1. Future Trends in Monitoring Keith J Ruskin, MD Associate Professor of Anesthesiology Yale University School of Medicine

2. Future Trends in Monitoring u Smaller u Cheaper (hopefully) u Well-connected u New interpretation of existing information

3. The Problem: u Lots of data u Very little recorded or interpreted u Operating rooms isolated u Patients on the go

4. Smaller, Cheaper

5. Smaller, Cheaper, Connected u Wireless Ethernet u Telemetry u Data collection u G3 wireless data service u Remote evaluation, treatment

6. Bluetooth u Wireless connection between personal devices u Short-range u Mobile telephone gets numbers from PIM u Wireless data collection and display, telemetry

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

8. Wearable Computing u Xybernaut: Pentium MMX, Win2K, 160mb RAM, 8 gb hard drive

9. Embedded Internet u Equipment can connect to the Internet u Communicates with other devices, user, manufacturer u Quality assurance u Technical support

10. The Connected Monitor u Siemens UPTIME service u Diagnostic information sent to repair center u Technician can diagnose, fix problem

11. The Connected Record Keeper u Vincenzo Lanza, MD Ospedale Fatebenefratelli, Palermo, Sicily u Anesthesia record keeping software u Designed to use Internet u Multiple hospitals throughout Italy

12. Wireless Technology: The Future u IBM Almaden u “Digital Jewelry” u Eyeglass-mounted camera u Wireless connection u Name, place recognition

13. Doctors Without Wires u Medical devices share information u Accurate drug administration u Improved communication between practitioners u Medical Internet resources at point of care

14. The Future: Computing Power u Data collection u Data management u Data interpretation u Subtle relationships u Decision support systems

15. Data Acquisition u Medical Information Bus (IEEE 1073) u Standard for connecting up to 255 medical devices u Not all devices compatible u Decreases errors in data capture

16. Automated Record Keeping: Advantages u Automatically record information u Improved accuracy and legibility u More attention to important tasks?

17. Advantages (Continued) u Information used for research, billing u Provide evidence during legal disputes u Quality Assurance u Scan records for critical incidents u Anesthesia “black box?”

18. Record Keeping: Quality Assurance u 434 incidents found in 5,454 automated records u 18 incidents (4.1%) reported voluntarily Sanborn KV et al Anesthesiology 1996 Nov;85(5):977-987

19. Data Sharing: Now u Anesthesia Record u Narcotic use u Quality assurance u Operating room management u Scheduling

20. Data Sharing: The Future u Medical record u History, physical, laboratory data u Physiologic data u Clinical information u Policies and procedures, treatment protocols u Communication

21. Clinical Databases u Data entered manually, acquired through ARK u Benchmarking u Compare costs, sentinel events u Knowledge discovery u Information buried in thousands of records

22. Decision Support Systems u May improve patient care u Recommended by IOM report u Successful when integrated into workflow u Flowsheets u Links to pertinent literature u Corollary orders, treatment guidelines

23. Decision Support: Expert Systems u Best when system broken down to simple variables u “If… then… else” rules u Good for laboratory values, simple guidelines

24. Decision Support: Neural Networks u Complex situations, multiple variables u Emulate human neuronal connections u Trained with sets of preexisting data u Good for alarm analysis, physiologic monitoring

25. Intelligent Alarms u Proliferation of monitors and alarms u Increasing levels of confusion u Analysis of alarms to diagnosis breathing circuit u More rapid diagnosis by anesthesia personnel u (Westenskow et al Anesthesiology 77:1074-1079)

26. Signal Fusion u Simultaneous acquisition from multiple sources u Redundancy used to regenerate signals u e.g., Heart rate from pulse oximeter, arterial line, ECG u Feldman JM et al. J Clin Monit 12:459

27. Conclusions u Smaller, cheaper, faster u Computers in the OR: u Automated record keeping u Access to information u Data integration and management u Improved patient care