April 2, 2004

Anesthesiology pioneers new direction in telemedicine

Featured Image

Some anesthesiologists at VUMC now wear a portable computer that allows them to see a video of a patient’s operation and his or her heart rate, blood pressure or blood oxygen levels. Photo Illustration by Matt Gore

Anesthesiology pioneers new direction in telemedicine

James M. Berry, M.D., professor of Anesthesiology, wears goggles that serve as the viewer for the small computer that is attached to his waist. Photo by Dana Johnson

James M. Berry, M.D., professor of Anesthesiology, wears goggles that serve as the viewer for the small computer that is attached to his waist. Photo by Dana Johnson

Superman can see through walls and now anesthesiologists at Vanderbilt University Medical Center can too.

To achieve new levels of safety and efficiency, a team at Vanderbilt has created a program that shows anesthesiologists what is happening in each of the operating rooms they are covering.

It’s called Vigilance; it runs on a wearable computer. It’s the first program of its kind anywhere, the developers said.

Development of Vigilance is led by Michael S. Higgins, M.D., associate professor of Anesthesiology, Surgery and Biomedical Informatics and executive medical director of perioperative services.

“We’re on the cusp of something really exciting,” he said a few days before the system was put into operation. “The beauty is, I can know at a glance what’s going on in every room I’m covering.”

Anesthesiologists rove among operating rooms to supervise anesthesia for two to four patients at a time. They also evaluate patients before surgery and see to patients’ needs in the recovery room after surgery.

Vigilance lets these doctors see information about all their patients while moving around and performing work.

The software also analyzes patient data and sends alerts whenever a patient might be at risk for injury. Vigilance integrates information from multiple pre-existing sources: the operating room’s anesthesia machine, heart monitor and video cameras are connected to Vanderbilt’s secure data network, and surgical teams use in-room workstations to document care and vital signs.

“Seconds can count,” said James M. Berry, M.D., professor of Anesthesiology. “This technology extends our senses so we can virtually be with each patient we’re following.”

Among the various views in Vigilance, the main screen corresponding with an individual case is divided into quadrants featuring the electronic log of the case (with vital signs), the read-out from the patient’s heart monitor, highlights from the patient’s medical history, and live video images from the operating room. The user also can view checklists for management of acute events, and can pan and zoom the video cameras to get a better view of what is happening.

If a patient’s heart rate or blood pressure or blood oxygen level cross a particular threshold, the computer will sound and an alert will pop up on the screen. Through new voice-controlled mini-phones clipped to their breast pockets, anesthesiologists and their teams are able to be in touch with each other in seconds.

Vigilance also produces a dynamic electronic schedule for each OR suite, with information on where patients are in the system, which cases are running longer than expected, who is working with whom, and so on. OR managers can use this information as needed to reorder the schedule, work in emergency cases, and predict on the fly any needs for overtime staff.

On the back of a “fanny pack,” the anesthesiologist wears a small computer that is connected by radio signal to Vanderbilt’s secure wireless network.

Weighing only an ounce, the viewer for the computer perches at the left front of the user’s goggles to provide standard full-color desktop resolution: the visual impression is of a free-floating, transparent reflection the size of a desk-top monitor. Navigation of the program is via a touch-pad worn on the belt (voice-controlled navigation is in the works).

March 8 was opening day for the new minimally invasive surgery suite in Medical Center East (formerly a pediatric OR suite).

That same day, Vigilance went into operation in the suite. With this program, and with MCE’s surgical robotics capabilities, this operating room suite is one of the most technologically advanced in the nation, Higgins said. Vigilance will roll out to other Vanderbilt operating room suites within a year, he said.

Paul J. St. Jacques, M.D., assistant professor of Anesthesiology, points out that, until now, telemedicine has mostly concerned extending the work of providers to remote locations. With Vigilance, “We’re alone in combining telemedicine with informatics to improve patient safety and OR management,” he said.

With its program of postsurgical visits and interviews, the department of Anesthesiology has for years maintained a data base measuring clinical outcomes for all patients against the record of medical management in the OR. Higgins and his team will study the effect of Vigilance on both patient safety and operating room efficiency. The team will also inquire into using data from the system to predict adverse events.

The Vigilance team will test the system’s usefulness as a physician extender. According to St. Jacques, there is a worldwide shortage of anesthesiologists. Vanderbilt anesthesiologists currently cover up to three cases at a time, and billing compliance requires that they cover no more than four cases at a time.

As rollout of Vigilance proceeds, the team will test whether it makes sense to extend these limits.

“This has sort of snowballed in the last few weeks,” Higgins said. Congress is preparing to release research and development funding for a Department of Defense initiative called The Operating Room of the Future.

At the urging of a DOD official who recently came to Vanderbilt to see Vigilance, Higgins and his team have applied for first-year funding of $4 million to accelerate development of the program.

Berry heads main OR

“People here are progressive and innovative,” said Berry.

He came to VUMC last November from the University of Mississippi. “I understand innovation and I like technology,” he said, explaining why he found Vanderbilt to be a good fit.

Berry became a ham radio operator at age 12, and today he has seven computers networked in his home.

Berry studied medicine at the University of Texas in Houston and was trained there before spending 10 years on the school’s faculty.