Computerized Operating Room Reports

September 21, 2006
Douglas E. Ott, MD, MPA
Douglas E. Ott, MD, MPA

,
Larry Demco, MD
Larry Demco, MD

OBGYN.net Conference CoverageFrom World Congress on Gynecologic Endoscopy and The 1st Annual Meeting of the Israel Society of Gynecological Endoscopy, 2000

Dr. Larry Demco: "We’re at the World Congress of Endoscopy here in Tel Aviv, Israel and I’d like to interview now Dr. Yona Tadir who’s one of the Chairpersons for the Conference. He has brought forth an interesting concept of a system now developed for us to dictate and insert pictures of our operations all in the same report which makes documentation so much better. Let us ask the doctor here to explain his system and how it works."

Dr. Tadir: "For many years there is an ongoing controversy about the optimal documentation of surgery and especially endoscopic surgery in which now with video cameras, it’s not only the surgeon which is responsible for procedures that he did endoscopically. Now the text report is very different from one person to another, some people do a more detailed one and some are doing less detailed. There is another tendency for the last ten years or so to use videocassettes in which they record the entire procedure. This created a problem or several problems; one of them is just storing so many videocassettes which people can’t do anymore. It’s also very difficult to go through all of these two hour records and see the one or two shots that are important, and that’s why people really stopped doing that and there is also another issue which is the legal issue. Some doctors are not so confident about what they did and they prefer not to make a documentation which may then later serve as a witness against them in court, and as such they stopped doing that because editing the video is even worse from the legal point of view. So that’s why there is really an ongoing controversy about that. Here we came with a new concept in which the camera is connected to a computer system that can instantly take any number of exposures during the procedure. All that the doctor has to do is just press a foot pedal, the computer system is showing him the picture and there is no stopping for even a second of the procedure. At the end of the procedure, the report comes with several representative photos of the entire procedure, and there is always the question of the text that should be attached to that. The surgeon has a microphone connected to his mask and anytime that he says something during the procedure that he wants to record, he can. This can also be recorded by the computer, and at the end of the procedure he can give that to the secretary and get an instant report with representative photos with the text that he wants to add into it. We are working now on something else, which will be a fixed template that the doctor can use in a very detailed form the way that he wants his reports to look. He can use that in order to create a tailored report for each procedure be it diagnostic or an operative procedure, and we truly believe that this is going to be the ultimate report for endoscopic procedures. I’m saying endoscopic because endoscopic procedures are being done in any case through the monitor with a TV camera so there is no need for any additional system just to hook that to the camera. Now this can be used for patient records, for archive, for sending it to the referral physician, to billing, or to any kind of electronic computer system that can go over the net. We really believe that this is going to be the ultimate approach, and once and for all stop the controversy of which system we’re going to use in order to document our procedures."

Dr. Larry Demco: "I was just wondering is this system just for one operating room or can all the operating rooms in the hospital be connected to this system?"

Dr. Tadir: "First of all, I must say even though I am not a sales rep for the company, it’s going to be a relatively cheap system that is connected to any endoscopic camera. So as many endoscopic cameras that you have and as many systems that you are going to use, probably in the future, it can be connected to one main station but computers are becoming so cheap now that the system will be hooked to every endo camera."

Dr. Larry Demco: "Is the system currently able to take short videos that you could have a 10- or a 15-second video as part of the record?"

Dr. Tadir: "Yes, that’s a very good question. The printed report is going to be on the still photos but if the surgeon wants to add to his electronic report several shots of an ongoing procedure of several seconds, it will be possible to put inserts in. Then if you want to show that or to use that for further consultation with a patient, yes, it will be possible. There is also another feature; this camera is now under development for having a special ability to detect abnormal tissue by using digital filters. This will allow the surgeon to define based on tissue out of fluorescence and probably also in the few cell induced fluorescence, and I assume not too many people know what induced fluorescence is. If you put some kind of a photo sensitizer that is being absorbed by different tissues differently, this is induced fluorescence. But also, the different tissue has different optical signature and this camera will be able to detect, lets say, connected to a colposcope, you’ll be able to see dysplastic tissue based on the optical characteristic of the tissue. So it will be upgraded in the future to something which is going to be much more attractive than just accommodation."

Dr. Larry Demco: "That’s a specific interest to myself because when I operate on patients being awake, and I see areas of endometriosis on one side of the pelvis that’s not painful and to look at the opposite side that is painful, I was always curious to see if we can somehow detect by a filter or optical means to be able to tell us which side would be painful and which side would not. So I’m looking forward to that future in that development and technology. One further question about the system, is it specific for all surgeons or is there specific programs that we can have for doctors who are dealing, for example, in oncological surgery?"

Dr. Tadir: "No, it’s not specific to anything. You can use the procedure not only in gynecology but it can be used for any other endoscopic procedure be it cystoscopy, arthroscopy, or anything else connected to any camera. Whatever you do with the camera and the monitor can be hooked and can be documented."

Dr. Larry Demco: "Many of us use predictated templates for our operating where we’d add specific things, does this system take in that possibility?"

Dr. Tadir: "Sure, within the next few weeks we are going to have the system we’re working on three fixed templates for gynecology. For laparoscopy, hysteroscopy and colposcopy this will be fixed but with adjustment to each. As we know, every physician has his own way of writing reports so once we have the pull down menu ready, then the text can be adjusted or tailored by each surgeon in the way that he is used to doing. Later on in the future, we are going to have it for other procedures as well."

Dr. Larry Demco: "You mentioned that we can dictate, but will the system have voice recognition for automatic dictation?"

Dr. Tadir: "There are two features, one is voice activation and the other one is voice recognition. Voice activation is ready now and the surgeon can activate the system simply by voice. In the future, and not in the too far off future, because there is a system now for voice recognition that the surgeon can teach the system his language, he can dictate that during the procedure and it’s a win-win situation. It’s not only that you’re going to get a much better operative report but you’re also going to save time and time is money."

Dr. Larry Demco: "I thank you very much for telling us a little about this system. I understand that it’s going to be launched in the United States very shortly, and we’ll be looking forward to that. Thank you very much."