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Digital Surgery and the Triple Aim Part 1

In healthcare we always discuss the triple aim, or how we can improve cost, quality and outcomes (CQO). In order to achieve this, we need to go beyond incremental improvement of best practices and have actual innovation processes in our healthcare environment. Technology is going to be our best ally making real strides towards achieving the triple aim. For instance, new AI algorithms have been developed that use the surgeon, the patient’s EMR and other data to improve OR scheduling and have found gains of more than 30% of OR time during a given day. In terms of quality, many new startups are using devices like Alexa, to respond and record to what the patients and physicians are expressing in a consult, rather than sitting the patient at one side of a desk and the physician in the other and have the physician look into a computer screen and type as opposed to speaking to the patient. In terms of outcomes, medical technology is now offering cures to many new diseases, new devices that are connected to the web or can be monitored remotely are appearing every day, many give patients a chance to recover and have a long and healthy life after conditions that used to be considered life threatening. Looking at the future, technology will be our main ally in making sure we move forward in the direction of the triple aim, but how can Digital Surgery move us towards the triple aim?

First of all, Digital Surgery tools, like 3D printing and AR can be used throughout the patient care cycle and will impact CQO in many different ways. Let’s start with diagnosis, once imaging data for the patient is available, this data can the be turned into both physical and digital 3D models that can serve several purposes but the first is Education. Education of the patient and education of the physician. The first thing that happens when a patient and a surgeon are discussing a patient’s case is that there is a massive asymmetry of information. The surgeons, because they always use that language, are very likely to assume the patients have greater understanding of medicine and anatomy than they do, the patients are scared and might say they understand even of they don’t. In fact, a study from 1995 shows that 79% didn’t know bleeding and hemorrhage where analogous and 78% didn’t know a fracture was a broken bone. This means one party is speaking another language and the other is too scared to ask.

Using a 3D printed digital model of the pathology or an animation on a mobile device, can be a very powerful tool for the physician to educate the patient in the pathology and the possible courses of treatment, using that exact patient’s anatomy and situation. The experience for the patient is totally different if they are show some CT slides or a pano x-ray and told you have an ameloblastoma in the mandibular angle as when they get shown an actual 3D model of the mandible that shows the lesion and the surgeon can show the patient how he plans to resect the tumor and what he plans to use to void the gap. This can greatly increase the patient’s experience and reduce uncertainty in a time when it abounds.

The above images show some of the models that can be segmented or printed differentiating the different types of tissue and showing the pathologies in great detail.

These tools can also be used for training of the surgeons themselves, as the surgeries can be performed virtually as many times as necessary to achieve the correct outcomes and assess the correct risks. 3D printed models can be used for surgical workshops before the fact and the surgeries can be performed tens of times before they are performed on the actual patient. This can greatly reduce surgical times and complication rates.

There are many more impacts from digital surgery in the continuum of surgical care that go for the triple aim and these will be addressed in our next blog entry.

We need to focus our healthcare in moving towards the triple aim, technology allows us to move in the right direction but the right technologies have to be implemented in the right points for the care to be the most effective. In the surgical continuum of care using 3D technologies for animation and 3D printing can greatly improve the patient’s experience and provide light in a moment of darkness. It can also help the surgeon be better as it will allow for the procedures to be practiced many times in advance, reducing complications and uncertainty when they are live with a patient in the table.

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