More Surgical Teams Using Real-Time 'Digital Playbooks'

Marcia Frellick

June 10, 2021

More surgeons are using a software solution in the operating room that walks the team through role-specific best practices for a procedure in real time, eliminating inconsistencies that come from varied experience levels and techniques.

The first 'digital playbook' for surgeries was developed by Chicago-based ExplORer Surgical as part of a three-part strategy: to reduce inefficiencies, cut costs, and improve outcomes to benefit surgeons and medical device makers.

Also available is remote, two-way, HIPAA-compliant connectivity so that surgeons can watch others doing a procedure in another location or serve as proctors, observing others who are learning a technique they are teaching. A third component of the software is data capture so that surgeons can know, for instance, how long each step of the surgery takes, and how that compares with surgeons nationally.

When comparing data, surgeons may find that some colleagues can consistently complete a certain step in the procedure in half the time as others. That could help them learn new techniques to reduce inefficiencies.

ExplORer data indicate that up to 10% of intraoperative time is spent on preventable delays, a waste consistent across most surgical specialties, Jennifer Fried, MBA, the company's cofounder and CEO, told Medscape Medical News.

Fried said that hundreds of healthcare providers and industry representatives use the ExplORer platform every month, and customer use is up 250% year over year.

She said that surgery is similar to aviation in the sense of having a takeoff and landing with checklists to complete along the way.

But pilots have instruments, indicators, and traffic controllers that provide constant support, she noted. That kind of support had been missing in the surgical realm.

Two other companies offer digital platforms to support surgeons, Fried said – Proximie and Avail.

While all three companies are focused on connectivity, she says, only ExplORer offers the playbook and data-capture components as well. 

The playbook will help replace some of the workarounds currently in use in operating rooms, such as surgeons putting together a PowerPoint presentation for a particular case or nurses taking notes in a notebook, she said.

ExplORer was founded in research in the Department of Surgery at the University of Chicago. Co-founder Alex Langerman, MD, a head and neck surgeon, and Fried, a healthcare venture capitalist who was doing graduate work at the university, launched the company in 2015 with funding from the National Science Foundation. In 2016, the company developed the commercial product.

ExplORer Surgical partners with medical device manufacturers who then contract with hospitals to install the software.

Fried declined to discuss costs for the software but said travel costs for surgeons have been greatly reduced since they can watch procedures on a screen from their own hospitals.

James Rickert, MD, an orthopedic surgeon with Indiana University Health in Bloomington, said his practice does not use these kind of support solutions, though he is familiar with them.

Rickert sees several benefits to ExplORer, among them a more seamless workflow. Having training available benefits both medical device makers and the surgeons, he said. Remote connectivity also saves surgeons from having to take time off work to get trained, perhaps in another city.

However, Rickert says he worries about a few things with such solutions.

One is that speeding up dissemination of instructions on doing a new procedure is not always preferable.

"The best example of that is metal-on-metal hips," he said. "They were widely in use way before it was understood that they had tons of problems," he said. "I'm not sure speeding the diffusion of use of a product is always necessarily the best thing."

He said he also worries that some surgeons may feel emboldened to try an overly complex procedure if they are tele-linked to an expert watching on a screen. Or surgeons may become too reliant on the technological support.

Rickert added that the remote experts are not actually in the operating room and that "a lot of [surgery] is feel and judgment and experience…If there's a complication you're still the only guy doing it."

He said he would like to see peer-reviewed research conducted on whether such solutions truly improve patient outcomes.

Fried is co-founder and CEO of ExplORer. Rickert has disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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