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Page 670 – Stanford Medicine X

I2OR: The intelligent ingegrated operating room of the future

Mark Desilets markdesilets@yahoo.com


Whenever I go into an operating room, I’m struck by a couple of things. First, there is an incredible collection of high-tech equipment, and second it’s a tremendously chaotic place with screens and wires and alarms. All of it is well-meant, of course, clever systems made by engineers like me, who can be forgiven in their invention for forgetting that their system is not the only one vying for the surgeon’s attention, or the anesthesiologist, or the scrub nurse – it may not even be the most important one! It takes training and practice and focus for our talented medical professionals to turn their attention where it is most needed at any moment, and it is a miracle that they get it right so often – not always, of course, but usually.
2017 has IOT, or the Internet of Things. Everyday consumer products have the ability to wirelessly connect and exchange information, so why not our high-tech ORs? I come from a medical imaging background, and you couldn’t design a CT that didn’t communicate with its couch to provide a helical CT, so why doesn’t a C-arm communicate and coordinate with a surgical table? Robotic surgical systems are all the rage, but why can’t they know about the positioning provided by a surgical table, or even adjust that positioning automatically to provide superior surgical access and outcomes? Why must every neural monitor, temperature control unit, pulse oximeter, and literally dozens of systems in the OR exist autonomously? Shouldn’t they coordinate information in a way that gives the surgeon and OR staff a comprehensive and prioritized view of the things that most affect the patient? And why shouldn’t all of the important things that happen to a patient be integrated into the patient’s medical record?
And I am not proposing that one company, even my own, can or should solve this problem. This problem belongs to the space shared by patients (foremost), operating room medical professionals, and device companies. And so it must be solved by teams of representatives from all three branches. What is needed is a place where patients, medical professionals, and medical device designers can come together to propose, debate, adopt, and ultimately offer ways for devices to share information and control with one another.
I propose an industry-wide effort to remedy this state of affairs – a consortium of medical professionals and medical device designers, informed by real stories of patients’ lives affected by the lack of proper OR information management. Like the imaging community came together to develop the DICOM standard, which allows for the interchange of image data among many systems from many different vendors, the surgical community must come together to develop a standard for OR system integration, control, and archiving.
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