Information Technologies

The ubiquitous access in a timely fashion to critical information is changing the daily practice of surgery on very simple but many crucial levels. Knowledge about a patient and all his or her tests was kept in the chart at the bedside or in the memory of the surgeon. Today that information resides on a central server, accessible anytime and anywhere through computer stations in the hospital, clinic, or office, or instantly at the bedside or parking lot using personal digital assistants (PDAs) or other communication devices. In addition, knowledge about a particular disease or the latest clinical trial results were previously contained in journals in the library or surgeon's office; that information is also available immediately through a computer or PDA. Likewise, with new wireless sensors attached to patients, vital signs will be made available on the server anytime from anywhere. The result is that the surgeon knows a great deal about the practice of medicine and their specific patients, in real time. The challenge will be trying to sort out the most important information and apply the decision making for the best outcomes.

Information systems are also becoming enterprises, supporting the entire hospital system for the patient and for efficient hospital management. There is a trend to patient-centric medicine: focusing all the information around a single patient's record, rather than focusing each functional piece of information (X-ray, laboratory test, etc.) in different departments. In addition a longitudinal record, from moment of entry into the hospital system until beyond final discharge, the entire patient encounter will be documented, tracked, billed, and analyzed for outcomes: clinical, administrative and financial. The University of Maryland has an innovative, integrated perioperative system, which tracks the patient from admission to outpatient surgery until discharge later that day, including the full surgical procedure [5]. Sophisticated vision recognition systems combined with smart tags monitor the patient, operating team, and operating theater and, supported by intelligent software and inference engines, automatically deduce and document the patient's progress from preoperative to postoperative care. Tracking personnel reduces lost time, trying to bring the operating team together in a timely fashion, while electronically labeling equipment and supplies permits just-in-time inventory and supply chain management.

The amount of authority the surgeon will be able to retain continues to diminish, especially in a time when automated information systems can much more efficiently perform processes and report outcomes than humans. As a busy clinical surgeon strives to spend more time seeing more patients and performing more surgical procedures, the administrative requirements and bureaucratic burdens dramatically decrease efficiency. The surgeon must adapt, and the most efficient way is to learn and harness the new technologies, rather that abdicating authority to administrators or becoming a slave to the technology.

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