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King CR, Fritz BA, Gregory SH, Budelier TP, Ben Abdallah A, Kronzer A, Helsten DL, Torres B, McKinnon SL, Tripathi S, Abdelhack M, Goswami S, Montes de Oca A, Mehta D, Valdez MA, Karanikolas E, Higo O, Kerby P, Henrichs B, Wildes TS, Politi MC, Abraham J, Avidan MS, Kannampallil T. Effect of Telemedicine Support for Intraoperative Anaesthesia Care on Postoperative Outcomes: The TECTONICS Randomised Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.21.24307593. [PMID: 38826207 PMCID: PMC11142280 DOI: 10.1101/2024.05.21.24307593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Novel applications of telemedicine can improve care quality and patient outcomes. Telemedicine for intraoperative decision support has not been rigorously studied. Methods This single centre randomised clinical trial ( clinicaltrials.gov NCT03923699 ) of unselected adult surgical patients was conducted between July 1, 2019 and January 31, 2023. Patients received usual care or decision support from a telemedicine service, the Anesthesiology Control Tower (ACT). The ACT provided real-time recommendations to intraoperative anaesthesia clinicians based on case reviews, machine-learning forecasting, and physiologic alerts. ORs were randomised 1:1. Co-primary outcomes of 30-day all-cause mortality, respiratory failure, acute kidney injury (AKI), and delirium were analysed as intention-to-treat. Results The trial completed planned enrolment with 71927 surgeries (35956 ACT; 35971 usual care). After multiple testing correction, there was no significant effect of the ACT vs. usual care on 30-day mortality [641/35956 (1.8%) vs 638/35971 (1.8%), risk difference 0.0% (95% CI -0.2% to 0.3%), p=0.96], respiratory failure [1089/34613 (3.1%) vs 1112/34619 (3.2%), risk difference -0.1% (95% CI -0.4% to 0.3%), p=0.96], AKI [2357/33897 (7%) vs 2391/33795 (7.1%), risk difference -0.1% (-0.6% to 0.4%), p=0.96], or delirium [1283/3928 (32.7%) vs 1279/3989 (32.1%), risk difference 0.6% (-2.0% to 3.2%), p=0.96]. There were no significant differences in secondary outcomes or in sensitivity analyses. Conclusions In this large RCT of a novel application of telemedicine-based remote monitoring and decision support using real-time alerts and case reviews, we found no significant differences in postoperative outcomes. Large-scale intraoperative telemedicine is feasible, and we suggest future avenues where it may be impactful.
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Feinstein M, Katz D, Demaria S, Hofer IS. Remote Monitoring and Artificial Intelligence: Outlook for 2050. Anesth Analg 2024; 138:350-357. [PMID: 38215713 PMCID: PMC10794024 DOI: 10.1213/ane.0000000000006712] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Remote monitoring and artificial intelligence will become common and intertwined in anesthesiology by 2050. In the intraoperative period, technology will lead to the development of integrated monitoring systems that will integrate multiple data streams and allow anesthesiologists to track patients more effectively. This will free up anesthesiologists to focus on more complex tasks, such as managing risk and making value-based decisions. This will also enable the continued integration of remote monitoring and control towers having profound effects on coverage and practice models. In the PACU and ICU, the technology will lead to the development of early warning systems that can identify patients who are at risk of complications, enabling early interventions and more proactive care. The integration of augmented reality will allow for better integration of diverse types of data and better decision-making. Postoperatively, the proliferation of wearable devices that can monitor patient vital signs and track their progress will allow patients to be discharged from the hospital sooner and receive care at home. This will require increased use of telemedicine, which will allow patients to consult with doctors remotely. All of these advances will require changes to legal and regulatory frameworks that will enable new workflows that are different from those familiar to today's providers.
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Affiliation(s)
- Max Feinstein
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Daniel Katz
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Samuel Demaria
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Ira S. Hofer
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
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Tensen E, Kuziemsky C, Jaspers MW, Peute LW. General Practitioners' Perspectives About Remote Dermatology Care During the COVID-19 Pandemic in the Netherlands: Questionnaire-Based Study. JMIR DERMATOLOGY 2023; 6:e46682. [PMID: 37632975 PMCID: PMC10335141 DOI: 10.2196/46682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic affected the delivery of primary care and stimulated the use of digital health solutions such as remote digital dermatology care. In the Netherlands, remote store-and-forward dermatology care was already integrated into Dutch general practice before the COVID-19 pandemic. However, it is unclear how general practitioners (GPs) experienced this existing digital dermatology care during the pandemic period. OBJECTIVE We investigated GPs' perspectives about facilitators and barriers related to store-and-forward digital dermatology care during the COVID-19 pandemic in the Netherlands, using a sociotechnical approach. METHODS In December 2021, a web-based questionnaire was distributed via email to approximately 3257 GPs who could perform a digital dermatology consultation and who had started a digital consultation (not necessarily dermatology) in the previous 2 years. The questionnaire consisted of general background questions, questions from a previously validated telemedicine service user satisfaction questionnaire, and newly added questions related to the pandemic and use of the digital dermatology service in general practice. The open-ended and free-text responses were analyzed for facilitators and barriers using content analysis, guided by an 8-dimensional sociotechnical model. RESULTS In total, 71 GPs completed the entire questionnaire, and 66 (93%) questionnaires were included in the data analysis. During the questionnaire distribution period, another national lockdown, social distancing, and stay-at-home mandates were announced; thus, GPs may have had increased workload and limited time to complete the questionnaire. Of the 66 responding GPs, 36 (55%) were female, 25 (38%) were aged 35-44 years, 33 (50%) were weekly platform users, 34 (52%) were working with the telemedicine organization for >5 years, 42 (64%) reported that they used the store-and-forward platform as often during as before the pandemic, 61 (92%) would use the platform again, 53 (80%) would recommend the platform to a colleague, and 10 (15%) used digital dermatology home consultation. Although GPs were generally satisfied with the digital dermatology service, platform, and telemedicine organization, they also experienced crucial barriers to the use of the service during the pandemic. These barriers were GPs' and patients' limited digital photography skills, costs and the lack of appropriate equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service. CONCLUSIONS Although remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs about the use of the service, barriers impeded the full potential of its use during the pandemic. Training is needed to improve the use of equipment and quality of (dermoscopy) images taken by GPs and to inform GPs in which circumstances they can or cannot use digital dermatology. Furthermore, the dermatology platform should be improved to also guide patients in taking photographs with sufficient quality.
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Affiliation(s)
- Esmée Tensen
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
- Ksyos Health Management Research, Amsterdam, Netherlands
| | | | - Monique W Jaspers
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
| | - Linda W Peute
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
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Lalor JP, Wu H, Mazor KM, Yu H. Evaluating the efficacy of NoteAid on EHR note comprehension among US Veterans through Amazon Mechanical Turk. Int J Med Inform 2023; 172:105006. [PMID: 36780789 PMCID: PMC9992155 DOI: 10.1016/j.ijmedinf.2023.105006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Low health literacy is a concern among US Veterans. In this study, we evaluated NoteAid, a system that provides lay definitions to medical jargon terms in EHR notes to help Veterans comprehend EHR notes. We expected that low initial scores for Veterans would be improved by using NoteAid. MATERIALS AND METHODS We recruited Veterans from the Amazon Mechanical Turk crowd work platform (MTurk). We also recruited non-Veterans from MTurk as a control group for comparison. We randomly split recruited MTurk Veteran participants into control and intervention groups. We recruited non-Veteran participants into mutually exclusive control or intervention tasks on the MTurk platform. We showed participants de-identified EHR notes and asked them to answer comprehension questions related to the notes. We provided participants in the intervention group with EHR note content processed with NoteAid, while NoteAid was not available for participants in the control group. RESULTS We recruited 94 Veterans and 181 non-Veterans. NoteAid leads to a significant improvement for non-Veterans but not for Veterans. Comparing Veterans recruited via MTurk with non-Veterans recruited via MTurk, we found that without NoteAid, Veterans have significantly higher raw scores than non-Veterans. This difference is not significant with NoteAid. DISCUSSION That Veterans outperform a comparable population of non-Veterans is a surprising outcome. Without NoteAid, scores on the test are already high for Veterans, therefore, minimizing the ability of an intervention such as NoteAid to improve performance. With regards to Veterans, understanding the health literacy of Veterans has been an open question. We show here that Veterans score higher than a comparable, non-Veteran population. CONCLUSION Veterans on MTurk do not see improved scores when using NoteAid, but they already score high on the test, significantly higher than non-Veterans. When evaluating NoteAid, population specifics need to be considered, as performance may vary across groups. Future work investigating the effectiveness of NoteAid on improving comprehension with local Veterans and developing a more difficult test to assess groups with higher health literacy is needed.
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Affiliation(s)
- John P Lalor
- Department of Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, US
| | - Hao Wu
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN, US
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, US; Meyers Primary Care Institute, University of Massachusetts Medical School/Reliant Medical Group/Fallon Health, Worcester, MA, US
| | - Hong Yu
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, US; College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, US; Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, MA, US.
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Abraham J, Meng A, Montes de Oca A, Politi M, Wildes T, Gregory S, Henrichs B, Kannampallil T, Avidan MS. An ethnographic study on the impact of a novel telemedicine-based support system in the operating room. J Am Med Inform Assoc 2022; 29:1919-1930. [PMID: 35985294 PMCID: PMC10161534 DOI: 10.1093/jamia/ocac138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The Anesthesiology Control Tower (ACT) for operating rooms (ORs) remotely assesses the progress of surgeries and provides real-time perioperative risk alerts, communicating risk mitigation recommendations to bedside clinicians. We aim to identify and map ACT-OR nonroutine events (NREs)-risk-inducing or risk-mitigating workflow deviations-and ascertain ACT's impact on clinical workflow and patient safety. MATERIALS AND METHODS We used ethnographic methods including shadowing ACT and OR clinicians during 83 surgeries, artifact collection, chart reviews for decision alerts sent to the OR, and 10 clinician interviews. We used hybrid thematic analysis informed by a human-factors systems-oriented approach to assess ACT's role and impact on safety, conducting content analysis to assess NREs. RESULTS Across 83 cases, 469 risk alerts were triggered, and the ACT sent 280 care recommendations to the OR. 135 NREs were observed. Critical factors facilitating ACT's role in supporting patient safety included providing backup support and offering a fresh-eye perspective on OR decisions. Factors impeding ACT included message timing and ACT and OR clinician cognitive lapses. Suggestions for improvement included tailoring ACT message content (structure, timing, presentation) and incorporating predictive analytics for advanced planning. DISCUSSION ACT served as a safety net with remote surveillance features and as a learning healthcare system with feedback/auditing features. Supporting strategies include adaptive coordination and harnessing clinician/patient support to improve ACT's sustainability. Study insights inform future intraoperative telemedicine design considerations to mitigate safety risks. CONCLUSION Incorporating similar remote technology enhancement into routine perioperative care could markedly improve safety and quality for millions of surgical patients.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Arianna Montes de Oca
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary Politi
- Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Troy Wildes
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephen Gregory
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Bernadette Henrichs
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Computer Science & Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Zhu Y, Sun X, Huang Y, Song X, Liu L, Feng L, Zhang Y. Application of multimodal identification technology in the innovative management operation department. Front Surg 2022; 9:964985. [PMID: 36211264 PMCID: PMC9537570 DOI: 10.3389/fsurg.2022.964985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background The optimization of surgical procedures and the management of surgical quality and safety have become the focus of attention of hospital managers. The application of multimodal identification technology in the innovative management mode of hospital operating department has made remarkable progress. Methods To investigate the effect of the upgraded multimodal identification technology on the innovative management of the operating department, 2,280 cases of laparoscopic surgery using traditional surgical management procedures from January to December 2019 before the management upgrade were set as the control group, and 2,350 laparoscopic surgeries with the upgraded multimodal identification management process from January to December 2020 were selected as the experimental group. The operating efficiency, material management efficiency, and patient experience and satisfaction of the two groups were investigated and compared. Results Compared with traditional procedures, the upgraded multimodal surgical management system significantly improves the efficiency of laparoscopic surgery and reduces surgical consumption and costs. In addition, the multimodal surgical information identification system significantly improves the surgical experience for patients undergoing laparoscopic surgery. Conclusion Application of multimodal identification technology improves the innovative management of operation department compared with traditional surgery management procedure.
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Affiliation(s)
- Yan Zhu
- Operating Room, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiaojiao Sun
- Operating Room, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yuemei Huang
- Operating Room, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiaochong Song
- Nose and Throat Department, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Li Liu
- Operating Room, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Laide Feng
- Operating Room, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yujian Zhang
- Head of the Surgical Department, the First Hospital of Qinhuangdao, Qinhuangdao, China
- Correspondence: Yujian Zhang
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