We live in a wireless world as consumers, but wireless monitoring in the perioperative setting and the ICU is not as advanced. How will it catch up?Do we really need to go wireless in the hospital and specifically in the perioperative setting? Intuitively it sounds like we should, because having wires to some extent is problematic for patients and there are questions about patient and clinician safety. We spend a lot of time untangling wires… but there are some risks associated with wireless technologies and cybersecurity, especially in medicine. One of the problems is an increased risk of hacking with wireless technologies, so we have to balance the benefits and risks, and issues related to cybersecurity will have to be resolved and mitigated before wireless monitoring gains widespread adoption in hospitals. Many hospitals are concerned with hacking so the imperative to wireless in medicine is less than before.
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In your editorials for Anaesthesia & Analgesia you have pointed out some of the challenges in implementing technology—financial, organisational, security, risk management, fatigue, information overload, cognitive saturation. Are you optimistic despite these challenges?I am very optimistic by nature as a person—I tend to be over-optimistic actually. There are multiple barriers to bringing new technology from the research arena into the clinical field. The main barrier is regulatory—in the U.S. the FDA regulations and in Europe the CE mark approval process; at the same time these barriers are here to protect the patient population. We don’t want innovation that will hurt more patients than help. The academic community needs to understand that we have to play the rules of the regulator if we want to bring innovation to the bedside.
The last barrier is cost. Hospitals and medical systems have to evaluate the return on investment of the technology. New technologies have to show value, either by purely decreasing hospital costs or by improving outcome. Overall the healthcare industry is moving this way, and there is more alignment between what the hospital wants and what the industry is developing.
What do you describe as digital quality improvement? Why do you say it’s not ready for widespread use (Gabel et al. 2016)?The concept of digital quality improvement is based on the use of digital technologies to improve quality of care. The most widely disseminated technology in hospitals is the electronic medical record (EMR), which is most often used for billing and quality improvement processes. The problem is that EMRs are not very user-friendly and it’s very difficult to change or design your own EMR to improve quality of care. Only 30% of hospitals have EMRs in the U.S. and Europe. When 70% of the EMR market is wide open, and industry knows hospitals are going to buy them, they don’t need to have a differentiator and take a risk to get more market share. A limited number of hospitals have this expertise, and many studies have been published in the last 5 years that use EMRs to change clinicians’ behaviour and improve quality. But most of these studies were conducted using custom-made anaesthesia information management systems and thus cannot be easily disseminated. Disruption will occur when clinical decision tools are made out of major vendors' EMRs so they can be disseminated from one hospital to the other.
Please explain your vision of a “data mart” to collect process and outcome metrics in real time about perioperative care (Cannesson et al. 2015). Will this enable a move from “big data” to “smart data”?When we are working in hospitals where the EMR is implemented we have data. The hospital leaders—the department chairs, CMOs, CEOs and chief quality officers— know the data is here, but very few places have actually accessed the data from the EMR. We understand that these data have a lot of value, because using the data we can display outcomes and look at the process of care—what we do well and what we don’t do so well. At UCLA, where we have 150 anaesthesiologists, we took the strategic decision to dedicate some of our medical
time and finances to have an IT team within the department to develop a data warehouse from the EMR. We have 1.5 FTE anaesthesiologists and 1 full-time engineer employed on the data warehouse.
We own the data, we have access and the expertise on how to handle data and share data with other departments. After 3-4 years of this development the department of anaesthesiology is becoming the hub for data sharing at the healthcare system level, and other departments are coming to us. It puts the department in a very strong position. There is no doubt that hospital leadership and clinicians will want more and more data to drive strategy and decide what to invest in.