MedTech Round Table: The ROI of Surgical Digital Transformation

Caresyntax hosted a roundtable discussion on how digital transformation—specifically the collection of data in the surgical suite—can drive both quality and return on investment (ROI). The participants included a panel of esteemed healthcare professionals in surgery, nursing, investing, sales, healthcare technology, and academics. The following is a summary of the new pathways and opportunities to ROI for surgeons, health systems, national healthcare organizations, insurers, and most importantly, patients.

The Complicated Relationship Between Quality and ROI

One of the greatest misconceptions in healthcare is that improving quality is expensive, labor intensive, and more costly. Yet the US continues to rank behind other countries in life expectancy and other measures of healthcare quality even though its per capita spending on healthcare is 50-200 percent higher.

The benchmark for providing value can be different depending on the provider, the organization, the health system, and the country where surgical care is delivered. Value is typically described as quality/cost.

ROI for Surgeons

For surgeons, ROI means looking at their performance more accurately to be able to learn how to improve their surgical technique. The biggest hurdle to realizing ROI comes from the surgical community and their resistance to change and the greater transparency and assessment using the data collected from the operating room (OR). But it is important to note that surgical outcomes are not just the result of the surgeon’s performance, video assessment can observe and collect data about the entire surgical team, preparation, workflows, processes, and supplies for a more comprehensive view of performance.

“When a surgeon can identify even the smallest technical performance improvement for themselves, the entire surgical team, and medical devices, that can lead to better patient outcomes and patients who fare better, cost less.”

When a surgeon can identify even the smallest technical performance improvement for themselves, the entire surgical team, and medical devices, that can lead to better patient outcomes and patients who fare better, cost less. Digitalization can bring experiences together.

Surgical Playbooks to Quickly Train Staff on Surgeon Preferences

Surgical playbooks can be created based on historical device and supply usage, and team workflow data, so that OR staff can train and learn in advance what materials the surgeon will need. This AI-enhanced software can help streamline the training process for new members of the team and traveling nurses, who are becoming essential to fill the staffing gaps experienced during COVID.

Leveraging AI to Identify and Reduce Surgical Variation

Data analytics and machine learning techniques are now being used simultaneously to uncover critical insights from the millions of data points collected by endoscopic and laparoscopic and open surgical video. With the help of AI, this can help reduce surgical variability, and over time, surgeons will be able to understand more clearly which techniques align with better outcomes. Using AI to review a critical portion of variance allows surgeons to look at the most important sections, to reduce having to sift through hours of data. More computing power enables that.

Objective Assessment to Improve Performance

Leveraging video-based surgical training offers unique insight into surgical technique and decision-making in the OR. It gives students, residents, and even experienced surgeons a broader and more in-depth view of their performance. Being able to review surgical video makes it easier to identify deviations from best practices and offer constructive and insightful feedback on how to improve.

Training for the Next Generation of Digitally Savvy Surgeons

For the next generation of surgeons, who have grown up with a comfort level for using technology and watching videos to learn, creating a library of surgical videos can make their training more convenient and comprehensive. Routine collection of surgical videos would allow the creation of a library with videos demonstrating how a safe procedure is done and could also include those that were determined to be unsafe. (A surgical resident may learn more from seeing something done poorly than watching a procedure done well.)

Surgeons in training are no longer relying solely on their teachers, they are taking control of their own surgical excellence by pursuing training and assessment outside the OR.

ROI for Health Systems

The participants in the recent roundtable discussion recognized that to effectively assess driving revenue, health systems must look at the entire surgical care continuum from maximizing OR time and streamlining operational workflow efficiency, to postoperative identification of ways to reduce surgical variability.

Optimizing Workflow Efficiency

Health systems today are overwhelmingly focused on the efficient delivery of care. This requires the need to automate as many manual tasks as possible and technology can help achieve that. Patient outcomes depend on how well the team works together yet there are limits to what the surgical teams can see and capture during surgery. Using a surgical data platform that can integrate, record, and analyze OR events can improve monitoring and measurement of critical safety moments and has the potential to dramatically and positively affect patient outcomes.

Predictive accuracy of surgical case duration plays a critical role in reducing cost of operation room (OR) utilization. The most common approaches used by hospitals rely on historic averages based on a specific surgeon or a specific procedure type obtained from the electronic medical record (EMR) scheduling systems. However, low predictive accuracy of EMR leads to negative impacts on patients and hospitals, such as rescheduling of surgeries and cancellation.[i]

“If a healthcare organization can show that they are using video-based assessment and that their surgeons have had their surgical technique peer-reviewed and have demonstrated competency, it will give their hospital a competitive advantage, which translates into more opportunities to increase their bottom line.”

OR surgical intelligence has the ability to identify processes that can be streamlined to make certain procedures more consistent in terms of duration. Identifying ways to make a procedure shorter directly translates to more procedures that can be performed, directly impacting the hospital bottom line.

Around 1 in 10 instrument trays are delivered to the operating room (OR) from the sterile processing department (SPD) with missing instruments, with another 1 in 20 containing broken instruments.[ii] These tray defects can result in increased risk to the patient, delays in surgery and substantial costs for the hospital. Video-based assessment could be used to optimize the work of the SPD. The camera can check tray to ensure instruments were placed in the right spot to proactively ensure a smoother workflow.

Attract and Retain Top Surgical Talent

In the competitive field of healthcare, attracting and retaining top surgical talent is crucial to ensure a reputation for delivering high quality care. In an age of increasing consumerism of care, patients will choose hospitals with the highest rated surgeons. If a healthcare organization can show that they are using video-based assessment and that their surgeons have had their surgical technique peer-reviewed and have demonstrated competency, it will give their hospital a competitive advantage, which translates into more opportunities to increase their bottom line.

ROI for National Healthcare Organizations

Transformational change requires broad consensus and a critical view for the sake of improving patient safety. The members of the roundtable agreed that to increase adoption of technology and digital transformation of the OR, it will require an international team of surgeons who can use their enthusiasm for early adoption of technology to establish international benchmarks to create a level of quality and execution to ensure the best outcomes.

Large government-run health systems like those in the UK are very progressive and have demonstrated interest in using OR data to conduct video-based analysis of surgical competence in order to issue licenses to surgeons. Significant progress has been made on the collection of consultant performance data in the independent sector and the NHS. In 2018, the Acute Data Alignment Programme (ADAPt) was launched to move towards a common set of standards for data collection, performance measure methodologies, and reporting systems across the NHS and the independent sector, with potential to be fully implemented by 2022 to 2023.This data will be made available for managers and healthcare professionals across the system to help support learning and identify outliers.[iii]

In the US, the Affordable Care Act created incentives for improving quality while reducing costs through Medicare Shared Savings and bundled payment programs.[iv]

Toward International Standards for Surgery

In aviation, any airplane malfunction can lead to an enormous loss of life. That is what led to creating international standards for having flight data recorders (originally called “black boxes”) installed in every passenger plane. These recorders have been mandatory since 1967 and are no longer black, but bright orange.

“In the future of surgery, regulatory bodies and licensing will be tied to demonstrated proficiency. Creating international standards can ensure that no matter where surgeons operate, they will have the ability to collect objective surgical procedure data and to use the data to improve their performance.”

Similarly, in the future of surgery, regulatory bodies and licensing will be tied to demonstrated proficiency. Creating international standards can ensure that no matter where surgeons operate, they will have the ability to collect objective surgical procedure data and to use the data to improve their performance.

The American College of Surgeons is doing something similar: The ACS Surgeon Specific Registry (ACS SSR™) in 2023 will offer the SSR Practice Improvement Initiative (SSR PII) – Quality Case Data Review and Reflection activity, allowing surgeons to perform quality data assessment with the goal of identifying trends, gaps, and improvement opportunities. The PII was developed by surgeons, for surgeons. It provides opportunities for continual collection, review, and education based on their case data, including outcomes.[v]

Establishing benchmarks on behalf of professional bodies could impact widespread adoption by global surgeon groups. For example, laparoscopic cholecystectomy has international benchmarks for safety. When critical surgical procedure steps can be quantified, assessed, and linked to outcomes, then ROI can be demonstrated and qualified.

ROI for Insurers

For medical malpractice insurers, return on investment is based on decreasing rates of loss and decreasing the cost of investigating cases. That is where the value of digital transformation and leveraging data collected in the surgical suite can make a difference.

An integrated surgical intelligence platform collects information across the preoperative, intraoperative and postoperative continuum: electronic health records, hospital information systems, supply/implant data, device data, imaging and rich surgical video. This helps to identify and reduce unnecessary variation in surgical care, which impacts a full range of clinical, operational, and financial metrics across all types of surgical and interventional procedures. Video-based assessment of team dynamics and communication and detailed cohort level analyses can provide new insights into surgical technique, surgical decision making, and surgical team dynamics to improve safety, quality, and efficiency.

Real-time data from the OR can be useful as an additional and important source of information in order to sharpen existing prediction models in the area of risk management and to develop new models.

Real-time data from the OR can be useful as an additional and important source of information in order to sharpen existing prediction models in the area of risk management and to develop new models. The availability of the relevant aggregated data for insurance companies would help drive operational and strategic decisions toward maximizing quality.

With a data-driven surgery platform, it is possible to create Surgical ACOs and implement Value-Based Care reimbursement for surgical interventions and to create more cost-efficient payment models between hospitals and insurance companies.

ROI for the Patient

Patients are, after all, the ultimate beneficiaries of data-driven, higher quality surgical care. When they can get the surgery that they need without experiencing complications or extended length of stay or readmission, it directly impacts their quality of life.

A network of digital applications integrated into a single OR technology platform that includes continuous big data analysis and AI as well as machine learning, represents a digital safety net for the OR.  AI can be used to alert the surgeon of critical surgical steps or anatomical conditions in advance to inform the best decision-making for each case.

Surgical digital transformation–the integrated collection and analysis of data in the surgical suite and applying machine learning and artificial intelligence—has shown that the future of surgery will be data driven and will create new pathways and opportunities to drive both quality and ROI.

Roundtable Panelists

Prof. Dr. Harald Schrem MBA

Consultant Surgeon, General, Visceral and Transplant Surgery at the Graz University Hospital, Austria. Published author with over 100 publications in international scientific journals. Dr. Schrem researches surgical issues and statistical methodology. He is co-founder of the KAMIQ Institute which is specialized in deep tech methodologies in healthcare.

PD Dr. Sören Könneker, MBA

Board Certified Plastic and Aesthetic Surgeon and Hand Surgeon at the University Hospital Zürich, Switzerland.

Deeptee Jain, MD

Orthopedic minimally invasive spine surgeon in St. Louis, Missouri. Recognized as one of the Top 20 Under 40 Spine Surgeons in the US.

PD Dr. Alexander Kaltenborn, MHBA

Academic surgeon teaching experimental surgery at Hannover Medical School Germany. Practices hand and plastic surgery as a Major (MC) in the German Armed Forces Medical Corps. Entrepreneur, CEO and Founder, KAMIQ Institute. Published author of >100 publications.

Alexander Kis, CFA Sr. VP Caresyntax

Healthcare investment professional based in London, England, UK.

Michael Woods, MD MMM, CMO Caresyntax

Board certified, fellowship trained surgeon and chief medical officer for Caresyntax.

Paul R. Summerside, MD

Emergency Medicine physician, Chief Medical Officer of AYA Healthcare, the largest travel nursing agency in the US located in Green Bay, Wisconsin and a board member of Caresyntax.

Florian Heusel

Caresyntax Sales Manager for the DACH region. IT expert and expert in German healthcare systems.

References

[i] A Machine Learning Study to Improve Surgical Case Duration Prediction. Ching-Chieh Huang, Jesyin Lai, Der-Yang Cho, Jiaxin Yu. medRxiv 2020.06.10.20127910; doi: https://doi.org/10.1101/2020.06.10.20127910

[ii] Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf. 2021 Apr;30(4):271-282. doi: 10.1136/bmjqs-2019-010740. Epub 2020 Oct 19. PMID: 33077512; PMCID: PMC7979531.

[iii] NHS 75 Digital Acute Data Aignment Programme (ADAPt) https://digital.nhs.uk/services/acute-data-alignment-programme

[iv] Landon, S.N., Padikkala, J. & Horwitz, L.I. Identifying drivers of health care value: a scoping review of the literature. BMC Health Serv Res 22, 845 (2022). https://doi.org/10.1186/s12913-022-08225-6

[v] American College of Surgeons (ACS) Surgeon Specific Registry (SSR) https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/january-17-2023-issue/acs-ssr-practice-improvement-initiative-opens-enrollment-in-2023/