging requirement for real-time interaction via two-way audio, video and data exchange between surgeons inter-operatively and, or other medical professionals located outside the operating room’s sterile field. These "consultations" would normally require both surgeons, or perhaps another clinical specialist, to physically be present in the same OR.
Finally, recording of surgical procedures and inter-operative data for inclusion in electronic medical record (EMR), is also becoming a necessity. Hard media recording, such as DVD recording, and electronic or digital capture of images and streams of moving video are now becoming a standard requirement in the integrated OR.
Consequently, integration of an operating room today has greatly evolved from simple routing of inter-operative video. Operating Room Integration is now a hospital information system access tool and communication system incorporating inter-operative video routing / capture / storage, network access to hospital data / electronic patient records / diagnostic imaging information, and real-time consultation capabilities for communication with other clinicians and specialists in locations outside the operating room.
Today’s operating room integration systems are designed with the following principle in mind:
Better, more complete, and instant access to patient information, and communication with related clinical departments without leaving the patient’s side, allows the surgical team to provide more comprehensive patient care and improve clinical outcomes, reduce case times and therefore the patient’s time under anesthesia, and helps eliminate potential to compromise the sterile environment.
Why integrate your operating room?
Video (and Data) Routing
Historically, point-to-point connection has been the standard for interoperative video display in the operating room. Each source (camera) had its own display monitor with an occasional secondary display monitor connected that showed the same source image. However, the proliferation of sources in today’s operating room means there are typically many more sources required than there are monitors present. In many newly opened operating rooms, there is a ratio of 3:1 (10 video and data sources to 3 display monitors in the sterile field). Display monitors are now associated with clinicians rather than video and data sources. This practice of using multiple images and data sources with multiple displays adds complexity to the operating room environment and demands a simple routing solution.
Access to Diagnostic Imaging
The use of light boxes and x-ray films offers a low cost traditional solution for reviewing diagnostic quality images in the operating room. However, clinicians have to leave the patient’s side to view the images outside the sterile field. The move to digital storage, retrieval and viewing (PACS), along with the emergence of other computer based imaging modalities and displays solves this problem, allowing multiple modalities to be viewed and manipulated simultaneously, without leaving the sterile field.
Access to Patient Data/Records
A combination of regulatory drivers is leading up to a directive for full access to patient records during procedures. These records range from simple patient charting to stored moving images. In order to access and review these records, which are primarily stored in a computerized or electronic format, LCD display monitors in the sterile field are fast becoming a requirement.
Recording/Capture of Clinical Images
The operating room environment is a critical "Data Acquisition Point." The ability to capture multiple video and data images from sources such as endoscopic cameras, light cameras, ultrasound, patient monitor, stealth, and so on, is vital to creating an enriched "universally accessible" patient record.
Remote Clinical Consultation
The availability of high quality transmission over an existing Hospital LAN means that bi-directional video conferencing can extend far beyond teaching and long distance telemedicine applications. Now clinicians can consult between operating rooms, showing multiple video sources, without leaving the sterile field. Additionally, "live" consulting with ancillary related specialties, such as pathology, can significantly enhance the speed and outcome of a procedure.
What the Future May Hold
Integration of evolving technologies for video and data in the operating room is essential and complex. Differentiating between solutions that will offer a long life from those that will become obsolete within 12 months is difficult. Video and data transmission is evolving toward digital, but what is the difference between analog and digital, and how does that affect today’s operating room environment? Can you mix legacy analog equipment such as C-Arms with the new digital cameras? Will the digital future be more or less expensive? Which digital signal, DVI, SDI, Mpeg2 or Mpeg4 will become the standard? How will storage issues revolving around digital images, video, and data be overcome and when? How will information captured during surgical procedures enhance the electronic patient record, billing, etc.?
These are questions that are difficult to answer in a fast evolving market. However, we can assume the following to be true:
The healthcare industry will continue to apply new technologies as they emerge and are proven effective in other industries. The operating room is a "mission critical" environment, both clinically and fiscally, and has unique requirements in comparison to other industries. The adoption of new technologies in the operating room will be driven by simple interface designs and high level industry drivers such as increased use of interoperative imaging, the use of universal electronic patient records and case reimbursement.
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