Invited post by Vahagn Nikolian: Telemedicine in the Future of Surgery

As wide spread adoption of technology has increased in our daily lives, so too has the arsenal of options physicians have to utilize and implement technology to take care of patients. Telemedicine, or the “use of electronic information and communication technologies to provide and support health care,” has resulted in improved access to care, increased resource efficiency, and decreased costs associated with routine health care. Given the promise for this resource, it is expected that the telemedicine market will demonstrate annual growth rates ranging between 20-50% for the foreseeable future.

Vahagn Nikolian MD – @VNikolian on Twitter
Fellow at @NYPHospital @ColumbiaSurgery Comprehensive Hernia Center

            Surgeons have utilized telemedicine in a variety of ways over the last decade. Pre- and post-operative patient evaluations utilizing telemedicine has become common in private practice and academic settings. Without a doubt, the accomplishments of the US Department of Veterans Affairs (VA) stands as the most impressive implementation of telemedicine technology. Annual VA Video Visits exceed more than 1 million regularly, with continued growth and allotment of resources expected for the next few years. Within the surgical patient population, the VA has demonstrated safety and feasibility in applying telemedicine to patients undergoing general, urologic, neurosurgical, plastic, obstetric, and gynecologic procedures.

            When considering new technologies, one must consider all stake holders and understand the impact that a deviation from the norm may have. Multiple studies analyzing patient satisfaction, time away from work, travel time, etc. have shown that patients are pleased with telemedicine encounters surrounding surgical care. Further, health care systems have demonstrated cost savings associated with implementation of telemedicine programs. For surgeons, telemedicine can provide an efficient means of evaluating patients and coordinating care. As the technology develops, utility in both rural and metropolitan settings must be assess to identify who would benefit most from these encounters.

            For telemedicine to continue to grow, concerns related to ethics of the platform must be scrutinized and overcome. The system must develop in a manner to ensure that health care data breaches are guarded against such that patients and providers are confident in the privacy and security of programs. Beyond cyber-security, other barriers hinder the widespread adoption of telemedicine platforms. First, licensure and practice laws for health professionals must be adopted that allow surgeons to more easily interact and take care of patients across state and, eventually, international borders. Additionally, reimbursement strategies must be reformatted to allow for patients to be evaluated without physically being in the same place as their provider. At the national level, enthusiasm for telemedicine is increasing, and reimbursement related to origination site requirements and definitions of rural qualifications have been updated to make telemedicine encounters more broadly applicable.

            In conclusion, telemedicine in surgery has received significant attention as patient satisfaction, decreased wait times, cost saving for both patients and health care systems have been demonstrated. With an emphasis on the patient and physician experience, telemedicine stands as an expected and natural evolution of surgical care. Moving forward, barriers at the local, regional, and national level must be overcome to allow for widespread dissemination and implementation of telemedicine in surgery. 

Entrada invitada: ¿Futuro de la cirugía en España? Por Sergio Sanchez-Cordero

Durante toda mi formación, he escuchado numerosos profesores explicar cómo iba a ser el siguiente curso, cuáles eran las dificultades y de qué manera iban a sucederse los acontecimientos hasta que consiguiera mi plaza en un hospital. Una vez entré a formar parte de un equipo quirúrgico, hablar de futuro es siempre hablar de incertidumbre. Nadie ha sido capaz desde entonces de aventurarse a determinar cómo será la medicina de aquí a cinco o diez años, cómo trabajaremos en los hospitales (incluso si trabajaremos en ellos) o qué actividad desarrollaremos en los quirófanos.

Sergio Sánchez-Cordero @sesanco – Residente de Cirugía

Actualmente, disponemos de un excelente sistema de salud, tenemos los mejores médicos en formación, los mejores instrumentos y el mejor entrenamiento que hemos tenido nunca, no obstante, las exigencias son mayores y a diario tenemos que manejar con el desequilibrio entre expectativa y realidad de nuestros pacientes. Así como la transformación de la cirugía abierta a la laparoscópica fue traumática para muchos, el futuro próximo revolucionará el marco en el que realizamos nuestra actividad quirúrgica. Por lo que, si una cosa tengo clara es que, la capacidad de adaptación al cambio es la característica más importante de los cirujanos en formación.

Por un lado, la cirugía basada en la seguridad del paciente y la calidad de vida va a producir un drástico impacto en la reducción de la iatrogenia en nuestros pacientes. El procesamiento de grandes cantidades de datos o “big data” y la inteligencia artificial aplicada, mejorará el conocimiento y monitorizará las consecuencias de nuestras acciones en los pacientes.  Si bien la formación de los cirujanos estuvo basada en el ensayo-error y el posterior análisis, la exigencia impuesta por la sociedad, no da margen de error a aquellos que por su condición de novel tienen más números de equivocarse. Por ello, se crearán plataformas y simuladores que se convertirán en un peaje durante la formación del residente. 

Si hablamos de innovación y cirugía, el Dr. J Marescaux, ya explicaba las revoluciones más inmediatas. Por un lado, la cirugía mínimamente invasiva, definida por plataformas robóticas, cirugía endoscópica y nuevas herramientas de acción quirúrgica que se están desarrollando, que hoy en día se encuentran en su expresión inicial, pero que irrumpirán en los quirófanos del futuro al tiempo que estaremos surcando la cresta de nuestra profesión. En segundo lugar, la integración y procesamiento de imágenes, tanto dentro como fuera de quirófano, el procesamiento de imagen a nivel molecular y la impresión en 3D, mejorarán la visibilidad de aquello que hoy vemos pero que nos abrirá la puerta a una realidad que actualmente no conocemos.

Y, por último, la revolución social afectará el modo en que nos relacionamos con el paciente y nuestros compañeros. Las plataformas digitales e interactivas y los sistemas de “telementoring” facilitarán la comunicación y la interconectividad entre los diferentes agentes del proceso. Investigación colaborativa, interacción con los pacientes, congresos online, etc. son algunas de las aplicaciones que nos encontraremos en un futuro próximo para beneficiar un mayor número de pacientes.

Por lo tanto, nos encontramos ante una nueva revolución que cambiará el escenario en el que estamos trabajando. Vienen épocas inciertas, con nuevos avances y recursos que dibujarán un escenario que, por ahora, es difícil de pronosticar. Nuestro objetivo como cirujanos es la adaptabilidad a un paradigma más “tecnológico” en el que seguiremos teniendo pacientes igual de “humanos”; con el reto de conectar una tecnología cada vez más inteligente y una humanidad cada vez más incomprensible.

#SoMe4Trauma by Dr. Ameera AlHasan

Trauma takes numerous lives every year, in both a civilian and military setting. Trauma is the bread and butter of the general surgeon and the humble beginning of every specialized surgeon thereafter. It is therefore imperative to foster a strong online community that brings together efforts to raise awareness, share ideas and ultimately improve trauma practice on a global scale. This is how SoMe4Trauma was born.


Raised under the umbrella of the bigger SoMe4Surgery initiative, SoMe4Trauma aims to breed a community of trauma and acute care surgeons, other medical and non-medical trauma care providers (including ER doctors, nurses, EMS, fire brigade etc.), trauma policy advocates and trauma victims. Some of our goals include connecting the trauma community, sharing tacit & explicit knowledge, advancing trauma education, and creating a friendly and entertaining learning environment. In such a brief time period, the SoMe4Trauma family has managed to grow exponentially and to generate impact on Twitter. Such success can be attributed to a number of factors including the relevance of trauma to the medical community and the public (and the high burden of disease it represents), the unconditional support of influential surgeons on Twitter some of whom are true pioneers of trauma surgery and the continuous interaction of the SoMe4Trauma and SoMe4Surgery members.


Contrary to what it may seem, SoMe4Trauma is not a random tweeting service. The “behind the scenes” work that goes on in preparing most tweets is tremendous. That includes scheduling, networking, emailing guests back and forth, designing posters and recruiting tweeters to help interact and support the conversations. A structured approach is essential as real life efforts get translated into mere tweets. It is our belief that “failing to plan is planning to fail”. Real value can only be generated with vision and vigilance. 
             

Finally, just as management in the trauma bay depends on team work so does the sustenance of an online community like SoMe4Trauma. We invite you not only to interact with us, but to contribute and become a trauma leader yourself. All you have to do is to follow and use the hashtags #SoMe4Trauma and #SoMe4Surgery as SoMe4Trauma continues to blow your mind…hopefully, without causing any injuries 😉