This article will appear in the upcoming July-August print issue of Surgical Products.

What does the future hold for the healthcare industry with regards to OR integration? Several industry experts answer that question (and many others) in this roundtable-style interview with Surgical Products.

SP: What are some of the expected benefits of OR integration that convince hospital facilities to invest the time, effort, and capital to embrace it?

Andy Larg, Director of Marketing, NDS Surgical Imaging: Procedural efficiencies, better patient outcomes, and profitability are key to any hospital’s long-term success. OR integration brings an array of critical and state-of-the-art imaging equipment together in a streamlined fashion. This creates a very powerful visual toolset for the surgical team. A variety of images can be sourced instantly, such as endoscopic video, intravascular ultrasound, patient vitals, and comparative data. Surgeons can access PACS servers, and be connected to other surgeons for consultation purposes. Making informed decisions faster will help shorten procedure times, improve OR turnarounds, increase the success rates of surgeries, and allow the facility to generate more revenue per OR.

Devon Bream, MPH, FACHE, Vice President, Global Medical Sales & Marketing, Black Diamond Video: Operating theaters have become more complex, whether that’s due to more complex procedures or whether that’s due to the amount of equipment in the rooms. Therefore, integration brings all of the different types of equipment together to work – not so much having the equipment talk to each other. I think that was a big fallacy when this market segment began 10 years ago. I don’t think that’s the core of what integration is anymore and why there’s continued investment in it. It’s more about how you make all these disparate pieces of equipment work together to really allow the clinicians to do these more complicated procedures or utilize more complicated equipment.

Michael K. Smith, Sales Director, OR Integration, FSN Medical Technologies: Management of the increasing number of video signals may be one of the leading benefits from video integration.  If you have as many as four video signals being generated in the OR in a conventional situation, you would have to utilize four displays. With the proper implementation of a video integration system, you could decrease the number of displays down to two and still be able to run an effective OR. Safety is another one of the leading benefits of video integration. Less cords on the floor means less trip and fall injuries in the OR. Current standards in hospitals across the country is the adoption of video integration.

SP: Why is it so important for hospitals to evaluate if OR integration is right for them?

Larg: Medical technologies are advancing rapidly, with innovations such as wireless video transmission, 3D imagery, and the imminent leap into 4K resolution. The complexities of running numerous pieces of equipment in different rooms, with varying data signals and formats, are now being simplified and solved. Avoiding the integration discussion and remaining static is not the answer. The cost of upgrading, resource planning, technical training, and time to return on investment will be among the main agenda items no matter when a hospital begins its evaluation. Integrated ORs require careful planning that can take over a year, and with technology advancing so quickly, it is important to review the integrated OR opportunity sooner rather than later.

Smith: The video integration market has been flooded with video routers of various sizes using several different types of hardware and software.  Finding a router that works for all of the hospitals parameters can be daunting but necessary for it to be effective.

SP: What are some of the factors that hold hospitals back from embracing OR integration?

Larg: The initial investment into an integrated OR can be significant, especially for smaller facilities where funding can be a major issue. A facility must have not only the space, but also the trained resources to run what is essentially an IT-centric environment. Some facilities may be lacking knowledge of modern digital equipment and the potential that exists with the integration opportunity.

Daniel Jerina, Business Development Executive, Healthcare Division North America, Barco: I think the number one factor is capital, because the systems – in general – tend to be pretty expensive, and they can get extremely expensive depending on the features in that system. Hospital capital budgets are shrinking, and their reimbursement rates are becoming more difficult to predict. There are a lot of financial factors involved in that decision. It’s a matter of allocating capital budgets appropriately.

Bream: I think the historical way of doing OR integration has been very costly. That's because the players in it have traditionally bought an off-the-shelf commercial product and repackaged it with their medical company logo and then had to resell it to the hospitals. So if you think about the amount of markup just to run a business that goes on when you are doing those kinds of transactions, it becomes really costly to hospitals. Programming is also a factor in terms of redoing the OR, putting in infrastructure, working with contractors. There’s cost of acquisition, but there’s also operating and programming costs on the hospital side. Also, a lot of end users are just confused. This isn’t buying a monitor or a surgical instrument. I think a lot of end users get into these projects and become very confused, and might even shy away from even starting a project if they don’t really have a good grasp on it.

Rob Mann, General Manager, Oasys Healthcare Corporation: There are many factors that could potentially hold back hospitals from deciding on integrating their ORs, such as the size of the hospital and rooms, the preference of the surgeons, and the hospitals budget. The size of the hospital is a huge deciding factor because if a hospital does not have many patients or surgeries they will not use an integration system to its full potential. The preference of surgeons vary between every hospital and surgeon. For instance, older surgeons are less tech-savvy and are probably not as interested in learning a whole new operating system. Finally, the budget of hospitals is the main deciding factor on whether or not to embrace OR integration. At OASYS Healthcare, we try to cater to these needs as best as we can by proving a budget and user-friendly system, making more hospitals interested in this new technology. To make it even easier to use, with the purchase of our system there are complementary training sessions on our system for the medical staff at the hospital as well as a 30-day post installation follow up.

Smith: Money is the biggest factor with the adaptation of the video integration in any hospital. But other factors include product awareness, fear of technology, and fear of change.

Lauren Stamper, ORIS Product Manager, Stryker Communications: Typically, the hospitals that don’t quickly embrace OR integration either haven’t had the opportunity to see it in use or are comfortable in their current workflow. A great analogy for this mentality is the sentiment of using paper patient charts versus using the EMR. There are many benefits to an EMR solution, but to learn that system after years of using paper charts can be overwhelming at first. However, people adapt quickly and once the EMR (or integrated OR) is utilized, the benefits become tangible.

SP: What factors — above all others — decide whether or not a hospital can pull off OR integration?

Larg: Obviously, you have to have the financial resources to do it effectively. Facilities need to take a close look at the level of investment based on their specific requirements, and forecast how quickly they can recoup those initial costs. Space planning, technical training, and skilled staff will of course be critical to success.

Smith: Hospital staff members may be apprehensive about new equipment or technologies that change their daily routine. Once the integration has been installed, the hospital staff needs to be in-serviced on a regular basis to make it successful.  If the hospital staff will not adopt the new technology into the daily routine, the product, no matter how beneficial, will not be successful.

Stamper: Any hospital, no matter the size or type, can pull off integration within the OR. Whether a hospital’s focus is improving efficiency in room turnover or increasing staff engagement, OR integration is a key component of success.

SP: What are some common mistakes you see from hospitals that undertake OR integration efforts that fall short of expectations?

Larg: Planning your integrated OR well is paramount to achieving your long-term goals. Having a clear understanding of how the integrated OR will be utilized and shared, by various surgical disciplines and subspecialities, will help determine exactly what equipment needs to be inter-connected in how large a space. The right integration technology, highly qualified design partners, and leading-edge equipment will complement a great plan. Choose wisely.

Bream: I think a lot of program managers and a lot of project managers really push off selecting a vendor until very, very, late in the project. I’ve always told customers that whoever they go with, just pick them early. Because the earlier they can get engaged, the less change order costs will be incurred and there will be better coordination with other vendor partners. The other most common mistake – and it sounds unbelievable – is not having the right cross-functional end user team on the hospital side. Sometimes the hospital will just have capital programming do it, but they will not include the clinicians. They have these beautiful, brand-new ORs that they’ve spent hundreds of thousands of dollars on, but the clinicians will be let down because they didn’t get a chance to voice what their true needs are.

Mann: One of the main reasons hospitals' expectations fall short is because they are improperly trained on how a system works. This is why OASYS Healthcare provides training sessions for the medical staff and ensures they are able to navigate through the system skillfully and easily.

SP: How has technology advanced to the point where OR integration is a viable option for many hospitals? What kind of technology is out there that hospitals want to invest in?

Larg: OR integration has now moved to the point where technology is very reliable, easy to install, and easy to use. Also, initial investment of newer OR integration systems such as Video-over-IP is not quite as expensive, which means many facilities can afford it, not just the best-funded ones.

Jerina: It’s kind of been driven by ease of use. The efficiency and the utilization that’s being gained by being able to centralize a lot of the control within one location. Also, with the history of this being a market and a product line that has been out for about 20 years now, it’s becoming more and more a standard of care – especially as you are starting to see more modalities.

Mann: OR integration is the only plausible way for a surgeon to perform minimally-invasive surgery, which has become a huge demand for many surgeons and patients due to its faster recovery time.  The technology behind surgery has advanced substantially throughout time.  It has arrived at the point where for surgeons would rather watch the surgery they are performing through a scope which leads to a HD monitor, rather than looking at the patient while operating. It is understood that every newly constructed/renovated OR will be specified with OR integration as a must, and a recent study reported that by the year 2016, 50 percent of all ORs will be fully integrated. Other technologies that are rapidly arising into the healthcare market are advancements in robots and their capabilities.

Stamper: The modularity of OR integration has made it viable for most hospitals. These solutions are modular in terms of functionality and size. They typically come with base functionality (such as video routing) and can be expanded upon based on the hospital’s unique needs (videoconferencing for teaching purposes, video/image capture for documentation purposes, etc.). In an era where EMR utilization is becoming more critical, hospitals may want to consider investing with integration vendors that are working closely with the EMR vendors to tie OR solutions to the patient’s chart.

SP: How will OR integration evolve with time?

Larg: OR integration is part of a rapidly moving technology curve that cannot be stopped. Over time, facilities can look forward to OR integration becoming even more affordable and reliable, with greater ease of installation.

Bream: Hospitals really need to be thinking that way. When they build these ORs, it’s not like they can change vendors the next day. They really need to be thinking five or 10 years out. I think where surgery is going is the continued evolution of bringing more and more technology into the OR, such as advanced imaging, advanced guidance systems, and advanced direct visualization. Just having those three different types of modalities. They all need to work together and will require more and more bandwith within the OR and on the hospital network. The biggest challenges hospitals need to address today is accepting the fact – like we do in our own homes with our own computers in our personal lives –  that these programs and technologies are all going to require more bandwith. We’re already the evolution from HD to 4K, and ultra-HD is standard. We’re also already seeing things come out with 8K. The amount of bandwith that the router and the software system needs to be able to accommodate is going to be tremendous. Hospitals need to be prepared as the surgeries develop and the technologies come into the OR to have an integration backbone that can handle that bandwith.

Stamper: The evolution of OR integration is constant. As new technologies are introduced into the OR, the integration system should be able to support them. Additionally, data is critical to decision making during surgery. The more access an OR has to information generated by hospital information systems (such as the EMR and PACS), the better equipped the surgical team is to make informed decisions that can ultimately affect patient outcomes. Ideally, the clinical team does not have to be tech-savvy in order to utilize these types of systems. Automation of room setup tasks (such as setting up video routes, importing patient data, pulling up PACS images, etc.) is essential. The less time circulating nurses have to spend interacting with the system, the more time they can spend focusing on the surgeon and the patient.

Jerina: The network approach is really going to be the true next step in the evolution of this technology. Being able to observe multiple ORs and the functionality of these rooms, not necessarily seeing every image that is coming from every source, but being able to see what systems are online, what systems are being used, being able to diagnose those systems from a central location, etc. Being able to provide a technology on a platform that most people are comfortable with is important.

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