By Margaret Ann Cross

Contributing Editor, Health Data Management

February 1, 2008

In most of the operating rooms at Massachusetts General Hospital in Boston, surgeons, nurses, and anesthesiologists have to ask one another for information that only one of them may be seeing—such as how a patient’s blood pressure is faring—and wait for an answer. In two ORs, however, such information has become visible to everyone in the room. Clinicians can look at a 40-inch flat-screen monitor on the wall to see patient information immediately.

“A surgeon may notice that a patient is starting to bleed more and can glance up and know immediately if his or her blood pressure is also decreasing, instead of having to ask the anesthesiologist,” says Dawn Tenney, associate chief nurse for peri-operative services. The surgeon, as well as the nurses and other staff members, have a better view of how the surgery is affecting the patient, she adds.

The screens display real-time data pulled from patient monitors and medical devices as well as from nursing documentation software and other information systems. Clinicians can see the name of the patient, the procedure taking place, allergy information, the names of all staff members present in the room, and streams of physiological data, such as heart rate and blood pressure.

The immediate, visual availability of information is improving patient safety and keeping clinicians in the OR better informed, staff members at the hospital say. That impact has been difficult to quantify, and some staff members admit they don’t look at the monitors, acknowledges Bethany Daily, administrative director for operating room business and information systems. Nevertheless, the basic premise of sharing information on large screens visible to everyone is very strong, she contends.
 
The hospital will roll out the technology to the majority of its more than four dozen operating rooms over the next several years. “It is just another safety net, another level of awareness,” Daily says. “There’s nowhere else that we post the patient name up on a board for everybody to see. There’s nowhere else where we are saying which staff members are in the room.”

Looking for Integration

Clinicians and administrators at Massachusetts General, which is part of Partners HealthCare System, started to talk about integrating real-time data from different electronic sources and computer systems in the operating room in 2002. But it wasn’t until two years later that the hospital found a company that would help it develop the technology, Daily says.

The hospital worked with LiveData, a Cambridge, Mass.-based computer integration firm. The vendor now sells the Web-based system, called OR-Dashboard, commercially.

Massachusetts General first developed and used the technology in its “operating room of the future,” a special room designed to facilitate the testing of new information systems and equipment. Implementing this system in other operating rooms is one of the hospital’s largest attempts to convert technology tested in the operating room of the future into widespread use, Daily says.

The idea of using a large electronic display to aid physicians and nurses could have great value because of its potential to increase clinicians’ awareness of all aspects of a surgery, says Yan Xiao, associate professor of anesthesiology and information systems and director of human factors and technology research at the University of Maryland. He has studied computers in care settings and has looked at how clinicians use such tools as whiteboards, large panels that can be written on with markers. Hospital staff members often use whiteboards to write patient demographic information and staffing details where a large number of people can see it.

Yet hospitals will face challenges in implementing technologies such as the OR-Dashboard, which is like an electronic version of a whiteboard, he suggests.

The key factors to consider when evaluating such technology are whether the information on the display is up-to-date, if the screen is located in a place that is easy to see, and what decisions people can make using the data that is presented.

“It is like the electronic displays of flight information in airports. If the information is accurate, updated, and easy to see, it would be useful,” Xiao says. “People should also be able to adapt it so that they are seeing the most relevant information.”

Two Out Of Three

To implement the system at Massachusetts General, administrators asked a team of nurses, anesthesiologists, and surgeons to identify what information would be most useful to see on a large screen in an operating room. One requirement was that all data selected should be relevant to at least two of the three disciplines—nursing, the medical specialty and anesthesiology.

“Even though the screen is large, it is still limited real estate,” Daily says.

That guiding principle helped the development team tremendously, says Wilton Levine, M.D., an anesthesiologist and clinical director of the Department of Anesthesia and Critical Care. “We had to think about what would benefit the most people in the room. It turned out that what was core knowledge tended to be core across the disciplines, and the process went very smoothly.”

Once the team outlined what data it wanted on the screen, the vendor created XML interfaces between the new system and specific medical devices and information systems.

For example, data comes into the new system from nursing documentation software developed in-house, which nurses in the operating room update throughout surgical procedures using computers in the operating rooms, Daily says.

The system also receives data from a position tracking system from Andover, Mass.-based Radianse, Inc. Staff members wear radio frequency identification badges, which communicate where they are at all times. When a new physician or nurse walks into the operating room, their name immediately appears on the monitor so that everyone can see who it is.

That guiding principle helped the development team tremendously, says Wilton Levine, M.D., an anesthesiologist and clinical director of the Department of Anesthesia and Critical Care. “We had to think about what would benefit the most people in the room. It turned out that what was core knowledge tended to be core across the disciplines, and the process went very smoothly.”

Once the team outlined what data it wanted on the screen, the vendor created XML interfaces between the new system and specific medical devices and information systems.

For example, data comes into the new system from nursing documentation software developed in-house, which nurses in the operating room update throughout surgical procedures using computers in the operating rooms, Daily says.

The system also receives data from a position tracking system from Andover, Mass.-based Radianse, Inc. Staff members wear radio frequency identification badges, which communicate where they are at all times. When a new physician or nurse walks into the operating room, their name immediately appears on the monitor so that everyone can see who it is.

“Our goal was to create a high-level communication tool that would not require human interaction to make it work,” Levine says.

The system is designed to be redundant to other information systems, and no data that is seen on the large-screen monitors is saved, Daily says. “That’s not to say we won’t store it at some point, but we are not doing it yet. We are not ready for the legal and other implications of storing all that data.”

Taking the technology out of the initial room where it was tested for more than a year—and where all information systems and medical monitors and devices were connected directly to the system—has created challenges, Daily says.

Bringing it to the second operating room required the hospital to purchase a server, which was brought onto the hospital’s network. Patient monitors then had to be linked to the network as well so that data could be sent back to the large-screen displays through the new server.

Proper Identification

I.T. staff had to ensure the monitors could properly identify themselves on the network. “The last thing we wanted to do was put up information from monitors that belonged to some other operating room,” Daily says. “It was critical that that data not have any way to get mixed up.”

Another challenge continues to be the lack of data jacks in older operating rooms, she adds. “What we would like to do is roll this out over a wireless network. We are working now on getting the security right in order to do that.”

Massachusetts General also is testing the system in a post-anesthesia care unit. The large monitor, placed in a three-bed recovery room, displays a select set of information from the three operating rooms that will be sending patients into the unit. Nursing notes, for example, indicate the stage of each surgery and whether any complications have taken place.

“It provides the recovery team situational information about the surgeries taking place, and that allows us to prepare in advance for the medications and equipment we might need to care for the patients we will be receiving,” says Scott Ciesielski, nursing director for the post-anesthesia care unit. “It also helps us make decisions such as whether or not we will need extra support staff in the room. It eliminates surprises, and it facilitates better communication. If we see that a patient has experienced complications during the procedure, it provides a trigger for us to ask the transport team more specific questions.”

The technology also has the potential to be used in intensive care units, so that anyone who walks into an ICU room will have an immediate picture of what is happening with the patient, rather than having to look at each monitor individually, Tenney says. Data from any monitor or computer system can be displayed, which makes the possibilities almost unlimited, she says.

Administrators say clinicians will have to agree to the validity of different applications. But most people who have been in rooms with the flat-screen monitors appreciate them, Levine says.

Learn more online

For more background on using information technology in hospitals, visit the hospitals portal at healthdatamangement.com/portals/hospitals. (c) 2008 Health Data Management and SourceMedia, Inc. All Rights Reserved. http://www.cardforum.com http://www.sourcemedia.com ://www.cardforum.com

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