Surgery, mHealth and the big data landscape

The opportunities for mobile health are endless. One area in which mhealth may allow improvement is in surgical education, where the traditional surgeon apprenticeship model is under threat from budget constraints and patient safety concerns. Andre Chow and Jean Nehme discuss.

The provision of high quality care is the universal aim of all healthcare systems and the individuals that work within it. However, huge variations exist in the quality of healthcare provision. This variation can occur between individual surgeons, departments, hospitals, regions and countries. More than ever, there is now an increased focus on healthcare transparency, and accountability for the standards of care that we provide. Large variations in performance are not tolerated, and healthcare systems and individuals are under pressure to continuously improve and to demonstrate that they are providing high quality care.

mHealth could play a crucial role within this environment, and has the ability to effect a paradigm shift in the way that we approach healthcare and patient management. The key is in the potential for mHealth applications to capture and process vast amounts of data.

You can’t improve what you can’t measure” is an old management adage, which applies just as well to healthcare as it does to other areas of life. Consider, for example, if golfers did not keep score, if students never knew the results of their tests, or if companies did not measure their sales. Without these simple key measurements, improvements in performance would be impossible.

Data is used currently in many different ways in healthcare. For example, individual patients and clinicians use blood sugar level data to directly alter a diabetic insulin regime. Colorectal surgeons keep track of their anastamotic leak rates to feed back on their surgical technique and patient management. Surgical departments keep track of postoperative length of stay to find ways of improving efficiency. Hospitals keep track of cases of MRSA to affect their antibiotic policies. Healthcare systems keep track of waiting list times to manage budgets and work force planning. The collection of data is crucial to maintaining and improving the quality of care that is provided.

“…healthcare is lagging significantly behind other industries when it comes to the use of data to affect performance.”

The use of data in healthcare has always been limited by two factors – the ability to collect the right data, and the ability to process, interpret and translate data into meaningful information. It is not surprising therefore that in a world where most of the world’s healthcare information is held in hastily scrawled hand-written notes in the basement archives of hospitals, that healthcare is lagging significantly behind other industries when it comes to the use of data to affect performance.

Digitization of healthcare records is undoubtedly an important task which is already being implemented in electronic health record systems at forward thinking hospitals. This will make storage, analysis, and processing of this large volume of data much more straightforward, and allow much more rapid cycles of change and improvements in performance.

Another area in which mHealth is likely to make a big impact is in community-based care. For the first time ever, clinicians now have the ability to directly access patients outside of the hospital system, and patients can directly communicate and transmit data in return. This can be collected and processed in the cloud with the potential for rapid feedback. Collecting data from patients in the community has always been a real weakness for healthcare systems. Now, through mHealth applications it may be possible to gain insight into important patient reported outcomes such as quality of life, which in the past has proven very difficult to measure. Although not a traditionally used outcome measure of healthcare, data on quality of life has a large part to play in regard to specialties, such as cancer care, where hard clinical outcomes must always be balanced against side effects and the patient experience. In an era where individual surgeons are now having their results accessible in the public arena, and hospitals are being stratified and scored by outcomes, the collection of this kind of data may come at just the right time to make a significant impact.

“One element that all these initiatives have in common is the need for developers and healthcare systems to collaborate and work together.”

Another area where mHealth may allow improvement is in the field of surgical education. With changes to working hours, budget constraints and patient safety concerns, the traditional apprenticeship model of surgical training is increasingly under threat. Surgeons are gaining much less operative experience than in years past, and there is a real danger that we will face a drop in surgical performance in the future as a result. Developments in the field of surgical simulation have responded to this challenge, but until now have always been limited by issues of accessibility and cost. Similarly, with new medical devices being released in increasing numbers, surgeons may have difficulty staying up to date with concerns over the safe introduction of these devices. With the majority of surgical professionals now carrying smartphones we have an opportunity to implement new curricula with interactive digital training combined with rapid personal feedback and improvement cycles. Needless to say this has implications also for revalidation programs which are in the pipeline.

One element that all these initiatives have in common is the need for developers and healthcare systems to collaborate and work together. Healthcare is a big business and is traditionally slow to adopt new technologies. This is in complete opposition to the agile and lean methodologies of the majority of software developers today. Therefore early contact between these two parties is essential. Without this collaboration, healthcare systems run the risk of being left behind in the world of data, and developers may never be able to make a significant difference to healthcare.

In summary, the future is surely a bright one. Supercomputers of yesteryear are now easily accessible and present in the pockets of the population. Powerful processing can now occur remotely and healthcare systems seem to be finally joining the digital world. Our responsibility, as medical professionals within the technology space, is to help guide development with a singular focus in mind – ensuring the best quality of care for patients. This will bring lasting value and the ability to make a real difference.

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About the authors:

Andre Chow is a General Surgeon with an academic background in Surgical Care Quality, Data Analysis and Tissue Engineering. Jean Nehme is a Plastic Surgeon with an honors degree in Surgical Simulation and Training. They are Co-Founders at Touch Surgery – a surgical training and education system built for mobile devices.

The Touch Surgery team aims to improve the practice of surgery worldwide using cutting edge and affordable technology. You can contact the team at andre@touch-surgery.com and jean@touch-surgery.com.

In what ways can mHealth improve surgical education?