Interaction concept and system architecture for the sterile information system OR-Pad in the perioperative area

Abstract

Access to clinical information during interventions is an important aspect to support the surgeon and his team in the OR. The OR-Pad research project aims at displaying clinically relevant information close to the patient during surgery. With the OR-Pad system, the surgeon shall be able to access case-specific information, displayed on a sterilepackaged, portable display device. Therefore, information shall be prepared before surgery and also be available afterwards. The project follows an user-centered design process. Within the third iteration, the interaction concept was finalized, resulting in an application that can be used in two modes, mobile and intraoperative, to support the surgeon before/after and during surgery, respectively. By supporting the surgeon perioperatively, it is expected to improve the information situation in the OR and thereby the quality of surgical results. Based on this concept, the system architecture was designed in detail, using a client-server architecture. Components, communication interfaces, exchanged data, and intended standards for data exchange of the OR-Pad system including connecting systems were conceived. Expert interviews by using a clickable prototype were conducted to evaluate the concepts.

Service-oriented Device Connectivity interface for a situation recognition system in the OR

“…The standardized SDC data transfer of contextual information with associated discovery and security aspects shall be encapsulated by our RPC-based middleware. For evaluation, a prototype was implemented and integrated into the SRS of [ 3 ] and context-aware OR-Pad of [ 2 ] in the research OR of Reutlingen University.…”

“…The three evaluation steps are examined during a proof of concept study by integrating the middleware within the SRS [ 3 ] and OR-Pad [ 2 ] project and demonstrating its functionality in this specific use case. The middleware was tested using seven orthopedical interventions of the OR-Pad : hip replacement, hip replacement revision, femoral osteosynthesis, lateral partial knee prosthesis, lag screw osteosynthesis reposition, and radial head arthroplasty reposition.…”

“…To achieve this, contextual information, e.g., device parameters, used instruments, etc., needs to be captured and analyzed. One of our applications for CAS is the OR-Pad system that addresses the improvement in the information flow for the surgeon within the perioperative area [ 2 ]: The system consists of a pre- and postoperative as well as intraoperative mode. Clinical information can be preselected preoperatively for display in specific surgical phases.…”

“…It should be unimportant for the SRS what the CAS are designed for. Possible use cases are filtering information automatically [ 4 ], providing pre-assigned information [ 2 , 5 , 6 ], selecting and controlling devices [ 7 , 8 ], or minimizing adverse events [ 9 , 10 ]. With a uniform SRS, CAS can act context-aware without bothering about implementing own recognition approaches, preventing them to get too complex, and all having the same data basis.…”

“…In contrast, our architecture uses a remote procedure call (RPC)-based middleware encapsulating the SDC complexity for exchanging contextual information with simple function calls. For evaluation, our implementation is integrated into the SRS of [ 3 ] and the context-aware OR-Pad of [ 2 ] providing and receiving contextual information by interacting with the middleware during seven simulated orthopedical interventions.

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