8 Future Technology Trends in the OR

How hands-free AV control will revolutionize medicine and improve patient outcomes.

The “internet of things” is a fascinating way to envision the future.  We are in the middle of witnessing a significant change in computing where every electronic device is becoming internet aware.  Having dozens of sensors and devices around our homes, cars and work are driving endless amounts of data and inspiring a new generation of innovators.

While the development of new smartphone and tablet technology commands a lot of attention, behind the scenes we are seeing things like internet enabled toothbrushes and basketballs test the limits on how much extra value-add we need in our lives.

It is no secret that consumerization is driving technology into the workplace at an unprecedented pace.  In the healthcare industry you don’t have to look much further than CES (Consumer Electronics Show) to get a sense where things are headed.

Looking specifically at the OR environment, it is interesting to look at how wireless AV systems and gesture-controlled technologies will revolutionize medicine and improve patient outcomes. Surgeons will be able to view images and other content as well as seamlessly communicate in real-time with experts around the globe.

Here are 8 trends growing rapidly in the consumer space and I predict will find their way into the OR in the next few years:

1. Surface computing – Integrating new technology into the OR can be a challenge for integrators.  The lack of space, flexibility and power make this a unique environment.  Surface computing takes advantage of super thin, strong and bendable glass and will replace walls, counters and even floors with viewable touch screens to interact with content.

2. Wearable computing – If having a computer on every surface isn’t enough, having technology woven directly into clothing and shoes can provide an even more intimate way to communicate and access information.  This moves with the medical personnel and allows a more fluid interaction with technology.

3. Google Glasses – A technology that will reach the consumer market in late 2013 will have an almost immediate impact in healthcare.  Almost in the same way that iPads proliferated healthcare, I predict that transparent wearable glasses will provide surgeons with the latest research, techniques, and imagery in real-time.  The ability to video tape and narrate from the eyes of the doctor and share seamlessly will revolutionize education and training.

4. Motion – With sensors built into clothing, surgical equipment and even the patient, new levels of insight into specific procedures and outcomes can be analyzed.  Best practices may be multidimensional in the future – going far beyond text books and lectures.  This also introduces the possibility of robotics – but that is too far out in time for this article.

5. Voice – A key technology in a hands-free environment is voice.  With improvements in natural speech recognition, as well as expanding languages and accents, the OR will become an environment that can adapt quickly to different scenarios.

6. Gesture – The OR is an environment where gestures play a huge roll.  Much of the communication between the medical team is of a non-verbal nature.  Technology has improved significantly in recent years understanding hand, body and eye movements.  Having sensors that are built into surgical devices and monitoring equipment that better understand verbal and non-verbal communication will improve automation in the OR.

7. Eye movement – It is rumored that eye tracking technology will be introduced in mid-March into the bestselling smartphone in the world.  Augmenting voice and gesture recognition, eye tracking technology can drive new levels of sophistication – even in the most focused, hands-on moments of a surgery.

8. Location tracking – Similar to how GPS technology works outdoors, indoor location tracking can be used in a number of ways in the OR.  Understanding who is in the OR and when will ensure that accurate scheduling is achieved, improving patient safety. 

Integrating these technologies in a safe, secure and frictionless way will provide levels of automation and measurement never before achieved.  Studying OR outcomes, combined with “big data” analytics enabled by these hands-free innovations, will make today’s healthcare professionals better and will revolutionize medical school going forward.

In the end, patient safety and improved outcomes are the primary objective. Several of these technologies are likely to make a remarkable difference in the efficiency and effectiveness of the OR in the next few years.

Replacing Drywall with Knowledge

The latest innovation in healthcare involves the use of walls and surfaces as computing devices.  It is a natural extension to a digital signage solution and improves communication while contributing to safer patient outcomes.  Located in a number of different healthcare facilities including hospital operating rooms, education centers and research labs.

Walls of Knowledge provide Integrators excellent opportunity around the consulting, design, hardware sales and installation, software integration as well as ongoing maintenance and professional services.  These are unique and highly customized solutions that automatically gather critical information from diverse systems, synchronize it with people and processes, and present it on rich displays.

The integrated displays have a measurable impact on the work of operating room teams and medical education professionals.  Pilots are currently underway across the world with numerous case studies available from the likes of Columbia University Medical Center, Weill Cornell Medical Center and Saint Luke’s Healthcare in Kansas City.

A major benefit to a Wall of Knowledge is Telementoring.  Medical specialists are sharing knowledge with one another across the world through virtual tools. With advanced audio, video and IT capabilities, the operating room has become a virtual classroom.  Additionally, with permission and web access, viewers not only see and hear a surgeon at work, but also observe the operation in context.

Remote viewers see all information on the patient and procedure as it appears on a dashboard during surgery. Other information, such as PACS, pathology specimens, and lab reports, are also on display for the remote viewer.

How to sell a Wall of Knowledge

The solution drives better outcomes by integrating information from critical clinical processes in the operating room, enhancing overall workflow, while focusing on patient-centered care.  It provides the surgical team with a complete picture of what’s going on in the operating room precisely as its happening.  Among the innovations involved, it automates the “safe surgery checklists” prescribed by the World Health Organization, the Joint Commission, and other groups.

Most software solutions are structured in a dashboard format, helping to reduce surgical errors and complications by helping team members to document compliance with protocols, and confirming the correct patient, procedure and site prior to surgery.  The Wall of Knowledge will ensure pre-procedure verifications are documented and the Time Out checklist is completed.

Other benefits of this solution include improving awareness and communication in the operating room, increasing the safety of medications, and reducing the risk of infections.  By facilitating teamwork among caregivers, it ensures that information is managed in real-time, properly handed off and staff is accounted for as they enter and leave the environment.

Designing the Solution

The technology must be central to the action, accessible, but not intrusive to the high-paced environment.   The user experience must be focused on ease of use, while acknowledging that healthcare professionals using the system will range from early adopters to laggards.  The audio visual system will need to support modern healthcare facilities and be compliant for this ecosystem.  Operating rooms vary considerably from facility to facility.  An Integrator will be able to assess the environment and recommend the best solution.

Quality of the AV hardware is very important for displaying surgical and endoscopic video, pathology specimen, PACS, and other images as well as providing telecommunication links between the operating room and other areas.  The Wall of Knowledge should support one-touch control for managing monitors, lighting, cameras, temperature, and other environmental settings as well.

Increasing the efficiency of your healthcare customer will yield more profitable reimbursements and lead to higher patient and staff satisfaction. 

Walls of Knowledge are a true win-win for the Integrator and healthcare decision maker.  The complexity of the solution, combined with the level of design, consulting and integration will drive projects that are longer term, revenue intensive and highly profitable.

Why Mobility Could One Day Save Your Life (and Business)

By: Jay McBain

One of the most exciting areas in healthcare is the emergence of new telemedicine technologies.  The use of long-distance video and data hookups linking remote community hospitals with specialists in large centers is saving lives.  In fact, recent studies have shown that telemedicine can provide the same level of care as having everyone in the same room.

New technologies are being introduced that are significantly improving the quantity and quality of patient outcomes.  Adding to this, a new level of specialization is emerging, allowing a much broader application of these technologies:

Telecardiology                                  Telepsychiatry                                Teleradiology

Telepathology                                   Teledermatology                             Teledentistry

Telesurgery                                       Teletrauma                                     Telerehabilitation

Telepharmacy                                   Telenursing                                     Telestroke

Here are some key trends driving new possibilities and challenges in remote healthcare:

Mobility – We are currently experiencing the first phase of pervasive computing, where billions of people will be leveraging trillions of devices and sensors.  The surge of smartphones and tablets, combined with the saturation of laptops, is driving a global phenomenon where society is connected all the time, regardless of location.  Thousands of new mobility products are emerging such as the connected automobile, refrigerators, glass surfaces right down to WiFi enabled toothbrushes.  Hundreds of WiFi enabled medical device categories have also emerged from simple weight scales, blood pressure monitors to more complex remote diagnostic equipment.

Ubiquitous Connectivity – One of the main limitations of early telemedicine solutions was the cost/complexity of obtaining quality bandwidth.  According to the World Bank, over 75% of the world’s population now has access to cell phones with over 6 billion devices now in use.  These cell networks are steadily improving and the majority of them now support seamless video across broadband level speeds.

Cloud Computing – The transition of key healthcare applications into the cloud has been growing steadily over the past few years.  It got a relatively slow start due to factors such as country specific regulations, fears of patient record security as well as industry demographics.  Applications are becoming smarter as more critical information is shared and more accessible as mobility and connectivity are driving more use cases.

Demographics – Doctors entering the system now, the so-called “millennials”, were born into the PC generation and have likely carried a mobile phone for over half their lives.  In fact, a recent study reported 70% of younger doctors report they use their smartphone clinically.  Healthcare will continue the virtual trend as baby boomer doctors retire and new generations of technology inclined doctors take their place. 

Consumerization – With the growth of consumer devices for self-diagnosis and treatment, combined with the proliferation of personal social networks, a number of potential pitfalls could arise in delivering telemedicine.  Imagine diagnosing a patient in 140 characters over Twitter or an impromptu Skype session dealing with sensitive medical issues.  While this may seem insecure and ineffective, consumer behavior may demand the health industry explore these mediums.

At the speed these new technologies are driving telemedicine, there remains significant barriers to adoption in emergency and critical care units. One major barrier is the regulatory challenges related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities. 

Another barrier is the lack of acceptance and reimbursement by government payers and some commercial insurance carriers creating a major financial barrier, which places the investment burden squarely upon the hospital or healthcare system.  Finally, cultural barriers exist driving a lack of desire of some doctors to adapt clinical paradigms for telemedicine applications.

How do Technology Providers take advantage of these trends?

The future of healthcare will be very personal and in real-time.  Facilities will need to be connected with the latest video, audio and networking technologies to enable specialists to connect with their patients immediately and deliver the quality necessary to improve outcomes. 

Health professionals will need to be armed with these tools regardless of their location.  Telemedicine will evolve from point to point connections across facilities to person to person across pervasive devices.  The doctor may be in his car while the patient could be out in the middle of a farm field – with other specialists and local emergency response teams all listening in.

The opportunities around consulting, integration, technology deployment, remote management, industry compliance management and service will grow significantly over the next 5 years.  Understanding industry and technology trends and being able to deliver the services, hardware and software to enable specialized solutions will be the key.

Will HDBaseT Replace HDMI in Healthcare?

HDBaseT is poised to replace HDMI as the new A/V/control standard in clinics, hospitals and other healthcare environments.

HDBaseT technology runs over standard Cat5e/6 cable and implements something it calls 5Play, a feature-set that converges full uncompressed HD video, audio, 100BaseT Ethernet, and various control signals. Perhaps the most compelling difference is that it transmits up to 100W of power - enough to drive a 37-inch TV. The inclusion of power within the feature set is particularly applicable to the healthcare market where installers are often burdened by the requirement for proximity to an outlet.

Another benefit is that it can extend up to 100 meters passively. HDBaseT has the bandwidth to support the highest video resolutions such as full HD 1080p as well as 3D and 2Kx4K formats. It is promising to be the first to provide all-in-one connectivity, making it possible for a single-connector TV to receive power, video/audio, internet, and control signals from the same cable.

Without jumping into too much of a technical discussion, HDBaseT is able to send much more information than HDMI over a set of 8 wires within a standard Cat5e or Cat6 cable because it uses much lower frequency modulated packets. These are not IP packets like you find in Ethernet and are not subjected to typical electromagnetic interference. Thus, the cables can run alongside medical devices and other infrastructure and not suffer signal degradation.

5Play – The future of networking in healthcare?

HDBaseT's protocol allows you to network your displays and other sources, similar to a home data network. The HDBaseT Alliance organization calls this 5Play and they demonstrated healthcare specific applications at the HIMSS (Healthcare Information & Management Systems) conference in February.  Future capabilities include diagnostic and testing machines, creating a new method of testing patients where the technician doesn't have to be in the same room.  This could be a breakthrough in healthcare and increase the efficiency and safety of medical professionals.

HDBaseT healthcare use cases could include display installations in patient rooms, lobbies, triage, waiting areas and more. HDBaseT can also link medical imaging devices such as CT and X-ray scanners to remote monitors, reducing technicians’ exposure to radiation.

The AV industry has become weary of new standards, many of them never hitting the market. HDBaseT took special precautions by founding the group with heavyweights like LG, Samsung, Valens Semiconductor and Sony Pictures and waited to announce and promote the new standard until after the HDBaseT 1.0 specification was finished. Work is already underway on 2.0, but 1.0 is announced and available with products supporting it out of the gate.

HDBaseT does bring a true standard - a unified and simplified protocol - to the market, not just a new cable.

What's Next?

Today, there is a growing abundance of content in the healthcare facility, including video, images and data. As HDTVs and other devices proliferate throughout the industry, the amount of content, and the ability to move it around the facility, becomes more complicated for integrators. The next stage in networking is the ability to control and distribute this content securely and be able to manage it effectively.

HDBaseT does have some weaknesses and needs to planned and managed carefully. Since HDBaseT is IP-based and carries a lot of data intensive information, it can easily overrun network traffic. It is important to isolate the data stream from the video stream which may mean running a local network for AV signals with a bridge to a data network for control and management. Expect commercial level products to come to market that have separate ports for signal transport and data/control transport.  Length of cable is still important for image quality and some legacy clinics and hospitals have challenging cabling environments.

Given the pros and cons, HDBaseT technology is well-positioned to offer a simple solution to meet the healthcare industry’s growing needs and will likely be an important consideration in the years to come.

The Future of Healthcare Runs on an iPad

The iPad has taken the healthcare industry by storm. In only 20 months since its launch, it has spread virally throughout clinics and hospitals in the US as well as around the world.








In fact, Tim Cook, the new CEO of Apple recently stated “over 80 percent of the top hospitals in the US are now testing or piloting iPad.” Other studies have shown that over a third of US doctors have fully implemented the iPad with another third are very close behind. These are impressive numbers for an industry known to be a laggard when it comes to technology.






With over 300 EMR companies scrambling to build mobile versions of their software as well as stimulus from governments around the world, this trend will undoubtedly continue. In the US, a free EMR app (native to the iPad) was recently certified for “Meaningful Use” allowing doctors who store and track patient data access to $44,000 in federal incentives.






EMR adoption still faces numerous challenges around the world including patient privacy, data security, resistance to change as well as cost of initial conversion of records. Recent versions of the iPad have delivered improved security such as more robust password handling and remote wipe. This has allowed Integrators to support the device in full HIPAA and HITECH compliant projects.






Experts are recommending an optimal security solution that is server based architecture with the iPad as a dumb terminal. Ensuring that the wireless access is securely encrypted and protected and patient records do not reside anywhere but on the server. Over time this will transition to the cloud, but major organizations are still building back-office infrastructure for compliance purposes.








iPads are also being used in other creative places in healthcare. For patients, they can act as a source of entertainment or distraction, providing a way for those who are bed-bound to browse the web, engage in social media, play games or watch a movie comfortably and privately. Doctors can use them to consult more easily while out of office as patient records are more convenient and accessible. Doctors are also using them as bedside education tools as well as registration and self-triage.






Integrators in the AV industry already have numerous solutions built on the iPad and these can now be ported into the healthcare industry. With over a million of these devices in healthcare organizations already, now is the time to deploy solutions that can make patient care more effective and productive.






Popular solutions include panels in the clinic room (projecting from the iPad) to self-service kiosks for registration and self-triage. The opportunities are endless for driving better patient outcomes as well as lowering the cost of providing healthcare. There is now a dedicated healthcare App store on iTunes that is quietly attracting thousands of developers.






Another trend following iPad adoption in healthcare is the increased use of smartphones. A recent study looking at doctors and residents found that 85% owned a smartphone and 56% of them reported using it in clinical practice. Age played a major factor with 70% of residents using their smartphone clinically, while only 39% of doctors practicing for more than 15 years reported the same.






For both iPads and smartphones, there is a significant difference between healthcare specialties. For example, only 52% of younger surgeons reported using their smartphone clinically, despite an ownership rate of 98%.






Integrators in the healthcare industry can expect the trend of consumerization to accelerate into the future. Healthcare professionals will continue to demand greater levels of integration with all of the technology in the environment, from medical devices and equipment, printers, scanners, computers and AV equipment.






This is an opportunity for Integrators to drive solutions that include a unique packaging of hardware, software and services.

Bring Your Own Device & Apps: The Consumerization of Healthcare Is Happening Now

If you haven’t been following the debate on BYOD – Bring Your Own Device – you soon will.  The debate was fueled by the rapid and surprising success of $300 Netbooks four years ago. IT providers as well as AV integrators were successful, for the most part, in keeping those consumer devices off the corporate network due to lack of security, manageability and weak horsepower.

Fast forward four years and the healthcare environment is changing significantly. Connectivity is moving towards ubiquity, the cloud business model is real and the tablet was released in 2009 that forever changed the hardware landscape.

The tablet market is growing at a dizzying pace. Gartner is calling for 294 million units worldwide within four years, while Forrester is expecting 82 Million of them in the U.S. alone by 2015.  Apple commands almost 90% share, but more than 125 other tablets have come to market by mid-2011.  In fact, recent studies have shown a quarter of all physicians in the US already using the iPad, with a commanding 79% preferring that over other tablet brands.

Some of the early limitations of tablets, like the Netbooks before them, included lack of security, manageability and compatibility.  Newer devices have improved and now offer PKI authentication certificates, biometrics and remote wipe capabilities making them acceptable to many health organizations.  One lesser known limitation is if the device is subject to a legal hold – the health organization is in a legal dispute of some kind – the end user will lose the device for an extended and unpredictable amount of time.

The story isn’t just about integrating and managing secondary and tertiary devices from the consumer market.  Industry experts as well as futurists are calling for more devices, perhaps dozens per individual, gaining access to each medical office.

What is BYOA?

The consumerization of IT isn’t just about hardware – we are at the beginning of another interesting trend:  BYOA – Bring Your Own App.  Some have predicted that the explosion of over 1 million apps may spell the end of the traditional desktop internet.  While that is likely premature, apps could provide some real advantages in the healthcare industry including cutting down on training time, allowing health professionals to feel more invested, and replacing costly software licensing with cheaper apps.

However, there are several issues with BOA including:

• ·         Compliance and regulations with regards to HIPAA, HITECH and others
• ·         Security of the data on public clouds and intermixing with consumer data
• ·         Portability of the output – getting the data back if something happens to company
• ·         Information fragmentation – decentralized data across hundreds of data centers and apps

We are already seeing examples where corporate communication has been fragmented into public clouds including personal email, LinkedIn, Facebook, Google+, Twitter, and a growing number of other social media tools.  As other app categories get more popular, such as practice management, human resources and expense reporting, integrators and IT personnel will be challenged with supporting this rapidly growing ecosystem.

It is an opportunity

IT and AV professionals will be crucial in managing this complexity of dozens of devices and perhaps hundreds of apps per person.  The necessity to collect and securely display the output of these applications pervasively throughout the health environment will be critical.  New services and practices will evolve that focus on enhanced security layers, compliance, data organization, data protection and vendor management in this increasingly fragmented world.  New revenue models will also evolve including micropayments by device and app – in many cases, pennies per month per individual.

To be effective in managing this potential chaos and, more importantly, profiting from it, integrators will need to have built a solid business foundation with predictable and repeatable business workflows.  Without “off the shelf” solutions, the level of complexity as well as the new micro-financial model could add significant risk.

The Future: Pervasive Computing in Healthcare

Jay McBain, Senior Vice President, Autotask Corporation

Much of the focus around the modernization of the healthcare facility has been around software, specifically the impact of Electronic Health Records, as well as government regulation, legislation, and stimulus funding. There is another trend that may have even a larger impact for Integrators and Solution Providers longer term: the explosion of internet-connected devices in delivering better healthcare outcomes.

Last year represented a tipping point for how technology will be used from a personal standpoint, in business, as well as governments and healthcare. The convergence of ubiquitous connectivity and cloud computing has one simple and very exciting output: the explosion of hardware gadgets we will use to access it anywhere and anytime.

On the hardware side, the following milestones have given strength to the pervasive computing argument:

1. The evolution of the cell phone into an all-in-one multimedia, gaming, social media, content and business access device.
2. The Netbook craze a few years ago, convincing millions of users that an inexpensive secondary or tertiary device is useful given the right environment.
3. The Tablet, namely the iPad, with sales of 15 million units over the first few months and projections of 50 million this year.

In the healthcare environment, whether at a hospital, clinic or home, almost every device that is plugged into electricity or running on battery power is now being offered (or being planned) with a WiFi option. It is becoming obvious that the health record will evolve to accept inputs beyond the keyboard.

Wikipedia currently defines 46 major categories for medical devices – and growing. In an average clinic, the examination room will likely have 20 devices interconnected to the personal health record within 5 years. From simple blood pressure units to complex anesthesia units, the amount of data collected will grow exponentially.

For the Integrator or Solution Provider, this presents both opportunities and challenges. As the amount of data grows, as will the requirement to monitor and share it both visually as well as auditorily. Even the smallest clinic will need audio/video installations in every room as well as the lobby for registration and self-triage. Making sure these 20 devices interoperate, are compliant with legislation such as HIPAA and HITECH, as well as secure and remotely manageable provide incredible new opportunity.

One of the challenges will be managing the consumerization of technology. With the growth of home healthcare, as well as rapidly shrinking barriers to entry, each device category may have dozens, if not hundreds, of choices for the doctor, administrator or consumer. Imagine the aisles at your local big box store being filled with these products, and much like the iPad, the technology will start to leak into the healthcare environment. Consumer technology rarely has the build quality, warranty, security and manageability of commercial grade technology and having it show up in a mission critical environment like a healthcare facility will likely result in unintended outcomes.

Convergence of technologies like mobility, connectivity, cloud and pervasive devices will drive significant opportunity for those Integrators or Solution Providers that figure out how to monetize it. The days of doing on premise network installs, supporting it through services or per device (or person) recurring revenue, and making margin on hardware and software will continue to decline over the next 10 years. In fact, the value is shifting to the front-end, where consulting, design, architecture, compliance and project management will provide the main source of income.

While the quantity of devices per customer will grow exponentially, the revenue opportunity per device will decline even more rapidly. In a pervasive world, the cost per devices shrinks to the point where extended warranty contracts or per device management becomes irrelevant. As more value is delivered through the cloud, the 20 devices, including audio/video, just become disposable conduits.

A final caution is that this is a gradual process. 20 medical devices in 5 years is the prediction, but the transformation of the healthcare industry itself is on a longer 10-15 year trajectory. Understanding these changes and how they apply to this industry is the first step. Next step, is a plan for your business to start capitalizing on the front end: your experience, guidance and industry thought leadership.