Robots are increasingly making their mark in the operating room, too. Originally approved for general abdominal procedures like gallbladder removal, robotic surgery—the surgeon manipulates computer controls rather than a scalpel—is now used for heart and prostate cancer surgery, gynecologic procedures, and bariatric surgery, among others. With the help of a tiny camera inserted through an incision "port," a surgeon can see the surgical field onscreen as he sits at a console in the operating room, from which he guides the robot's instruments, also inserted through ports. Someday, the doctor guiding the robot could be sitting at a console literally across the world from the patient. If remote surgery eventually becomes commercially available, many lives might be saved in hard-to-reach locations, from remote islands to battlefields.
Proponents of robotic surgery note that the robot's "hands" are steadier and have a wider range of motion than human hands and that the instruments are more flexible than traditional laparoscopic instruments. This can lead to less pain and blood loss, and potentially better clinical outcomes, they say. But results of studies on outcomes are mixed, says Richard Satava, a professor of surgery at the University of Washington. "If it costs more to do the same operation with the robot, that will slow down the adoption somewhat," he says.
Records reform. Meanwhile, a slow but sure transformation in the way patient records are gathered and stored gained momentum last winter when the economic stimulus package set aside $19 billion for healthcare information technology. Currently, just 1.5 percent of private hospitals can claim a comprehensive electronic medical records system in all clinical units, according to a study published in the New England Journal of Medicine in April. An additional 7.6 percent have a basic system in at least one unit. But putting patient records into digital form and into the massive national database envisioned by President Obama has the potential, assuming it happens, to provide a wealth of information about which treatments work and which don't—and to speed diagnosis and medical care and curtail unnecessary tests and procedures.
A number of institutions offer a hint of what is possible. In the emergency department at Kaiser Permanente's Oakland Medical Center, doctors and nurses carry flat computer tablets about the size of a piece of paper that can access every Kaiser patient's entire medical record. If a patient has previously visited any Kaiser Permanente facility, ER staff can immediately call up his or her medications and any recent test results. They can also sit down next to a bed and show patients an X-ray, say. When Palomar Medical Center West near San Diego opens in 2012, patients will sleep on "LifeBeds" covered in "smart" fabric that records their heart rate, pulse, and respiration and sends the info directly to their medical record.
On a medical/surgical unit at the University of Pittsburgh Medical Center, a flat-screen monitor is mounted on the wall near the foot of every bed. Hospital staffers wear ultrasound ID tags, and as soon as they walk into the room, their name and job title pop up. The system then makes the appropriate chart information available onscreen—a phlebotomist would see what blood draws to do, for example, while a nursing assistant might see what medications are due. The patient has access to the information as well. "Everyone's engaged, sharing the same information," says Tami Minnier, chief quality officer for UPMC. That's important, say experts. Whereas medical practice has traditionally tended to be paternalistic, practitioners now believe that the sense of empowerment that patients get from being engaged in their care can lead to better outcomes. It's the "I think I can" approach.
Besides engaging people in decisions about their own care, hospital administrators are exploring ways that physical structure and environment can ease anxiety and promote wellbeing. "Evidence-based design" is inspired by studies suggesting that patients heal better if they have access to nature, natural light, and artwork, for example. In one oft-cited study, researchers found that surgical patients whose rooms looked out on trees used less heavy medication, suffered fewer minor complications, and went home nearly a day sooner than patients whose rooms looked out on a brick wall. The plans for Palomar Medical Center West call for a plant-filled central atrium and gardens at each end of every floor, and rooms with floor-to-ceiling windows looking out on the mountains, furnished so that family members can stay overnight.