Gumming up the works.

• Author: Chopra, Gopal K.
• Position: Medicine & Health

IN THE MILIEU of a strained health technology implementation environment spurred by government policy, we all are asking if we are fundamentally changing care for the better? Moreover, why is innovation taking so much time and pain to implement?

As a physician and surgeon, it always has been exciting and a privilege to be at the forefront of using, testing, and creating seminal technologies that would change the way we do surgery. At each point of transformation, the decision to use a particular technology is based on outcomes. Will my patient benefit? The real test to its insertion into my day, however, was very much that it was easy to use, seamless to my procedural behavior, and, even better, made me faster and safer to win the day. Outcomes focus meant my patients went home with a better result than using prior solutions or methods, and fewer risks had been taken for any care management or procedural decisions.

My daily environment is not dissimilar to the Mission Control Center of NASA's Johnson Space Center. I have controllers on various instruments across the hospital and office, feeding me data--and I am the flight director in charge of the overall mission and with all the associated parallel events.

Let us take a view into the daily log. A patient in the intensive care unit is kept under an anesthetic as his brain is recovering from a stroke and the subsequent surgery we had performed to stop the bleeding that caused it. The patient is connected to a ventilator to support his breathing and has inserted in him a pressure monitor and EEG to understand the physiology that was occurring in the brain. A variety of other key monitors are measuring blood pressure, oxygen, heartbeat, and cardiac rhythm. Teams were assessing trends in the information, and I am running the protocols to make pharmaceutical tweaks to ensure we have a safe recovery, watching for minor changes that might alert us to events that are detrimental to recovery.

A patient in the ER had just arrived after being knocked over as a pedestrian by a fast biker and is shuttled to the CAT scanner, which is being programmed for my prescription to best assess the bony and soft tissue (organ) anatomy of the head and spine so we can identify any acute signs of significant injury. The scanner is taking these images and assembling them into a 3-D reconstruction in a matter of less than one minute. I am linking to the images remotely and on the line with the ER team--the members reviewing the status of the patient from similar monitors as the patient in the ICU.

I quickly can identify certain early signs of injury that I am trained to recognize, and already am several decision nodes along the management protocol pathway so that care teams can...