We are in a digital age. Digitisation is everywhere in our life. The world around us has changed in last two decades especially thanks to some spectacular inventions or techniques invented in the field of Information and Communication Technology (ICT). Today, the sheer amount of data handled today is staggering and amounts to a “Digital Big Bang explosion.” Some notable inventions relevant to our discussion here are operating systems, search engines, data servers, mobile smartphones, tablets, mobile apps, high speed broadband and mobile Internet (2G, 3G, 4G), fiber optic cabling for networking, etc.
Healthcare providers (hospitals, diagnostic centres, etc) have traditionally lagged behind other industries in terms of implementation of ICT Solutions both in data as well as image management perspectives. While most of the hospitals in India can now boast of at least a basic level of HIS (Hospital Information System), we still lag behind the rest of the world in terms of planning and implementation of image management and storage point of view, be it in the form of Radiology PACS (Picture Achieving and Communication System), Cardiology PACS or Operating Room PACS and Digital OR, to name a few. Like most of the other fields, we need to do a lot of “catching up” in image storage field before we can consider ourselves at par with other developed or developing nations. In this article, my focus will be on “Digitally Integrated Operating Rooms” or “Digital OR”.
There is unfortunately no universally accepted definition of Digital OR, but it can be broadly defined as “an OR which is equipped to provide streamlined control of audio-visual and data information in a universally acceptable, Medical Standard digital format in the form of image and video archiving and communication platform that brings together multiple IT systems, processes and procedures from both inside and outside the healthcare facility on to one user friendly interface.” Sounds really complex, isn’t it? But in reality, it isn’t!
The need for a DIGITAL OR
- As discussed above just observe how the world has changed around us in last decade – Data Explosion equivalent to a Digital Big Bang
- Look at the inventions in digital arena which have transformed our lives forever: Google, smartphones, tablets, apps, cloud computing and storage, broadband (3G, 4G, 5G), high speed IP Network, data cabling, etc
- Concept of green hospital means paperless hospital and it means digitisation of OR procedures as an integral part of it
- Surgeons have to rely on more number of equipment and robotics to perform surgeries effectively, the complexity of which is increasing day by day as a result of new discoveries, researches and techniques. In other words, The OR Complex has literally become “Complex” in management
- Digitisation also means more effective, less error prone, less time consuming and more patient friendly surgeries
Scenarios in integration
- No digital integration at all
- Level 1 of Digital Integration: Video routing, display and limited storage of individual systems inside OR
- Level 2 of Digital Integration: Limited scope of Integration of some modalities inside and outside OR
- Level 3 of Digital Integration: Fully digital, modularly upgradable digital OR
Criteria for opting for vendors for DIGITAL OR
- Open architecture
- Customisability & modularity
- Full system integration
- Investment protection/future proof
- Ease of use – single point of operation
- Good implementation with skilled IT team in perfect co-ordination with hospital IT Team
- Easy service and maintenance
Challenges in implentation of Digital OR in India
- Non-techno savvy management, seeing it as a “fancy tool”
- ICT is not a clear cut “return-on investment” tool
- We tend to satisfy present IT needs more than visualising future IT problems and make a provision for the same now
- It is a nightmare if existing OR is not planned with data cabling. Shutting down OR even for a day in a busy hospital disrupts entire surgical procedures calendar
- Digital OR technology even at Level 2 is relatively expensive to install and maintain
- No statutory compulsion as of now to digitise image management
- The complexity and cost of storage (physical, cloud) of huge files of radiology itself is a challenge, hospitals would want to avoid another challenge out of digital OR image storage which are typically bulkier than radiology because of HD, duration
Tips for avoiding mistakes
- Digital OR concept is the future – so wake up to it before it is too late
- Plan your hospital IP network with latest bandwidth/ technology
- Avoid common mistakes during planning and implementation of digital OR
- Hire a consultant if you are not equipped to deal with it on your own
- Plan not as per your present need, visualise 5-10 years’ needs and plan accordingly
- Customise digital OR concept for each OR as per your needs rather than generalising it
- Go for complete modular solution for super-specialty/complex OR situations for limited scalable solution for general/ non-complex OR
- Go for a vendor neutral solution
- Plan for storage and management for images SEPARATELY from Radiology PACS to avoid data explosion, mismanagement and infighting between departments
- Go for CE/FDA approved Medical Grade System, Displays and Software even if not compulsory in your country
- Look for a vendor who has sufficient experience and IT skills to handle such projects in your area. Planning, installation, maintenance and upgradation is critical in this type of project
Conclusion
- Digital operating room is logically the next big step to be taken by every healthcare institute in some form
- You will need it sooner than you think
- Plan in advance, avoid mistakes, take help from professionals/consultants if needed
- Enjoy the benefits of a Digital, seamlessly integrated OR in your setup in near future (if not already implemented !)
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