Surgeons, caregivers explore potential of innovative technologies andprocesses

Issue: October 2008

ByAnthony M. DiGioia III, MD

This month, Orthopedics Today introduces a column about some of the technologies and innovative processes that will shape our specialty and the manner in which we must deliver patient-centered health care now and in the coming years.

While advances in technology can help orthopedic surgeons in the right situation, we must remember to put them in their proper context. We all have a fascination with the latest technology, treatments, surgery, procedures, implants, etc. Unfortunately, our interest in just the technology, though sincere, sometimes exceeds the real benefits of what those technologies can offer. More importantly, physicians and health care professionals should have at least as much interest in perfecting processes and developing dedicated focused care teams.

Towards these goals, we have learned that we must enhance performance and use technologies as measurement, evaluation and training tools as well. In the end, improved and innovative processes may have more value or at least provide as much value-added improvements from the patients’ perspective as most new technologies.

What are the most innovative processes and technologies, and how do these innovations address problems from the patients’ perspective so that we can all deliver exceptional care experiences to our patients and their families? These are some of the most important questions we must ask ourselves, and these are the questions we hope to address in this column.

At Magee-Womens Hospital at the University of Pittsburgh Medical Center, we use a concept called MyPerformance, which focuses on merging the art and science of performance in health care using a patient- and family-centered care (PFCC) methodology. There are MyPerformance components that address the specific needs of caregivers, patients and physicians, and we have a special set of instruments grouped together in our “Toolbox.” Many of the technologies and processes in the MyPerformance Toolbox can be used alone or in combination, including:

observation systems that permit us to look through the eyes of our patients as they go through their care experience, and include video observations and flow tracking systems; patient and family “shadowing programs,” and informal surveys of the patient and family;
medical resource management tools based on aviation crew resource management principles applied to the operating room setting;
computer-based simulators — including image overlays and virtual ultrasound trainers;
games for rehabilitation; and
Healthplex Wellness Centers.

Anthony M. DiGioia III, MD
Anthony M. DiGioia III

We use these tools to look through the eyes of our patients and document the flow of care and efficiencies in our Bone and Joint Health program, which specializes in treating patients with hip and knee arthritis.

In our video observation project, we installed digital video recorders similar to ones used in the security industry and use them to monitor orthopedic patients’ complete postoperative recovery period while they are in the hospital. Two cameras inside a patient’s room record contacts any staff or caregiver have with the patient. We also record who visited the patient and track how long they visited and what they did while they were there … again, as a means of documenting a care experience as well as improving our communication with the patient.

By analyzing the recorded data in this clinical setting, we can measure and improve patient care, analyze staff and workflow, and monitor safety and efficiencies. Similar video systems were also installed in two orthopedic operating rooms, which capture data on workflow, setup, efficiency and the performance of the teams.

We also integrated an indoor positioning and tracking system using both radiofrequency and ultrasonic technologies in three areas of the hospital, including the inpatient orthopedic section and two outpatient clinical areas. This system tracks all movement of staff, patients and equipment and does not interfere with the staff’s regular routine.

This tracking system can be combined with video observations to capture the entire experiences of patients, families and caregivers. The end result becomes an excellent learning and training tool because we provide information in a timely way that was never available before.

Tools for patients and doctors

In adapting the MyPerformance program for patients, we use customized video games that engage patients in their own rehab while distracting them from their postsurgical pain. Their performance can be tracked over time, provides rapid feedback on their individual performance and even encourages competition between patients. For example, patients can select a game/activity such as ankle pumps, leg lifts or heel slides, and then engage in the activity and follow along as if they are the main character in a video game. We are now also using off-the-shelf Wii Fitness to enhance patients’ rehab experiences.

“Unfortunately, our interest in just the technology, though sincere, sometimes exceeds the real benefits of what those technologies can offer.”
— Anthony M. DiGioia III, MD

MyPerformance for physicians consists of computer-based training simulators that have been shown to improve surgeons’ performance. One example is the ultrasound training simulator, which represents an innovative approach for sonography education. The simulator allows clinicians to practice performing examinations on a mannequin while viewing real-time sonographic images.

The scanning motions and techniques used by interventionalists and surgeons realistically simulate the same skills necessary to perform the procedure. By practicing on the simulator for as much time as they need to achieve initial competency, any interventionalist should be able to perform the procedure more effectively in a shorter period of time than having to have learned in the actual clinical setting, resulting in less discomfort for patients.

Our 3-D image overlay (IO) simulator is a unique 3-D display technology that offers a combination of real and virtual environments. Originally designed for use with intraoperative surgical navigation, IO has been extended as a visualization and training tool for multiple clinical challenges.

The design is based on a flexible clinical module that allows the integration of data into surgical and clinical settings. IO uses augmented reality display techniques to combine computer renderings with the user’s view of the objects of interest. For example, a 3-D image of a bone reconstructed from CT data can be displayed at the exact location of the real bone, or the location of a breast mass in the soft tissues, regardless of the position of either the surgeon or the patient.

In effect, IO can provide the viewer with “X-ray vision” in a wide variety of applications, including orthopedics, neurosurgery and breast cancer. The user does not need to look away from the surgical field to view the image; it appears “within” the patient.

In future columns, we will bring to you the innovations of emerging technologies as well as new and unique approaches to care delivery in orthopedics and other medical specialties —especially lessons that we can learn from other industries, since we can all continue to learn from each other!

For more information:

Anthony M. DiGioia III, MD, can be reached at The Orthopaedic Program, Magee-Womens Hospital, 300 Halket St., Pittsburgh, PA 15213; 412-641-8654; e-mail: tony@pfcusa.org. He has no direct financial interest in any products or companies mentioned in this article.