Digital workflow reaches surgery

Enterprise-wide integration has become the driving force behind many healthcare IT projects. Planners should include the operating room in their digital workflow schemes, according to participants in a joint CARS/International Society for Optical Engineering workshop on surgical PACS and the digital operating room.

Digitization of the operating room will require development of a so-called surgical PACS (S-PACS), said Prof. Heinz Lemke, a professor of computer sciences at the Technical University of Berlin. Imaging can play an important role in surgical planning, intraoperative navigation, and postsurgical assessment.

But digital communication between radiology and surgery is effectively nonexistent, Lemke said.

"PACS does not join up radiology and surgery. There is no sharing of infrastructure, no sharing of an information base, and no workflow integration," he said.

Any S-PACS should be based on best practice surgical workflows, Lemke said. Surgical DICOM (S-DICOM) functionalities should also be specified.

Creation of common standards will be an important part of any move toward a fully digital operating environment, said Kevin Cleary, Ph.D., deputy director of the Imaging Science and Information Systems Center at Georgetown University in Washington, DC. Proponents of futuristic surgical suites are not likely to relish such a task.

"Standards are difficult to develop, standards work is not that exciting, and it may be hard to get funded," Cleary said. "But, obviously, there is a need for this if we really want to have systems interoperability and plug-and-play. Otherwise, things can't talk to each other."

The design of future operating rooms that incorporate digital workflows and equipment should be subject to careful consideration, he said. Initial steps have already been taken in this direction, with the organization of a workshop on potential surgical practices in 2020. Separate working groups were asked to highlight research priorities in six key areas:

• operational efficiency and workflow

• systems integration and technical standards

• telecollaboration

• surgical robots

• intraoperative diagnosis and imaging

• surgical informatics

Their recommendations have been published in a comprehensive report.

Massachusetts General Hospital has already devised its operating room of the future. The virtual room represents a facility for minimally invasive surgery and examines how it could function more efficiently.

Dr. Wilton Levine of Mass General's anesthesia and critical care department described an ongoing project to evaluate how data from this futuristic room could be used to better effect throughout the hospital. Real-time access to patients' physiological data and OR scheduling information, for example, could help when allocating recovery room beds, he said.