Adding Layers to ‘Operating Room Integration’

AI will take the concept beyond simply connecting all devices — and make ORs safer and more profitable.

OR integration can mean many different things to many different people. It could be as simple as getting all the devices in the OR connected or giving surgeon fingertip access to case data and images so they know exactly what they’re looking at and where they’re going. For others, integration goes further, it means capturing metrics like surgical duration, patient’s anesthesia exposure which will help them improve their efficiency and outcomes.

The beauty of an integrated OR is in the eye of the beholder. Each OR in the country falls somewhere on this large OR Integration spectrum of some being on board, some are in the process, and finally the others are just beginning to realize they need to get there fast.

Whether you’re in a traditional OR with old-school practitioners who rely more on their instinct than technology, an entry level suite with connections to X-rays and other imaging systems; or a technologically modern OR environment where surgeons who want as much data as possible, one thing is crystal clear that integration can make your space more efficient and more profitable, and ultimately more safer for patients.

Start with the basics

I have seen firsthand how facilities being their integration journey. One of my clients recently invested in a basic visualization OR Integration package. The package lets the surgical team swipe images in real time, pulling up EMR charts and labs that they need during the case without any delays.

Most facilities should seek some basic level of integration package from a vendor. Every entry-level system now features a centralized touchscreen controls for devices within your OR. With wireless connectivity to electronic medical records and intraoperative images, the surgical teams work more precisely and efficiently. The ability to control, from a central console, the room’s lighting, audio, and video systems, as well as the clinical devices, makes for an efficient, modern procedure. A circulator or other member of the OR team uses a touchscreen to put the right information on the right display screen, often anticipating the surgeon’s needs. I have been in ORs with just three monitors and other rooms with as many as seven, but ability to move that data and/or image across those screens seamlessly is a game-changer.

Before this integration, information couldn’t be moved from screen to screen; the surgeon would have to physically move around the OR to see it. With rooms that didn’t have imaging devices in them, the patient would have to be moved to the OR after the imaging took place elsewhere or the surgeon had to wait for the images to be shown to them.

On some level, everyone understands that a certain amount of integration is needed. If OR time costs are $150/minute, and if efficiencies from integration can shave 20 minutes off a case, that’s $3,000 in saved time or “cost avoidance.” The payoff for these systems is tremendous. A basic system can be purchased for $120,000 to $150,000, so they pay for themselves very quickly, some within the 90 days of implementation

Beyond the basics

CONTROL CENTER Touchscreen interfaces allow nurse circulators to navigate multiple images for the entire surgical team to view on large wall-mounted screens.

As ORs evolve, data will take precedence over instinct alone. More accurately, the data that aids surgeons in the decisions they make by providing information on how to reduce surgical times, decrease unnecessary anesthesia exposure, and more. Predictive analysis will help the surgeon reduce operative times, minimize anesthesia exposure, and streamline every step of the procedure. Each incremental layer of integration isn’t just about bells and whistles; it’s about better patient outcomes. All micro-increments of integration in the OR lead to better patient outcomes. For example, if you can control the amount of anesthesia exposure, a patient will spend less time in the PACU and can more quickly move to the next stage of their journey, which for HOPD and ASC patients is recovering at home.

Patient outcomes are always the most important factor. Your OR is arguably the most expensive real estate in your building. Every square foot is packed with high-cost technology, and the returns on that investment depend on your throughput. The more efficient your OR, the more cases you can safely complete, driving both patient outcomes and revenue. Since hospital admission is expensive, the revenue streams that come out the OR drive everything. As insurance companies incentivize outpatient surgeries, they will continue to expand, maximizing reimbursements will require quick, safe, and successful procedures.

Adding layers to your platform

There are some academic healthcare institutions already implementing “wheels-in, wheels-out” automation times for patients. The clock starts when you wheel a patient into the OR and ends when you wheel them out, at which time revenue generation ceases. This is currently done manually, with a perioperative professional documenting, for example, that a patient arrived at 1:38 p.m. and left at 2:55 p.m. — a mundane task for an already busy circulator. It would be much better for technology to automatically document when patients are wheeled in and out, saving time for the circulator and potentially eliminating “revenue-leakage” due to inaccurate manual estimates.

While this isn’t precisely a feature of OR integration as we commonly define it, it’s integration-adjacent and an example of the many benefits of technology-proofing your OR. Surgeon break times also can be automatically documented, providing more data for analyzing why some cases finished on time while others did not.

We will see data take precedence over instinctive decision-making.

Many integration features and the data they provide also lead to teaching and process improvement opportunities. With AI and automation, leadership can quickly analyze why some cases ran long, identify trends, and create best practices for the institutions that elevate performance. Again, all of these advances are about how to best operate with maximum efficiency for the facility and most effectively for the patients. This isn’t yet sold as part of an integration system, but provides insight into the future.

Into the future

After you’ve given the surgeon the integration tools and once the system has paid for itself, it will be time to consider adding or upgrading technology. After all, a Blackberry was great before 2007, but it can’t compare to the iPhone of today. Likewise, you should continually upgrade to continuously evolving towards smarter, faster, and more adaptive space.

How valuable will this data turn out to be? Consider that we didn’t fully understand the true value of patient electronic health records when they were mandated by the Affordable Care Act. Then came the pandemic, and EHRs proved invaluable during the COVID-19 response. The same is true with OR integration systems. There are a lot of data points, but no one has taken the time or made the effort to use them in ways that can truly help surgeons. This results in lost revenue, as opportunities were lost to see what went wrong in procedures that resulted in a trend for certain type of surgeries taking longer for a facility to perform this year compared to last year. We’re all going to be learning about surgical processes at an exponentially faster clip. And we’ll get analyses out of it that will not only help the patient, but also the utilization of everything in the OR space. What used to take a long time to figure out will be figured out in days, weeks, even hours.

Integrated ORs will provide countless data points, and AI will be critical sifting through for rapid analysis of the data and assisting organizations in exponentially advancing work in the OR as has never been seen before. Instead of relying on instinct and anecdote, we’ll get analyses that will not only help the patient but also improve the utilization of everything in the OR space. Things we used to think would take a long time to figure out will be figured out in days, weeks, even hours. Out-of-norm surgery times will no longer remain mysteries. The data points that currently are clues to issues that are never solved will soon be used to quickly figure out what went wrong. AI will help us determine what it was, leading to more efficient and profitable ORs.

Facilities can decide just how far they want to take their OR evolution, but the future is undeniably data-driven.