At the 180-bed Mary Imogene Bassett Hospital in Cooperstown, N.Y., the flagship facility for the Bassett Healthcare system, surgeons view PACS images on flat screens atop rolling carts, and can manipulate and use the images themselves, using keyboards equipped with cleanable skins, says Kathy Brooks, administrative director, anesthesia and surgical support systems, for the health system. In addition, Bassett has implemented a wide-ranging perioperative information systems with components for perioperative, interoperative, and post-operative care, and anesthesia management, from Surgical Information Systems (SIS, Alpharetta, Ga.) Using the anesthesia component from SIS, anesthesiologists at Bassett are among the few in the industry currently documenting patient data electronically in real time during surgery.
Interestingly, optimization, at least in the short run, doesn't always mean adhering to a single vendor-source strategy, say IS executives. “We were ready to go to the next generation of PACS and RIS, and we had partnered with Siemens Syngo to do PACS, RIS, and voice integration,” says UMC-Tucson's Schafer, speaking of the Malvern, Pa.-based Siemens Medical Solutions. “But we had some issues, so we decided to upgrade hardware and software with Fuji” (the Stamford, Conn.-based Fujifilm Medical Systems USA). “So we're going to keep Fuji for PACS and go with Siemens for RIS.” The key with both PACS and RIS in the context of the OR, he adds, is that “You've got to keep it pretty simple, because the doctors are demanding.”
Meanwhile, Bassett Healthcare's Brooks says she believes that implementing perioperative systems will be another key to optimizing surgeons' work, as those systems will continue to improve patient flow, OR nurse and anesthesiologist workflow, and overall OR efficiency. “There are a number of hospitals moving ahead right alongside us,” she adds. “I believe that many of the hospitals, particularly academic centers, cutting-edge hospital systems, will be looking in this direction,” and moving forward both on surgery PACS and on perioperative systems at the same time.
So what should CIOs do when they think about what surgeons like Michael Haak want? “I think the biggest thing is just appropriate planning and engagement, as you migrate from a film-based to a digital world,” says Florida Hospital's Majors. “It's a different conversation than everybody was having five years ago, because acceptance of digital images has now taken place. So it's just providing the right tools and environment, along with the existing surgical environment, to really meet their needs, which are diverse across all the different surgical specialties.”
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Takeaways
Experts and those in the trenches say that CIOs should:
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Think strategically about how their OR automation plan fits into their overall strategic IT plan.
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Consider not only surgery PACS, but also other systems that enhance the process of surgery, such as perioperative and interoperative systems, including those that allow OR nurses and anesthesiologists to document patient vital signs and other measures in real time.
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Keep in mind the diversity of needs of different surgeons (cardio-thoracic, orthopedic, neurologic, urologic, etc.), and the different needs based on planned or emergency surgery requirements.
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Healthcare Informatics 2008 November;25(11):43-45
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