The operating room has four speakers in the ceiling for the computer's use, and a microphone for surgeon to communicate. White and IBM experimented with different microphones and adjusted the voice application to filter out common noises such as pumps and equipment beeps to prevent interference.
At the start of operation, the doctor directs the computer to read vital data from the clinical database such as the patient's name, diagnosis and the procedure to be performed. This ensures everyone in the room is on the same page before the start of surgery.
Once the surgeon says the word “incision,” the computer times the operation and notifies personnel when they need to perform such actions as giving the patient his next dose of anesthetic. This allows them to concentrate on the patient, rather than watching the clock, and reduces the likelihood of error.
The doctor can also record data into the patient's file during the operation. For example, he can direct the camera to take a picture and record a description rather than having to remember later the specifics of the photo.
“Pictures used to be stored without data because I couldn't enter it while operating,” said Dr. Burke. “Voice opens up an entirely new source of data occurring at the point of care when it is freshest and most accurate.”
Paging Dr. Digital
Adler of Gottlieb Memorial tried using pagers and cell phones to keep in touch with the staff, but found this unsatisfactory. Instead, the hospital now uses wireless communication badges from Vocera Communications.
These two-ounce badges can be worn on a lanyard around the neck or clipped to clothing. The badges access the hospital's 802.11b wireless LAN to connect to the Vocera Server. The server sends messages to another badge over the WLAN, or links to the hospital's PBX to connect to phone lines. The hospital has 320 of the badges, shared by the 800 staff on three shifts.
The badges have a built-in microphone and speaker, and the server uses voice recognition software to interact with the wearer. The user can access another person by name, nickname, external phone number, internal phone extension, job title or other description such as “the nurse covering Room 48B.”
Since the user's location can also be tracked, someone can give a command like “connect me to the nearest security guard.” For privacy, users have the option of plugging a headset into the badge, but in most cases the users will go to a private area or transfer the call to a land line before discussing patient information.
“One of our biggest concerns is with HIPAA (Health Insurance Portability and Accountability Act),” Adler explained. “We did a lot of training on not having conversations about sensitive patient information, and we don't take physician conversations in the patent rooms.”
However, there are some advantages to having the patients hear conversations. For example, when the patient speaks Spanish, an interpreter can be reached through the badge and the conversation conducted immediately without an interpreter having to come to the patient's room.
There are trade-offs, though. The badges have an LCD screen on the back for text messages and email, but that screen is too small to use with the telemonitoring system nurses use to see results from a patient's heart monitor.
Thus certain nurses carry a separate device for that purpose.
Adler said that Vocera is looking at a larger form factor that could also be used for telemonitoring. But she isn't sure if the hospital will change to the larger devices.
“I don't know if we want to go to a dual use for these devices,” she said. “Right now the weight is perfect and the way in which you use it is so easy.”