Report from CARS: Digital workflow reaches surgery

June 28, 2005

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

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

Digitization of the operating theater 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. He is not expecting many proponents of futuristic surgical suites to relish such a task.

"Standards are difficult to develop, standards work is not that exciting, and it may be hard to get funded," he 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 theaters that incorporate digital workflows and equipment should be subject to careful consideration, Cleary said. Initial steps have already been taken in this direction, with the organization of a workshop looking ahead to 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 is designed to represent how a facility for minimally invasive surgery could function more efficiently.

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

For more from the CARS meeting in Berlin, visit the CARS Web cast.

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