The day kicked off with a two part session on "Applying Real-Time Integration in the OR." The presenters started with "blood and guts" anesthesiologist, Warren Sandberg. He noted that the surgery department has limited - and frequently constrained - resources. He described the value of extending data beyond the location
What Sandberg's describing is more than audio visual data (combining images of displays from various cameras and device displays), but data integration that allows for the rearrangement and massage of data to better manage clinical care delivery.
Mark Meyer compared and contrasted the differences between the value of surgical video alone and video with real-time data from patient connected instrumentation combined with operational (procedure, personnel) and clinical data (relevant history, allergies, etc.). A large screen display may be able to aggregate all the data in an OR, but an important requirement is to provide different views of the data, based on roles or what the user's trying to accomplish.
The system Meyer's uses at Mass General is from LiveData. This system acquires data (not just images) into a comprehensive "recording" that captures a complete record of each case. The system also captures positioning data of the patient, staff and equipment. The system can also create data trends from data aggregated across all patient connected devices, and display different screen formats based on reaching certain milestones in the surgical case. The data is all archived, and takes about 50 MB per case.
Conventional full disclosure systems are proprietary, run on a proprietary network, very costly, and are unit based (rather providing an enterprise architecture). The LiveData system captures data from multiple vendors with a goal to improve throughput and patient safety in the OR.
Next up, Phil Brzezinski, VP for Healthcare Systems at LiveData. He was inundated with questions about their system (as presented by Sandberg and Meyer) before he even had a chance to present. The 50 MB figure above does not include digital video - video generates a huge amount of incremental data. He notes that while other HIT apps may collect most of the same data, buyers must ensure that they can get access to the data in the form and at the time in which it serves the greatest good.
LiveData's initial market was the electrical power distribution industry, where they created dashboards for utilities. Back in 2003 and 2004 they did their core research, looking at medical devices - the data generated, data formats, interfaces, etc. They also spent considerable time within the surgical environment gathering requirements.
Visual integration: "Using the clinical workflow at the point of care to determine the optimal display of patient data, images, communication tools and ancillary information to maximize quality and efficiency of care." This is much more than just a "picture." Their value proposition:
- Improving patient safety and productivity (thus improving throughput and utilization),
- Improving communications and coordination between departments,
- Leveraging IT investments by extending and synthesizing the data from multiple systems into new information, and
- Gathering data critical for "quality of service" payments.
In the realm of patient safety, LiveData helps reinforce Joint Commission safety protocols. The system also improves situational awareness and facilitates safe patient hand-offs.
All of the data in the LiveData dashboard comes from other systems - nothing is entered into LiveData. A common display configuration may include staff which is updated by scheduling apps, positioning systems and other sources. The patient data includes basic demographics, orders, allergies, etc. The central portion of the display is tabbed to follow case set-up, briefing, intraop, closing, debriefing, and protocol. Users are able to note when logistical problems crop up for later analysis. on the right is the progress log and a summary of cases for that room for the rest of the day. An example was also show where the day's schedule was laid out horizontally along the bottom of the display along a time line. The system provides team communications: coordination, awareness, cooperation, and communications.
The LiveData Historian is the archive module, allowing for retrospective playback and analysis of procedures for process optimization. The archive module can provide specialized displays that match video of the case with any other data that occurs in time sync.
Phil presented a brief vision of the "visually integrated" hospital as a lead in to how LiveData systems are configured and delivered to customers. There are 6 key components:
- Data sources and mappings
- Workflow description and definition
- Custom user interface or workflow
- IT and Biomed integration for security and system maintenance
- Image routing and management choices
They start the process by identifying data sources and mapping relationships. The actual system configuration is completed, along with data mapping. A rapid prototyping process is used to enable customers to confirm the configuration, and rapidly arrive at an optimal system configuration.
Guess what? Vendors who are already established in the OR are not really keen on the integration that LiveData is providing. This is the common reticence vendors feel when presented with solutions that move beyond the conventional end-to-end proprietary product strategy. Some vendors may claim provide many of the same capabilities as LiveData - caveat emptor. Hospitals will have to push their vendors to support an integrated vision. You must insist your vendors support standards and process unification efforts. Demand open systems at a lower level of granularity - in other words, integration between complete systems is frequently ineffective; integration between sub modules is frequently necessary for meaningful integration. When looking at vendor solutions, consider vendors outside the list of usual suspects to include open source and innovative startups.
Questions: LiveData has yet to deal with a company that is not willing to share integration data, although some vendors are not ready technically for this, or are limited in what they're really willing to share. The LiveData system does not replace anesthesia record keeping system, but integrates with them to get data, drive the dashboard, and track workflow. The LiveData system will integrate with a third party audio visual integration system from vendors like Stryker or Storz. A question of customer readiness shed light on the fact that LiveData customers are currently "early innovators" who already have high levels of automation. Less automated hospitals look to LiveData to do more than integrate existing data, and help with basic automation too.
Warren Sandberg finished these two marathon sessions with an indepth view of the financial issues (and ROI) that revolve around care delivery - using the OR as an example. Today's reimbursement environment is rife with highly detailed mundane documentation requirements in order to realize optimal reimbursement. Any "up coding" where codes that reflect higher than normal clinical complexity must be appropriately documented - "if it's not documented you didn't do it, even if you did." Pay for performance (P4) is increasingly adding to the "mundane documentation" requirement for physicians and caregivers. Sandberg's presentation demonstrated how they used an anesthesia information management system and some additional systems facilitated the consistent capture of this detailed documentation as required be the case and payor. The financial impact was significant at MGH.
The benefits of this improved documentation included a significant financial impact, as well as reductions in LOS and improved patient outcomes. As reimbursement becomes more entwined with patient safety and outcomes (e.g., P4P), systems for billing, department operations, logistics systems,other clinical information systems, and medical devices will become more tightly integrated. LiveData is positioned facilitate this integration.