Future Trends in MonitoringFuture Trends in Monitoring

Keith J Ruskin, MD

Associate Professor of Anesthesiology

Yale University School of Medicine

Future Trends in MonitoringFuture Trends in Monitoring

Smaller Cheaper (hopefully) Well-connected New interpretation of existing information

The Problem:The Problem:

Lots of data Very little recorded or

interpreted Operating rooms isolated Patients on the go

Smaller, CheaperSmaller, Cheaper

Smaller, Cheaper, ConnectedSmaller, Cheaper, Connected

Wireless Ethernet Telemetry Data collection

G3 wireless data service Remote evaluation,

treatment

BluetoothBluetooth

Wireless connection between personal devices

Short-range Mobile telephone gets

numbers from PIM Wireless data collection

and display, telemetry

Wireless EthernetWireless Ethernet

2 to 11 megabits per second ECRI: No interference with equipment Faster connections on the way Uses: Data collection, telemetry, clinical data

Wearable ComputingWearable Computing

Xybernaut: Pentium MMX, Win2K, 160mb RAM, 8 gb hard drive

Embedded InternetEmbedded Internet

Equipment can connect to the Internet Communicates with other devices, user,

manufacturer Quality assurance Technical support

The Connected MonitorThe Connected Monitor

Siemens UPTIME service Diagnostic information sent to repair center Technician can diagnose, fix problem

The Connected Record KeeperThe Connected Record Keeper

Vincenzo Lanza, MDOspedale Fatebenefratelli, Palermo, Sicily

Anesthesia record keeping software Designed to use Internet Multiple hospitals throughout Italy

Wireless Technology: The FutureWireless Technology: The Future

IBM Almaden “Digital Jewelry” Eyeglass-mounted camera Wireless connection Name, place recognition

Doctors Without WiresDoctors Without Wires

Medical devices share information Accurate drug administration

Improved communication between practitioners Medical Internet resources at point of care

The Future: Computing PowerThe Future: Computing Power

Data collection Data management Data interpretation

Subtle relationships Decision support systems

Data AcquisitionData Acquisition

Medical Information Bus (IEEE 1073) Standard for connecting up to 255 medical

devices Not all devices compatible Decreases errors in data capture

Automated Record Keeping: Automated Record Keeping: AdvantagesAdvantages

Automatically record information Improved accuracy and legibility More attention to important tasks?

Advantages (Continued)Advantages (Continued)

Information used for research, billing Provide evidence during legal disputes Quality Assurance

Scan records for critical incidents Anesthesia “black box?”

Record Keeping: Quality Record Keeping: Quality AssuranceAssurance

434 incidents found in 5,454 automated records 18 incidents (4.1%) reported voluntarily

Sanborn KV et al Anesthesiology 1996 Nov;85(5):977-987

Data Sharing: NowData Sharing: Now

Anesthesia Record Narcotic use Quality assurance

Operating room management Scheduling

Data Sharing: The FutureData Sharing: The Future

Medical record History, physical, laboratory data Physiologic data

Clinical information Policies and procedures, treatment protocols Communication

Clinical DatabasesClinical Databases

Data entered manually, acquired through ARK Benchmarking

Compare costs, sentinel events Knowledge discovery

Information buried in thousands of records

Decision Support SystemsDecision Support Systems

May improve patient care Recommended by IOM report Successful when integrated into workflow

Flowsheets Links to pertinent literature Corollary orders, treatment guidelines

Decision Support: Expert SystemsDecision Support: Expert Systems

Best when system broken down to simple variables

“If… then… else” rules Good for laboratory values, simple guidelines

Decision Support:Decision Support:Neural NetworksNeural Networks

Complex situations, multiple variables Emulate human neuronal connections Trained with sets of preexisting data Good for alarm analysis, physiologic monitoring

Intelligent AlarmsIntelligent Alarms

Proliferation of monitors and alarms Increasing levels of confusion Analysis of alarms to diagnosis breathing circuit More rapid diagnosis by anesthesia personnel

(Westenskow et al Anesthesiology 77:1074-1079)

Signal FusionSignal Fusion

Simultaneous acquisition from multiple sources Redundancy used to regenerate signals e.g., Heart rate from pulse oximeter, arterial line,

ECG Feldman JM et al. J Clin Monit 12:459

ConclusionsConclusions

Smaller, cheaper, faster Computers in the OR:

Automated record keeping Access to information Data integration and

management

Improved patient care