A lot of solutions look for problems. This is one of the chief cautions in buying new equipment, and a way to explain how easy it is to overbuy when you're in the market for a digital video recording device.

If you're making that decision, the first thing you'll want to ask yourself is, what is the need? What are you going to do with the images you record? It's like anything in medicine. You identify the need, and then you identify the treatment. In buying equipment, that'll help you avoid having to justify the purchase after you've paid for it.

The uses of digital recording
You won't likely need a digital video recorder if your documentation system is totally paper, if paper photographic images or videotape are adequate for both clinical research and reimbursement, and if you don't expect to get into electronic records management.

As the technology has become available, though, more and more surgeons are finding digital recording an effective method for documenting their procedures. Whether it's still images or segments of video, digital documentation lends itself to clinical analysis, surgical recordkeeping, academic presentation, legal backup or even patient viewing.

Paul Arnold, MD, FACS, of Arnold Vision in Springfield, Mo., used to record his procedures on videotape. When he opened his present ASC last year, however, it included digital recording technology. Despite the cost, he says, the advantages are clear.

"If you can spare the expense, it's the better option," says Dr. Arnold. "If you're ever going to use these recordings for any sort of teaching purposes, digital is the way to go. It's much more convenient for editing." Recording to a computer hard drive and using its editing software, he explains, is simpler than working with the specialized equipment necessary for videotape editing.

There are two categories of recording devices. One is a component of a flexible endoscopy or microscopic system, an automated recording feature that saves images to a computer's hard drive, like Dr. Arnold's. The other - the primary focus of this column's product roundup - records directly to a digital video disc in standard file formats compatible with any computer.

"One of the reasons that DVD recording is taking off is that it allows surgeons to transfer, archive and access information more easily," says Sandy Masterman, division manager for Imaging Associates in Charlotte, N.C. Unlike videotapes, you can easily upload to a computer or e-mail the contents of a DVD. Plus, she says, the portable media takes up less storage space and costs about the same as tapes.

Formats and options
The three primary operating formats of digital video recorders are

• DVD-R, which is recordable but non-rewriteable;
• DVD-RW, which is rewriteable;
• DVD-RAM, which is more like a computer's removable hard drive.

Both DVD-R and DVD-RW are compatible with most DVD players. DVD-RAM, which offers the highest quality of recording, isn't compatible with many standard DVD players.

MPEG-4 is the latest recording format, offering a higher quality of image than the earlier MPEG-2 format. The difference may be important to those who value the diagnostic uses of recording, says Ms. Masterman.

"The reason for buying the recorder is to be able to capture the image," says Safia Amatullah, MBA, administrative director of perioperative services for Mt. Sinai Hospital in New York, which uses its recording devices for endoscopy as well as surgical videoconferencing. "From a physician standpoint, the image is definitely key."

Ms. Amatullah notes that you'll want to ensure that your seeing-and-recording devices are consistent in their resolution. "High definition is the buzzword," she says. "Today they're making instruments with high definition right in the scopes." Since the monitors they display to can also be high definition, "you'll want to record at the same capacity you see on the screen."

Each manufacturer's recorder has its own features, benefits and unique approaches, but functionally they all operate the same and produce the same end results. I advise potential buyers to begin their search with their preferred surgical scopes vendor - assuming that you're satisfied with the quality of those products and the reliability of the service.

"The good news is that there's a lot of options out there," says James Laskaris, a clinical analyst for MD Buyline, a Dallas-based healthcare research consulting firm. "Other companies can probably put pressure on [your vendor] pricewise, and get you what you need."

If the recording device is intended to be part of an integrated OR system, you'll also want to keep compatibility in mind. Will future expansion plans be able to incorporate this hardware, or is this just a stopgap measure until your integrated OR environment is completed?

"When you do buy a recorder, it's typically going to go with another component, such as a scope," says Ms. Amatullah, "so you want to make sure they're compatible."

More often than not, the recorders are purchased as part of a larger system. Dr. Arnold, who bought his from the same vendor that supplied his center's microscopes, explains, "It becomes a question of whether you want to put the pieces together yourself, or just get the turnkey system where everything you want is included." In addition to the microscopic and room cameras and recorder, Arnold's system includes live video streaming to monitors elsewhere in the facility for family or academic viewing. "I found it was easier to go with the package," he says.

"Most of the devices have features allowing you to tie several devices into a single recording system," says Mr. Laskaris. "Then it's an issue of cost versus utilization. Are you going to buy one setup for three or four rooms? Can you get your physicians to share? How many physician workstations do you need? These are all cost differentials. Match utilization and cost and outcome for the patient, and somewhere between you'll find the best option."

Ease of use
Additionally, a recording device should be easy to use with a comparatively small amount of training, given everything else that goes on in the OR. Most are fairly intuitive and straightforward, often offering touchscreen controls or a single-button image capture. "Mostly they function like PCs or digital cameras these days," says Mr. Laskaris, "and surgeons are pretty sharp, they know how to use those."

Still, notes Ms. Masterman, a preliminary trial is critical. "Anyone making this decision should get a demo unit and see if it fits their needs," she says. "Make sure the physicians are comfortable working with it, and the biomeds. There is a transition period, especially if you're coming from analog technology. They have to be willing to sit down and learn how it works, otherwise they'll be frustrated."

While most models are simple to use, she says, "most practices are very busy and just want to get it in and get going, and they'll need to trial it before using it in a surgical situation."

The reliability of technology
"We have found that the failure rate of these has been limited," reports Laskaris. "That leads me to believe that they are fairly reliable."

However, he adds, "medical technology is moving by leaps and bounds," and like computers, electronic equipment dates quickly. "It's likely that you'll feel you want to update it before you ever see it fail."

Ms. Amatullah says that thinking about that potential upgrade could be an important consideration. "In today's marketplace, you'll want to ask your vendors, 'If we purchase something today, how obsolete is it going to be tomorrow?'" she says.

"This is a relatively new technology, only in the last several years," Laskaris agrees. "Look at where the technology is now, and think of where it can go."