Tech Trends That Are Transforming Outpatient Care

Five innovations that have already made a major impact at today’s facilities.

Technology lends itself to a future-centric mindset. In a world where innovation occurs so rapidly, it’s natural to obsess over the game-changing products, devices and systems of tomorrow. But with all the recent advances in surgical technology, sometimes it’s worthwhile to step back and appreciate where we’re at today.

In addition to robotics and virtual reality simulation training — both of which were covered in detail in this issue — here are five other ways technology is currently transforming how providers deliver care in outpatient facilities.

1. Custom and smart implants. Custom implants are used in joint replacement surgery for patients with unique anatomical characteristics or specific defects. Previously, these implants were limited in options and relied on traditional manufacturing methods, but advancements in technology, particularly 3D printing, have revolutionized the manufacturing process, according to Mathias Bostrom, MD, chief of the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery (HSS) in New York City. “The ability to 3D-print with metals lets us design implants that are difficult to manufacture,” says Dr. Bostrom. “That’s been a game changer.” Currently, Dr. Bostrom says these implants are primarily used in patients who couldn’t get anything else due to their particular cases — and are understandably producing much better results than suboptimal off-the-shelf components.

Embedded with sensors in the small stem of the tibial component, smart implants capture much of the same data as accelerometers — step count, distance traveled, etc. — and transmit that data to providers who can view it via a cloud-based dashboard. The benefits are clear, but there are limitations. “The real issue right now with these implants is that they don’t collect continuous data, and providers don’t know how to best use the data yet,” says Seth A. Jerabek, MD, an orthopedic surgeon at HSS.

“If technology makes it easier to do something, people will learn to adapt to that technology.”
Joseph C. Kvedar, MD

2. AI in GI. While the potential of artificial intelligence (AI) in all facets of surgical care is on everyone’s mind, an increasing number of GI centers have already benefitted from this technology by helping gastroenterologists improve their adenoma detection rates (ADRs) by identifying difficult-to-see flat polyps and polyps hidden by folds. With AI technology, a box is connected to the endoscope’s light source and the AI functionality highlights areas on the screen where a suspected polyp may be — even making an optional sound alert.

“It’s well documented that polyps can be missed during colonoscopy due to several reasons, including failure of recognition, particularly if the angle of view isn’t right or there is a reflection or other visual block,” says Ahmed Saeed, MD, of Premier Gastroenterology of Kansas City (Mo.). “That’s where AI comes in. It assists with adenoma detection by highlighting polyp areas we couldn’t normally see with speed and accuracy.”

Dr. Saeed began using AI in colonoscopy procedures as an adjunct to increase ADR when the technology received FDA market approval in 2021. Although in his own experience Dr. Saeed says the alerts from the technology are highly accurate, he understands it is an adjunct tool secondary to the surgeon’s skill. “It’s the physician’s responsibility to evaluate the area it highlights and confirm it’s a polyp that needs to be removed,” he says.

3. Superior visualization. The steady shift from standard HD imaging to 4K imaging systems has been occurring at facilities large and small for years — and the benefits of improved visualization can result in new procedures being performed for the first time in an ASC setting. Case in point: endoscopic spine surgery (ESS), an extra-minimally invasive approach to treating patients with chronic back and leg pain that uses a high-definition camera attached to an endoscope inserted through a tiny incision — or dual incisions. Although ESS has been traditionally performed at hospitals, technological advances in visualization are expediting its migration to ASC.

“A significant advancement in the field of ESS is the evolution of the high-definition camera,” says Alex Vaccaro, MD, PhD, MBA, president of Rothman Orthopaedic Institute in Philadelphia. “This is extremely important to allow optimal visualization of all the neurovascular structures, surrounding soft tissues and bone.”

IN YOUR IMAGE Custom knee replacements improve overall function by replicating each patient’s natural anatomy.  |  Edward Westerheide

4. Handheld ultrasound. Nerve blocks are the most targeted form of analgesia available, and the precision of regional anesthesia stems from the ultrasound technology providers use to pinpoint the correct anatomical site. However, traditional laptop-style ultrasound devices with at least two probes can be pricey — ranging from $25,000 to $60,000. Handheld ultrasound devices that employ semiconductor technology and use a single probe head for multiple uses can be purchased for $2,000 to $9,000, making them a budget-friendly option for facilities with razor-thin margins.

“The handhelds, which attach to your phone, are versatile and vary in quality based on how expensive they are,” says Michael A. MacKinnon, DNP, FNP-C, CRNA, MSN, an anesthesia provider at Northeastern Anesthesia and host of popular podcast Anesthesia Deconstructed. “It all comes down to what sort of fidelity you need for what you’re doing and how much that fidelity will impact your ability to block the patient, which of course determines the outcome of the block.”

Dr. MacKinnon adds that if your budget is $10,000, consider a new handheld over a used laptop-style machine, because the fidelity of a top-of-the-line handheld will exceed that of an older laptop. As more players enter the handheld ultrasound market and data accumulates to support the efficacy of these portable tools, expect even greater adoption by anesthesia providers.

5. Patient apps. While some ASCs still rely on phone calls to remind patients when to arrive and hand out printed discharge instructions, most now use automation to handle the calls. Mobile health apps have helped surgical facilities do everything from settle the nerves of waiting family members to share essential pre- and post-op instructions to send friendly reminders about coming-due payments. Smartphone-based patient communication apps vary greatly depending on the application provider, but the data suggests they generally improve outcomes, reduce surgical cancelations, decrease patient misunderstanding and increase compliance with instructions.

What about pushback from technology-challenged patients? Resistance is lower than ever, says Joseph C. Kvedar, MD, a Harvard Medical School professor and board chairman of the American Telemedicine Association, a nonprofit that provides clinical practice guidelines for virtual care. “If technology makes it easier to do something, people will learn to adapt to that technology,” he says. “They’ll do it enthusiastically because it makes their lives easier, and it makes it easier for them to take care of themselves.”

Dr. Kvedar’s point is astute, as the technologies we’ve just highlighted each make life easier for patients and providers alike. OSM