Inside OR Integration

A closer look at the considerations that go into seamlessly connecting the technology within your operating room

Few surgical leaders will argue that an integrated OR is a more efficient OR. They may, however, split hairs over what actually constitutes an integrated OR in the first place. After all, integration means different things to different people.

At a minimum, an integrated OR refers to seamless technological platforms that give surgeons and staff customizable and more centralized control over instrumentation and devices, such as video routing, clinical data, dashboards, surgical lighting and medical records. But the latest systems can even use artificial intelligence (AI) to guide surgeries, look at trends and help providers consider options in real time.

If you’re looking to give your traditional OR a modern makeover, here’s how to navigate the many variables inherent in upgrading to an integrated OR suite and how those who have done it incorporate thoughtful design into the process. 

Real-time monitoring

At DISC Sports & Spine Center in Southern California, board-certified, Harvard and Emory University-trained orthopedic spine surgeon Rojeh Melikian, MD, specializes in microscopic and reconstructive techniques using some of the latest technologies on the market. He believes that the use of high-tech equipment in the OR is becoming a staple of modern surgery. “We used to have 10 systems to control 10 things,” he says. “Today, multiple things can run through just one system.”

With an integrated OR, a big change for Dr. Melikian was being able to instantly access surgery charts and video streaming. This allows everyone to monitor the surgeries as they are happening, which is especially important for microscopic surgery, in which he specializes. “Our anesthesiologist can watch the progress and adjust accordingly,” he says. “And outside the OR, recovery room nurses can also monitor and prepare. The best thing is that it keeps everyone on the same page. Everyone can see exactly what I am seeing.”

Karen Reiter, RN, CNOR, RNFA, CASC, vice president, operations and payor management at TriasMD, the parent company of DISC, likens the modern-day OR to an orchestra, with the integrated system playing the role of the conductor. “From an administrator’s perspective, when a system ensures everyone is speaking the same language and there’s this visual communication of data between everyone in the OR, it’s really a beautiful thing,” she says. Ms. Reiter also points to the added efficiency that is baked into technology that affords staff real-time monitoring capabilities. “Instead of the surgeon having to stop and ask for an instrument, the scrub tech can anticipate what they need next,” she says. “Or when anesthesia is closely monitoring the progress, they aren’t going to give extra sedation when they can see the surgeon is wrapping up a case.” 

This real-time monitoring that allows multiple providers to see and react to the procedure taking place is an integration feature many surgical leaders view as critical — as is the quality of the video images they are viewing. That quality has increased drastically in recent years. For instance, not too long ago HD was the dominant resolution. Now that 4K (and even 8K at some facilities) has literally entered the picture, there’s a trend toward even higher resolutions in the OR with benefits like increased depth perception, better hand-eye coordination and overall higher-resolution imaging that can enhance the smallest vessel or fiber.

Whatever definition you choose, it’s crucial to have consistency throughout the entire system chain. In other words, your imaging isn’t in true 4K unless the instruments and routing system are also equipped for 4K.

EXPERT ADVICE

Four Keys to Investing in New Technology

Investing in new OR technology can change the way surgeries are performed for the better. But it can also be an enormous undertaking in terms of the financial and time investment. Fortunately, Suraj S. Soudagar, MBA, principal and project executive at IMEG in Naperville, Ill., says there is a proven blueprint for finding the right technology for your facility’s needs. Here are the key steps to take prior to investing in technology in the OR.

1. Talk to an equipment supplier. These professionals can explain the differences between systems in terms of what is available now and what will likely be the norm in the near future.

2. Get multiple perspectives. Vendors, while they tend to push the products in which they specialize, can provide a better sense of price points and what types of hardware are needed to complete a system based on specific goals.

3. Hire an outside consultant. These industry experts can do an important cost vs. benefit analysis. They can also help make an evaluation based on several key factors to determine what type of investment may make the most sense now and well in the future.

4. Keep up with educational training. Find out what students are learning now and what they will be trained to use when they enter the surgical field as doctors.

—Natalie Hope McDonald

Making the case

Knowing how to invest in your OR integration system often comes down to understanding the surgical needs of your specific patient population and the skillsets of your surgeons — and finding the right fit between the two. 

Dr. Melikian believes that because many providers now have a solid relationship with technology, upgrading to newer, smarter systems is much easier than in the past. But he reminds leaders that an important consideration to make is how well any new system will integrate with the technology that is already being used in their facility. For instance, integration systems should be able to seamlessly interface with everything from navigation equipment to robotic platforms to AI — technologies that are increasingly making their way into ASCs. “The goal of any of these platforms is to improve patient outcomes,” he says. “We can now do things in an outpatient center that we would have previously only done in the hospital.” 

Of course, investing in the latest technology also often means increasing the physical footprint of an OR. In the ASC, this sometimes means designing larger ORs that are capable of hosting surgeries that used to be designated to a hospital setting. For leaders considering how to invest in integrated OR systems today, Dr. Melikian says a single question will often go a long way toward helping leaders with their decision-making: “What outcomes does it increase and how will it be able to handle other technology in the future?”

Based on the benefits outlined by Dr. Melikian, it’s hard to imagine why any facility wouldn’t want to invest in an integrated system. Still, the cost of these systems is an obstacle for many ASCs — particularly those with the tightest of margins. If your center falls into that category, Ms. Reiter suggests looking at the big picture. “The expense is worth it in the long run,” she says. “I can’t imagine going back to separated communications between systems.” If you’re still struggling, try to find a surgeon in your facility who has worked with an integrated system and convince them to champion your case for making the switch. “It’s always easy to get something across the finish line when you’re working with surgeons who have already experienced the tremendous benefits of an integrated OR,” says Ms. Reiter. OSM