Design of a Teleconsultation System for WebBased Surgical Medical Record

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Design of a Teleconsultation System for Web-Based
Surgical Medical Record
V. Lavrentyev, A. Rafiq, F. Tamariz, C. Boanca,
R. Merrell Virginia Commonwealth
University Richmond, Virginia rmerrell_at_mcvh-vcu.ed
u
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Statement of Problem

• Consultation in the midst of an operation has
  been difficult or impossible although the
  availability of consultation in this critical
  time in patient care has obvious benefit
• Consultants including teleconsultants must try to
  understand how the operation arrived at this
  juncture yet the surgeon seeking advice may have
  little time for review of the case or the
  procedure
• The consultant must rely upon the surgeons words
  and the image the surgeon provide in order to
  prepare a recommendation.

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SdCISRS Surgical data Collection, Integration,
Storage and Retrieval System

• Deconstruct surgical procedure for master clock
• Synchronize to master clock
• Integrates text entry, physiologic data sets, and
  video data streams
• Incorporates multiple layers of data resources
• - text
• - surgery image event
• - video review from master clock

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SdCISRS Integrates

• Audio-Visual capture and playback
• Electronic Medical Records (EMR)
• Electronic Op Notes
• Manual entry or-
• Automated voice dictation or-
• Audio voice capture
• Images
• Photos, Radiology

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Hardware Setup in Operating Room
Videoconference equipment tower
Monitor B
Laparoscopic equipment tower
Monitor A
Assistant
Operating Table
Surgical field
Laparoscopic Camera orientation
Network camera orientation
Primary Surgeon
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Camera Setup in Operating Room
Network camera orientation
Camera visual range
Laparoscopic Camera orientation
Surgical field
Operating Table
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Previous Work and Validation

• Laparoscopic cholecystectomy could be captured in
  software for subsequent accelerated quality
  review answering 21 questions in some 10 minutes
• SdCISRS system could capture open surgery event
  such that procedure could be evaluated in some
  ten minutes to answer 17 critical questions but
  needed a navigator technician
• SdCISRS in present configuration could be
  evaluated in about six minutes with a tutorial
  but without a technician
• Robotic camera control from a distance validated

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Hypothesis

• Teleconsultants can discern the course of an
  operation promptly using a web interface and join
  the virtual procedure with immediate ability to
  render advice

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Solution to be tested

• Use SdCISRS for a standard thyroidectomy
• Modify SdCISRS to stream to a web site interface
• Call consultant and state question find
  recurrent laryngeal nerve.
• Send consultant to the web site to quickly review
  the case to this point
• Ask consultant to return to live interaction ASAP
• Provide consultant with robotic camera access
• Interact and ask the question
• Survey the consultants for evaluation

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Teleconsultation Hardware Integration Architecture
Monitor
(local signal)
Polycom
Polycom
Monitor
Monitor
(remote signal)
(remote signal)
LAN
LAN
(10/100 Mbps)
(10/100 Mbps)
IP Internet Connection
Computer
(remote network
Camera signal)
Switch
Router
Surgeon
Synchronized
LAN
(10/100 Mbps)
CCD camera
Remote Consulting Location
Internet and SQL data base server
SdCISRS
IP Network
Camera
Operating Room
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Web-Based Surgical Medical Record Interface
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Web-Based Remote Camera Control Interface
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Results
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Results

• Consultants reached in Bucharest and Moscow with
  continuous connectivity
• Consultants spent about three minutes reviewing
  background and 45 minutes of surgical procedure
• Consultants provided confident answers in
  agreement with operating surgeon in all cases

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Conclusions

• The isolation and fragmentation of surgical
  events can be brought into sharp focus and clear
  light by comprehensive data collection and event
  capture
• The captured data may be
• shared in real-time by consultants or command and
  control personnel
• Studied off time with subsequent real time
  consultation
• Created in part by the consultant in telepresence
  operating a camera
• The system is robust, reliable and highly
  accurate