Tuesday, April 30, 2013

Tech Reps in the Operating Room & Other Hoary Tales

So, I had just about finished all pre-surgical prepping.  I had bathed in antibacterial soap to make sure pathogens would flee from me in disgust.  I had listened to the soothing, melodic voice of a nurse, humming a Jay-Z melody, in her quest to lower my vitals.  Now, flat in my back on a gurney, I sign permission slips that would give the man the right to take away parts of me.  The anesthesiologist said I would no longer be required to count backward from a thousand.  Rather, I would slip off peacefully into some dream space, absent the heavy incest mutterings of Freud.  And just before I was wheeled into this action drama, with my sinuses playing a central character, I was asked to sign a waiver that gave permission for a salesperson/technologist to be present in the operating room.  I responded that this presence would be acceptable as long as there would be no transactions over my warm, still body during the four-hour surgery.  And protests rose in the amphitheater like angels pushing back from the heavens’ heavy cumulonimbus clouds.  I recall a nurse in the operating room saying that they would take care of me because they liked me.  I remember saying that I thought it was because I had insurance, thinking before I sank into that blissful pit of despond, that I shouldn’t joke too much with those who are about to cut.  But old habits die hard.

During the run-up to surgery, I noticed how technology is transforming even the most traditional medical practices, such as one I visit outside of Nyack, NY.  All conversations with the doctor are immediately digitized.  An electronic wand sweeps my forehead and my temperature is attained.   And so on.  Within hours, these digital files sit on my surgeon’s mobile device in NYC.

And this is hardly earth-shattering.  Portable technology, especially when imbedded in wearable devices, already allows much of this basic testing to be performed remotely.  Mobihealthnews reports that Sense4Baby, a fetal monitoring system, uses a wireless monitor that straps to the belly of the pregnant woman and transmits data about fetal and maternal heart rates and monitors contractions.  Data is sent via Bluetooth to a smartphone or tablet and is uploaded to a secure cloud.

Perhaps one of the most useful advances will come from maximizing the use of data and to better glean from social media sites what consumers are actually thinking and saying about pharmacology and treatment regimens.  Treato, an Israeli company, has developed and algorithm that scours thousands of social media sites.  Such insights will likely provide the next generation of patient intelligence.

Now back to the salesperson in the operating room.   Before my surgery, I had read at Venturebeat.com about Nurep, a startup that provides medical device support for physicians in the operating room.  From what I understand, this company enables medical device representatives to see more physicians, to increase sales, and cover a broader geography.  The service guarantees physicians 24/7 support in the operating room, including on-demand, virtual support.

For hospitals this is a very touchy issue and most have gone to considerable lengths to restrict access of device reps to physicians, the purchasing department, and the C-level suits.  Some places actually electronically track the presence of reps on the hospital floors.  This is vital oversight as where there is technology, there is big money.  In an earlier blog, I referred to Steven Brill’s masterful piece in Time Magazine about how new medical technologies are driving up patient costs and padding the wallets of executives.

On the other hand, we patients want our doctors to be technologically proficient.  A few years ago, I was undergoing another sinus surgery that involved imaging technology.  This is a useful extension of the surgeon’s eyes and hands when she is poking around the brain floor.  In this instance, the imagining technology failed and the surgeon continued “manually.”   I was not consulted.  And I was not happy about this hand-job.

I live close to Manhattan and am blessed with access to some of the best medical institutions in the world, including Roosevelt Hospital where I spent a little time.  Nonetheless, the adoption of technology is often tied to age, experience, and probably face time with Xbox.   I want my surgeon to be totally at ease with latest technology.  If she is comfortable with a tech rep at her side, so am I.

Just tell me long before I slip into that chemical bliss.

Thanks, Doc!

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