Surgical Telemedicine: Projection of Surgical Expertise in the WWAMI Region

A collaborative research project with UW Telemedicine, UW Surgery and Biorobotics Lab, UWMC, and Harbor Surgical Associates, and Gray’s Harbor Community Hospital in Aberdeen, WA.

Abstract

Telemedicine refers to the use of information-based technologies such as videoteleconference, computer, and communications systems, to project healthcare and specialty expertise across geographic distances. In the Pacific Northwest, concentration of subspecialty expertise- especially surgical expertise- in the only medical school servicing the WWAMI region offers a compelling opportunity for developing a surgical telemedicine program. There is increasing interest at a Congressional level in such methods of standardizing care, primarily as a means of improving patient safety.

Surgical disorders frequently require urgent intervention before a complete diagnostic evaluation can be done. Unexpected findings in the OR especially in critically ill or fragile patients often lead the surgeon to seek consultation. Technology limitations delay and limit the value of this consultation, frequently until after irrevocable decisions have been made. We propose a surgical telementoring program that addresses these issues, facilitating timely consultation on all aspects of the patient data and projecting specialty expertise to the hand of the remote surgeon. Such a system has potential for substantially improving patient outcomes and providing patient-specific education to our regional surgical community.

Despite the perceived benefits of such a system, many issues need to be resolved to create the basis for sustained, routine, and facile teleconsultation and telementoring. These include procedural issues and etiquette:

(*) Confidentiality
(*) Consent
(*) Security and safety
(*) Cost for services, set-up, maintenance, and etc.
(*) Electronic protocol for medical documents
(*) Responsibility
(*) Liability
(*) Patients' preference: teleservices vs in-person services

and engineering issues:

(*) Communication/networking : latency due to time delay, bandwidth, traffic prioritization
(*) Efficient shared surgery environment for cooperation and telecollaboration
(*) Device optimization in both master and slave : high bandwidth, high fidelity, movement scale and reasonable force level
(*) 3D visualization with high update rate
(*) Delay: effects of visual and haptic delay in bidirectional force (haptic) feedback
(*) Dynamic overlay feasibility of digital imaging data (MRI, CT, etc.) without performance degradation
(*) Safety and durability of equipment

Our research partner, Computer Motion, Inc. (http://www.computermotion.com), has the first device (Socrates) to be cleared by the FDA in the newly created category of Robotic Telemedicine Devices. SocratesTM allows collaboration using audio and video conferencing, shared control of an endoscopic camera (when implemented with the Aesop Robotic Camera Control system), and video annotation of the surgical endoscopic image in the OR. It is an ideal platform for this project. In collaboration with Cara Towle and Dr. Tom Norris of the UW Office of Telemedicine, we have secured financial support for installation of two Socrates systems with appropriate telemedicine links for a one year trial program between Gray’s Harbor Community Hospital in Aberdeen, and the University of Washington Medical Center.

Drs. Juris Macs, Akbar Ali, and Brent Rowe of Harbor Surgical Associates and members of the hospital OR leadership at Harbor Community Hospital will be our partners in this research project. We have developed a series of specific goals to demonstrate feasibility, utility, and economic viability of such a system and will incorporated them in the framework of a 1 year clinical trial. Data on real-time, bedside surgical teleconsultation from this trial will include technical issues of connectivity, etiquette for surgical teleconsultation, patient factors including patient notification and consent, cost-benefit calculations to both patient and referring physician, and finally ancillary benefits including educational benefits, to the UW surgeons, residents, and to the Academic Medical Center. After analysis, if these data support measurable benefit from the projection of surgical teleconsultation to a regional partner institution, they will be used to gather support for a wider Surgical Telemedicine consortium, as illustrated in Figure 1. We hope to take this project to the Academic Medical Center, the University leadership, the WWAMI state legislatures, and to the federal government as a means of improving quality and reducing cost through projection of surgical specialty expertise in the WWAMI region.

Proposed Phased Surgical Telemedicine Consortium

(*) Note: Most of the BRL publications are available on-line in a PDF format. You may used the publication's reference number as a link to the individual manuscript.