U.S. patent application number 16/366345 was filed with the patent office on 2019-07-18 for systems and methods for surgical and interventional planning, support, post-operative follow-up, and functional recovery trackin.
The applicant listed for this patent is DePuy Synthes Products, Inc.. Invention is credited to Jennifer DiPietro, William J. Frasier, William C. Horton, Namal Nawana, Michael O'Neil, Matthew Parsons, Robert E. Sommerich.
Application Number | 20190216452 16/366345 |
Document ID | / |
Family ID | 50275366 |
Filed Date | 2019-07-18 |
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United States Patent
Application |
20190216452 |
Kind Code |
A1 |
Nawana; Namal ; et
al. |
July 18, 2019 |
SYSTEMS AND METHODS FOR SURGICAL AND INTERVENTIONAL PLANNING,
SUPPORT, POST-OPERATIVE FOLLOW-UP, AND FUNCTIONAL RECOVERY
TRACKING
Abstract
Various systems and methods are provided for surgical and
interventional planning, support, post-operative follow-up, and
functional recovery tracking. In general, a patient can be tracked
throughout medical treatment including through initial onset of
symptoms, diagnosis, non-surgical treatment, surgical treatment,
and recovery from the surgical treatment. In one embodiment, a
patient and one or more medical professionals involved with
treating the patient can electronically access a comprehensive
treatment planning, support, and review system. The system can
provide recommendations regarding diagnosis, non-surgical
treatment, surgical treatment, and recovery from the surgical
treatment based on data gathered from the patient and the medical
professional(s). The system can manage the tracking of multiple
patients, thereby allowing for data comparison between similar
aspects of medical treatments and for learning over time through
continual data gathering, analysis, and assimilation to
decision-making algorithms.
Inventors: |
Nawana; Namal; (Weston,
MA) ; Horton; William C.; (Duxbury, MA) ;
Frasier; William J.; (New Bedford, MA) ; O'Neil;
Michael; (Mansfield, MA) ; Sommerich; Robert E.;
(Norton, MA) ; DiPietro; Jennifer; (North Easton,
MA) ; Parsons; Matthew; (Dartmouth, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
DePuy Synthes Products, Inc. |
Raynham |
MA |
US |
|
|
Family ID: |
50275366 |
Appl. No.: |
16/366345 |
Filed: |
March 27, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
13803763 |
Mar 14, 2013 |
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16366345 |
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61739514 |
Dec 19, 2012 |
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61702073 |
Sep 17, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2010/0093 20130101;
G16H 50/70 20180101; A61B 17/50 20130101; A61B 34/10 20160201; A61B
5/742 20130101; G16Z 99/00 20190201; A61B 2017/00115 20130101; A61B
2017/0262 20130101; G06Q 10/10 20130101; A61B 5/0022 20130101; A61B
2010/009 20130101; G01L 5/00 20130101; A61B 2034/105 20160201; A61B
2034/101 20160201; G16H 50/20 20180101; A61B 34/20 20160201; G06F
19/321 20130101; A61B 5/4848 20130101; A61B 5/746 20130101; A61B
17/02 20130101; A61B 2034/254 20160201; A61B 6/485 20130101; A61B
17/025 20130101; A61B 5/7282 20130101; A61B 34/25 20160201; G06Q
10/00 20130101; G16H 50/50 20180101; A61B 5/7475 20130101; A61B
8/08 20130101; A61B 5/4824 20130101; G16H 40/20 20180101; A61B
5/4833 20130101; A61B 2034/2057 20160201; A61B 5/4509 20130101;
A61B 2034/256 20160201; A61B 5/1118 20130101; G16H 10/20 20180101;
A61B 5/4566 20130101; A61B 5/4571 20130101; A61B 2034/252 20160201;
A61B 2017/00119 20130101; G06Q 50/24 20130101; A61B 6/506 20130101;
A61B 2034/2055 20160201; G06F 19/325 20130101; A61B 6/4494
20130101; G16H 40/40 20180101; G16H 40/63 20180101; G06F 19/3481
20130101 |
International
Class: |
A61B 17/02 20060101
A61B017/02; G06Q 10/00 20060101 G06Q010/00; G16H 50/70 20060101
G16H050/70; G16H 50/50 20060101 G16H050/50; G16H 40/40 20060101
G16H040/40; G16H 40/20 20060101 G16H040/20; G16H 40/63 20060101
G16H040/63; G16H 10/20 20060101 G16H010/20; A61B 8/08 20060101
A61B008/08; G16H 50/20 20060101 G16H050/20; A61B 6/00 20060101
A61B006/00; A61B 5/00 20060101 A61B005/00; A61B 5/11 20060101
A61B005/11; G01L 5/00 20060101 G01L005/00; G06Q 10/10 20060101
G06Q010/10; A61B 34/20 20060101 A61B034/20; A61B 34/10 20060101
A61B034/10; A61B 34/00 20060101 A61B034/00; A61B 17/50 20060101
A61B017/50 |
Claims
1. A method for a patient-specific surgical procedure, comprising:
causing a customized surgical plan to be loaded onto an augmented
reality device; and performing an orthopaedic surgical procedure
with the augmented reality device in accordance with the customized
surgical plan, wherein performing the orthopaedic surgical
procedure includes selecting a surgical instrument based on
information displayed by the augmented reality device and operating
the surgical instrument based on visual indications provided by the
augmented reality device.
2. The method of claim 1, wherein the visual indications provided
by the augmented reality device include a digital template of the
patient's bone overlaying the patient's actual bone.
3. The method of claim 2, wherein the augmented reality device is
operable to change the digital template when the surgical
instrument is properly positioned relative to the patient's
bone.
4. The method of claim 1, wherein a display of the augmented
reality device changes in response to a position of the surgical
instrument changing during the operation of the surgical
instrument.
5. The method of claim 1, wherein performing the orthopaedic
surgical procedure includes positioning the surgical instrument to
permit the augmented reality device to identify the surgical
instrument.
6. The method of claim 1, wherein performing the orthopaedic
surgical procedure with the augmented reality device includes
accessing the customized surgical plan on the augmented reality
device to display a three dimensional rendered image of a patient's
bone.
7. The method of claim 6, wherein accessing the customized surgical
plan on the augmented reality device to display the three
dimensional rendered image of the patient's bone includes
displaying a digital template of the patient's bone overlaying the
patient's actual bone on a display of the augmented reality
device.
8. The method of claim 7, wherein the display of the augmented
reality device changes when the surgical instrument is properly
positioned relative to the patient's bone.
9. The method of claim 1, wherein the augmented reality device
includes a head-mounted device.
10. A method of utilizing a patient-specific surgical plan, the
method comprising: providing surgical plan information on a
display; identifying a surgical instrument; updating the surgical
plan information based on the surgical instrument; monitoring a
position of the surgical instrument; and providing an indication to
a user when the surgical instrument is properly positioned relative
to a patient's bone.
11. The method of claim 10, wherein the indication is a visual
indication.
12. The method of claim 11, wherein the visual indication includes
a digital template of a patient's bone.
13. The method of claim 12, wherein providing the visual indication
includes changing the digital template to indicate to the user when
the surgical instrument is properly positioned relative to the
patient's bone.
14. The method of claim 10, wherein the surgical plan information
includes patient-specific medical images.
15. A system for utilizing a patient-specific surgical plan,
comprising: a surgical instrument including a tag; and an augmented
reality device including a display, a sensor operable to scan the
tag and generate an electronic signal, and a controller operable
to: (i) receive the electronic signal, (ii) determine a position of
the surgical instrument based on the electronic signal, and (iii)
operate the display to provide an indication to a user when the
surgical instrument is properly positioned relative to a patient's
bone.
16. The system of claim 15, wherein the controller is operable to
operate the display to overlie a digital template of the patient's
bone on a patient's actual bone.
17. The system of claim 16, wherein the controller is operable to
operate the display to change the digital template when the
surgical instrument is properly positioned relative to the
patient's bone.
18. The system of claim 16, wherein the controller is operable to
operate the display to change the digital template during movement
of the surgical instrument before the surgical instrument is
properly positioned relative to the patient's bone.
19. The system of claim 15, wherein the controller is operable to
operate the display to provide surgical plan information on the
display.
20. The system of claim 15, wherein the augmented reality device
includes a head-mounted device.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] The present application claims priority to U.S. patent
application Ser. No. 13/803,763 entitled "Systems And Methods For
Surgical And Interventional Planning, Support, Post-Operative
Follow-Up, And Functional Recovery Tracking" filed Mar. 14, 2013,
which claims priority to U.S. Provisional Patent Application No.
61/702,073 entitled "Systems And Methods For Surgical Planning,
Support, And Review" filed Sep. 17, 2012 and to U.S. Provisional
Patent Application No. 61/739,514 entitled "Systems And Methods For
Surgical Planning, Support, And Review" filed Dec. 19, 2012, which
are hereby incorporated by reference in their entireties.
FIELD
[0002] The present disclosure relates generally to systems and
methods for surgical and interventional planning, support,
post-operative follow-up, and functional recovery tracking. More
particularly, the present disclosure relates to planning,
supporting, and reviewing surgeries that involve medical devices,
e.g., medical implants and instruments.
BACKGROUND
[0003] A traditional model for planning surgeries that involve
medical devices includes several phases. These phases typically
include wellness and prevention, diagnosis, and treatment.
[0004] The wellness and prevention phase typically involves a
patient a monitoring their own health and having periodic check-up
visits with a physician. The diagnosis phase typically involves the
physician determining an ailment of the patient when the physician
determines that the patient has a health problem. The physician can
reach the diagnosis by consulting any one or more knowledge
sources, such as their previous experience and knowledge,
consultation with colleague(s), review of print and/or electronic
literature, and review of diagnostic tests/procedures.
[0005] During the treatment phase, the physician typically
determines a treatment plan for the patient to address the
diagnosis, e.g., to relieve the patient of symptom(s). The
treatment plan for many types of musculoskeletal and neurological
diagnoses, for example, typically begins with a conservative,
non-surgical treatment involving one or more therapies such as diet
modification, exercise, medication, rest, limb elevation, limb
mobilization, physical therapy, chiropractic care, etc. If the
conservative, non-surgical treatment fails to adequately address
the diagnosis, e.g., fails to adequately remedy the patient's
symptom(s), or if the physician determines that the patient's
condition is such that an approach more aggressive than a
conservative, non-surgical treatment is needed to achieve desired
results, the physician typically modifies the treatment plan to
include a less conservative treatment. For diagnoses involving
joint and/or bone ailments, e.g., spine ailments such as scoliosis,
shoulder ailments such as injured rotator cuffs, knee ailments such
as injured ACLs, etc., the less conservative treatment typically
includes at least one invasive procedure such as injection therapy
or a surgical procedure. Determining which surgical procedure to
perform on the patient and determining which surgical techniques
and medical devices to use in the selected surgical procedure
typically involves a significant amount of time and planning by at
least the performing surgeon.
[0006] Planning each surgical procedure also logistically typically
involves coordination of numerous hospital resources. This planning
also typically involves coordination with the patient for
outpatient preparation and testing. A traditional model for
supporting and managing surgeries that involve medical devices
includes several phases. These phases typically include surgical
planning, inventory planning, intra-operative support, post-surgery
logistics, and charge capture or billing
[0007] During the surgical planning phase, a surgeon or a staff
member at the surgeon's office contacts the hospital where the
surgery is to be performed to schedule resources such as operating
rooms, equipment, and support staff. The hospital maintains a
surgery schedule using a spreadsheet, whiteboard, or internal
enterprise resource planning system that includes information such
as the type of surgery, the name of the surgeon, the date the
surgery is to be performed, and the supply and equipment needs of
the surgery. A representative of a medical device company obtains
the surgery schedule periodically and, for each surgery that
involves a medical device provided by the medical device company,
meets with the surgeon to discuss a plan for the surgery.
[0008] After establishing a plan for the surgery, the
representative orders the various medical devices believed to be
necessary for the surgery in the inventory planning phase. The
medical devices are shipped from the medical device company or a
distributor affiliated therewith to the representative, who is then
responsible for providing the medical devices to the hospital for
sterilization in advance of the surgery.
[0009] Prior to the surgery, the representative is typically relied
upon to provide pre-surgery training on any new or modified medical
devices or instruments. Such training can include use of hands-on
demonstration equipment or review of surgical brochures provided by
the medical device manufacturer. The representative is generally
responsible for selecting and executing the appropriate training,
based on the available supporting materials.
[0010] During the surgery itself, the representative is typically
present in the operating room, regardless of the complexity of the
surgery, to provide technical support to the surgeon and staff. The
representative is also present to track consumption of inventory as
well as components in need of maintenance or replacement.
[0011] After the surgery, the representative ensures that consumed
inventory is replenished and that reusable instruments are
sterilized and prepared for subsequent use.
[0012] Finally, the representative assists hospital staff in
completing paperwork that identifies the patient and the inventory
consumed. A purchasing group at the hospital reviews the paperwork
and transmits it to the medical device company or its distributor.
A manual reconciliation process occurs thereafter to determine
billing amounts and to trigger inventory replenishment.
[0013] There are a number of inefficiencies associated with
existing surgery planning, support, and management models. For
example, by the time a patient consults a physician regarding
self-detected symptom(s), the patient may have difficulty
remembering the exact timing and/or intensity of symptom
progression over a period of days, weeks, or months, which can
adversely affect a physician's ability to accurately diagnosis a
problem and/or determine the necessary aggressiveness of
treatment.
[0014] For another example, during treatment, it can be difficult
for a physician to monitor the patient's progress and compliance
with the treatment, particularly during non-surgical treatment in
which the patient is not under direct medical care, e.g., in a
hospital, at physical therapy, etc, and more particularly when the
patient is not under daily supervision of medical care.
Additionally, the patient may provide inaccurate treatment progress
information to the physician, such as by forgetting the exact
timing of treatments performed at home or by being embarrassed to
reveal failures in maintaining the suggested treatment and
therefore not providing the physician with completely accurate
information, and/or the patient may accidentally not perform a
recommended treatment as instructed, such as by improperly
performing an exercise, misunderstanding diet requirements, by
forgetting to take medication at a recommended time, etc. The
physician may therefore have difficulty determining whether and how
to modify the patient's treatment plan, which can delay and/or
hinder the patient's healing.
[0015] For example, during planning of a surgical procedure, a
surgeon is typically more likely to perform a familiar,
previously-performed procedures and use familiar, previously-used
medical devices, e.g., to increase the surgeon's comfort and
confidence in performing the surgery and to decrease the amount of
time necessary to prepare for the surgery. However, the patient may
thus not benefit from newer, improved surgical techniques and
medical devices and/or from more effective treatments for specific
symptoms.
[0016] For another example, a surgeon may plan a certain
intervention but not fully execute the plan for any one or more
reasons, e.g., wrong site surgery, unintended malposition of a
device, and inadequate decompression of a nerve or alignment of
anatomic elements.
[0017] For yet another example, a large portion of the
representative's time is spent in the operating room during routine
procedures in which the representative's assistance is rarely if
ever necessary. The representative also spends a significant amount
of time completing paperwork and performing surgical planning,
inventory management, and other logistical tasks. This time could
be better spent supporting more complex surgeries in which
representative input is crucial, or generating new business for the
medical device company. Furthermore, there are significant costs
associated with employing a large staff of representatives.
[0018] These models also suffer from a number of inventory-related
inefficiencies. For example, in the field of orthopedics, medical
device kits are typically assembled so as to provide the necessary
implants, tools, and instruments for any of a variety of types of
surgery, ranging from the most routine to extraordinarily complex.
As a result, many of the medical devices in the kit are not used
during routine procedures, and are needlessly transported,
inventoried, tracked, processed, sterilized, etc.
[0019] Accordingly, there remains a need for improved systems and
methods for surgical and interventional planning, support,
post-operative follow-up, and functional recovery tracking.
SUMMARY
[0020] The present invention generally provides systems and methods
for surgical and interventional planning, support, post-operative
follow-up, and functional recovery tracking.
[0021] In one aspect, a medical system is provided that in one
embodiment includes a processor configured to receive treatment
plan data regarding a plurality of patients. The treatment plan
data includes a plan of medical treatment corresponding to each of
the patients. Each of the plans have associated therewith at least
one medical diagnosis in common with all of the plans. The
processor is also configured to determine effectiveness of each of
the plans and to determine a suggested plan of medical treatment
for a patient based on the determined effectiveness. The patient
has the at least one medical diagnosis. The processor is also
configured to provide the suggested plan to a user.
[0022] The system can vary in any number of ways. For example, the
processor can be configured to receive compliance data regarding
compliance of the patients with their corresponding plans, and
determining the effectiveness can include determining based on the
compliance data an extent of each patient's compliance with their
corresponding plans. Determining the suggested plan can include
choosing at least a one of the plans having a highest level of
compliance. For another example, the plans for a first subset of
the patients can include a non-surgical treatment, the plans for a
second subset of the patients can include a surgical treatment, and
determining the suggested plan can include comparing outcomes of
the non-surgical treatments with outcomes of the surgical
treatments. Determining the suggested plan can include choosing at
least a one of the plans having a best outcome among the surgical
treatments and the non-surgical treatments. For still another
example, determining the effectiveness can include determining an
effect of each of the plans on the at least one medical diagnosis,
and determining the suggested plan can include choosing at least a
one of the plans having a most desired effect on the at least one
medical diagnosis. For another example, the processor can be
configured to receive performance data regarding performances of
surgical procedures included in each of the plans that include
performance of the surgical procedure as at least part of the
medical treatment, and determining the effectiveness can include
choosing at least a one of the plans based at least on the
performance data. For another example, the system can include a
display, and providing the suggested plan can include showing the
suggested plan on the display.
[0023] In another embodiment, a medical system is provided in that
includes a storage unit and a processor. The storage unit is
configured to store a plurality of medical diagnoses and store a
plurality of medical treatments. Each of the diagnoses has a
plurality of patient-specific factors associated therewith. The
patient-specific factors include at least symptoms. Each of the
treatments having one or more of the medical diagnoses associated
therewith. The storage unit also stores an effectiveness of each of
the treatments as related to their associated one or more medical
diagnoses. The processor is configured to receive symptom data
indicating a plurality of symptoms experienced by a patient,
determine which one or more of the stored medical diagnoses are
associated with the received plurality of symptoms, provide the
determined medical diagnoses to a user, determine which one or more
of the treatments are associated with the determined medical
diagnoses, and provide at least one of the determined treatments to
the user. The at least one of the determined treatments has the
highest effectiveness associated therewith.
[0024] The system can have any number of variations. For example,
the stored effectiveness for each of the treatments can be based on
any one or more of compliances of previous patients with a
treatment plan associated with the treatment, an effect of the
treatment on the one or more medical diagnoses associated
therewith, an outcome a surgical procedure included as part of the
treatment, and compliances of previous patients with a post-surgery
treatment plan associated with the surgical procedure. For another
example, the system can include a display. Providing the determined
medical diagnoses can include showing the determined medical
diagnoses on the display, and providing the at least one of the
determined treatments can include showing the at least one of the
determined treatments on the display.
[0025] In another embodiment, a medical system is provided that
includes a processor configured to receive plan data regarding a
virtual performance of a surgical procedure on a patient, and to
receive performance data regarding an actual performance of the
surgical procedure on the patient. The performance data is received
in real time with the actual performance of the surgical procedure.
The processor is also configured to determine if the plan data
varies from the performance data. If the plan data is determined to
vary from the performance data, the processor is configured to
provide a warning to a user and to repeat the determining for
subsequent performance data received in real time with the actual
performance of the surgical procedure. The warning includes an
indication of the determined variance. If the plan data is
determined to not vary from the performance data, the processor is
configured to repeat the determining for subsequent performance
data received in real time with the actual performance of the
surgical procedure.
[0026] The system can vary in any number of ways. For example, the
processor can be configured to receive plan data regarding a
plurality of virtual performances of the surgical procedure on a
plurality of patients, and to receive performance data regarding a
plurality actual performances of the surgical procedure on the
plurality of patients. The performance data is received in real
time with the actual performances of the surgical procedures. The
processor can also be configured to determine if the plan data
regarding the plurality of virtual performances varies from the
performance data regarding the plurality actual performances,
determine if any one or more of the determined variances are a same
type of variance, and provide a recommendation to a user performing
another virtual performance of the surgical procedure based on the
one or more determined variances determined to be the same type of
variance. For another example, the indication of the determined
variance can include a recommended course of action to match the
actual performance of the surgical procedure to the virtual
performance of a surgical procedure. For yet another example, the
processor can be configured to collate all of the determined
variances of the plan data from the performance data and of the
plan data for the subsequent performance data, and to provide the
collated determined variances in a report. The report can be a
paper report or an electronic report. For yet another example, a
type of the received performance data can include at least one of
data regarding movement of a surgical instrument being used in the
actual performance of the surgical procedure, movement of staff
present for the actual performance of the surgical procedure,
patient vital signs, identification of a surgical instrument being
used in the actual performance of the surgical procedure,
identification of staff present in the actual performance of the
surgical procedure, an amount of tissue retraction, a duration of
tissue retraction, and one or more real time images of the patient
acquired during the actual performance of the surgical procedure. A
type of the received plan data can correspond to the type of the
received performance data. For still another example, the
determined variance can include at least one of a surgical
instrument being moved relative to the patient than in the actual
performance of the surgical procedure different than in the virtual
performance of the surgical procedure, a surgical implant being
used in the actual performance of the surgical procedure being
implanted at a different location within the patient than the
surgical implant used in the virtual performance of the surgical
procedure, different radiation exposures in the actual performance
of the surgical procedure and the virtual performance of the
surgical procedure, different lengths of tissue retraction time in
the actual performance of the surgical procedure and the virtual
performance of the surgical procedure, different pharmaceutical
administration to the patient in the actual performance of the
surgical procedure than in the virtual performance of the surgical
procedure, a different number of staff being present in the actual
performance of the surgical procedure than a number of virtual
staff present in the virtual performance of the surgical procedure,
a different duration of a step in the actual performance of the
surgical procedure than in the virtual performance of the surgical
procedure, a different surgical instrument being used in a step of
the actual performance of the surgical procedure than in the
virtual performance of the surgical procedure, and a step performed
in the virtual performance of the surgical procedure not having
been performed in the actual performance of the surgical procedure.
For another example, the warning can include at least one of an
audible sound, an illuminated light, a flashing light, a vibration
of a surgical instrument being used in the actual performance of
the surgical procedure, and a text warning on a display.
[0027] In another embodiment, a medical system is provided that
includes a processor configured to receive post-surgery treatment
plan data regarding a plurality of patients. The post-surgery
treatment plan data includes a plan of medical treatment
corresponding to each of the patients. Each of the plans has
associated therewith at least one surgical procedure in common with
all of the plans. The processor is also configured to determine an
effectiveness of each of the plans, and to determine a suggested
plan of medical treatment for a patient based on the determined
effectiveness. The patient has had the at least one surgical
procedure performed thereon. The processor is also configured to
provide the suggested plan to a user.
[0028] The system can have any number of variations. For example,
the processor can be configured to receive compliance data
regarding compliance of the patients with their corresponding
plans, and determining the effectiveness can include determining
based on the compliance data an extent of each patient's compliance
with their corresponding plans. Determining the suggested plan can
include choosing at least a one of the plans having a highest level
of compliance. For another example, determining the effectiveness
can include determining an effect of each of the plans on at least
one medical diagnosis, and determining the suggested plan can
include choosing at least a one of the plans having a most desired
effect on the at least one medical diagnosis. The patient has been
diagnosed with the at least one medical diagnosis. For yet another
example, the system can include a display, and providing the
suggested plan can include showing the suggested plan on the
display.
[0029] In another embodiment, a medical system is provided that
includes a diagnosis and treatment module, a pre-op module, an
operation module, a post-op module, and a recovery module. The
diagnosis and treatment module receives information regarding a
plurality of symptoms of a patient from the patient, receives
augmented information regarding the plurality of symptoms of the
patient from a medical professional, provides a recommended
non-surgical treatment for the patient based on at least the
information regarding the plurality of symptoms and the augmented
information, allows selection of a non-surgical treatment for the
patient from a plurality of available non-surgical treatments
including at least the recommended non-surgical treatment, receives
information regarding compliance of the patient with the selected
non-surgical treatment, provides a recommended invasive treatment
for the patient based on at least one of the information regarding
compliance, the information regarding the plurality of symptoms,
and the augmented information, and allows selection of an invasive
treatment for the patient from a plurality of available invasive
treatments including at least the recommended invasive treatment.
The pre-op module allows a three-dimensional electronic simulation
of the selected invasive treatment to be performed on a virtual
patient using a plurality of virtual instruments. The virtual
patient is a model of the patient based on gathered medical data
regarding the patient, and each of the plurality of virtual
instruments are modeled on an actual instrument available for use
in the selected invasive treatment. The pre-op module also stores
the electronic simulation in a storage unit. The operation module
compares an actual performance of the selected invasive treatment
on the patient with the stored electronic simulation, provides
electronic feedback regarding the comparison during the actual
performance of the selected invasive treatment that indicates
progress of the actual performance of the selected invasive
treatment versus the stored electronic simulation, triggers an
alarm if the comparison indicates that a step of the actual
performance of the selected invasive treatment differs from the
stored electronic simulation beyond a predetermined threshold
amount of tolerable variance, and stores data regarding the actual
performance of the selected invasive treatment in the storage unit.
The post-op module compares the stored electronic simulation with
the stored data regarding the actual performance of the selected
invasive treatment, and, based on the comparison of the stored
electronic simulation with the stored data regarding the actual
performance of the selected invasive treatment, determines a
variance between the stored electronic simulation and the stored
data regarding the actual performance of the selected invasive
treatment in the storage unit. The recovery module provides a
recommended post-op treatment plan for the patient based on at
least the stored data regarding the actual performance of the
selected invasive treatment, allows selection of a post-op
treatment for the patient from a plurality of available post-op
treatments including at least the recommended post-op treatment,
receives information regarding compliance of the patient with the
selected post-op treatment plan, and provides a recommended
follow-up treatment for the patient based at least on the
information regarding compliance of the patient with the
recommended post-op treatment plan.
[0030] The system can vary in any number of ways. For example, the
system can include a processor configured to execute the functions
performed by the diagnosis and treatment module, the pre-op module,
the operation module, the post-op module, and the recovery module.
The system can also include a storage unit storing the diagnosis
and treatment module, the pre-op module, the operation module, the
post-op module, and the recovery module. The processor and the
storage unit can be included in a singular unit. The system can be
provided with only a subset of the diagnosis and treatment module,
the pre-op module, the operation module, the post-op module, and
the recovery module. Each of the diagnosis and treatment module,
the pre-op module, the operation module, the post-op module, and
the recovery module can be modular components such that any one or
more of the diagnosis and treatment module, the pre-op module, the
operation module, the post-op module, and the recovery module can
be selectively added to the system and removed from the system.
[0031] The diagnosis and treatment module can vary in any number of
ways. For example, the diagnosis and treatment module can receive
information regarding at least one of a plurality of
patient-specific factors regarding the patient. The
patient-specific factors can include any one or more of physical
examination data, images of the patient, laboratory test results
for the patient, demographic data for the patient, and/or on
historical tests for the patient. Receiving the information
regarding the at least one of the plurality of patient-specific
factors can include receiving data from a plurality of sensors,
e.g., a smartphone camera. The recovery module can receive
information from the plurality of sensors after the actual
performance of the selected invasive treatment. The recommended
follow-up treatment can be based at least in part on the
information from the plurality of sensors. The information
regarding the at least one of the plurality of patient-specific
factors can include receiving data regarding a scoliotic curve of
the patient. The diagnosis and treatment module can provide
modeling of potential curve progression to the patient based at
least in part on the data regarding the scoliotic curve. The
recovery module can provide modeling of potential curve progression
to the patient based at least in part on the data regarding the
scoliotic curve and on the stored data regarding the actual
performance of the selected invasive treatment. The information
regarding the at least one of the plurality of patient-specific
factors can include receiving data regarding any one or more of
mobility, gait, walking speed, flexibility, muscular strength,
posture, range of motion, pain, neurologic tracking, joint movement
tracking, bone density, and musculo-skeletal pain levels. For bone
density, the diagnosis and treatment module can be configured to
gather the bone density information using an image of the patient
including an image of a bone density marker including a first
material having a first density and a second material having a
second density.
[0032] For another example, the diagnosis and treatment module
receiving the information regarding the plurality of symptoms can
include receiving data from a plurality of sensors, e.g., a
smartphone camera. The recovery module can receive information from
the plurality of sensors after the actual performance of the
selected invasive treatment. The recommended follow-up treatment
can be based at least in part on the information from the plurality
of sensors. For yet another example, the diagnosis and treatment
module receiving the information regarding the plurality of
symptoms can include receiving data from a neural mapping device.
The diagnosis and treatment module can measure a pain level of the
patient by comparing the patient's neural map and associated
self-described pain scores to a plurality of neural maps regarding
a plurality of other patients and to a plurality of self-described
pain scores of the plurality of other patients, thereby allowing
the diagnosis and treatment module to normalize the self-described
pain levels of the patient and the plurality of other patients. For
another example, the diagnosis and treatment module can provide a
historical success rate for each of the plurality of available
surgical treatments. For yet another example, the diagnosis and
treatment module can provide access to one or more knowledge
sources regarding the recommended invasive treatment. The knowledge
resources can include any one or more of print literature,
electronic literature, training, and experts. For still another
example, the diagnosis and treatment module can provide a suggested
diagnosis for the patient based on at least the information
regarding the plurality of symptoms and the augmented information.
The diagnosis and treatment module can provide the suggested
diagnosis comprises providing a plurality of suggested diagnoses.
Each of the plurality of suggested diagnoses can be provided with a
level of confidence based at least on historical accuracy of the
diagnosis for patients having similar symptoms to the plurality of
symptoms. The levels of confidence can be based at least on a
comparison of a plurality of attributes associated with the patient
and a plurality of attributes associated with the diagnosis. For
another example, the diagnosis and treatment module providing the
recommended non-surgical treatment can include providing a
plurality of recommended non-surgical treatments. Each of the
plurality of recommended non-surgical treatments can be provided
with a level of confidence of success based at least on historical
outcomes of the non-surgical treatment. The levels of confidence
can be based at least on a comparison of a plurality of attributes
associated with the patient and a plurality of attributes
associated with the non-surgical treatment. For yet another
example, the diagnosis and treatment module providing the
recommended invasive treatment can include providing a plurality of
recommended invasive treatments. Each of the plurality of
recommended invasive treatments can be provided with a level of
confidence of success based at least on historical outcomes of the
invasive treatment. The levels of confidence can be based at least
on a comparison of a plurality of attributes associated with the
patient and a plurality of attributes associated with the invasive
treatment.
[0033] The pre-op module can vary in any number of ways. For
example, the pre-op module can monitor the patient in a hospital
prior to performance of the actual performance of the selected
invasive treatment at the hospital. The monitoring can include at
least one of vital signs of the patient, pre-op preparations
performed on the patient, and a location of the patient in the
hospital. Based on the monitoring, the pre-op module can trigger at
least one of an operating room preparation for the actual
performance of the selected invasive treatment and a recovery room
preparation for the actual performance of the selected invasive
treatment.
[0034] The operation module can have any number of variations. For
example, the operation module can track a number of instruments
used in the actual performance of the selected invasive procedure.
For another example, the operation module can track a number of
times each of the instruments used in the actual performance of the
selected invasive procedure have been used in a plurality of
invasive procedures. The post-op module can trigger an alarm when
the number of times for any one or more of the instruments exceeds
a predetermined threshold number, the predetermined threshold
number reflecting at least one of a maximum number of times an
instrument can be used in invasive procedures before needing
sharpening, a maximum number of times an instrument can be used in
invasive procedures before needing lubrication, a maximum number of
times an instrument can be used in invasive procedures before
needing replacement, and a maximum number of times an instrument
can be used in invasive procedures before needing calibration. For
yet another example, the operation module can determine when any
one or more of a non-sterile person and a non-sterile instrument
enters an area in which the actual performance of the selected
invasive treatment is being performed, and in response to the
determination, trigger an alarm indicating breach of sterility in
the area. For another example, the operation module can identify an
instrument to be used in the actual performance of the selected
invasive procedure and provide an indication of a position of the
instrument in an instrument tray to be provided in an area in which
the actual performance of the selected invasive procedure will be
performed. The indication can include at least one of an audio
signal and a visual signal. For another example, the operation
module can gather data for a medical practitioner involved in the
actual performance of the selected invasive procedure in a period
of time following the invasive procedure. The data can include an
energy level of the medical practitioner and nutrition of the
medical practitioner. The post-op module can compare the gathered
data for the medical practitioner with the stored data regarding
the actual performance of the selected invasive treatment so as to
determine recommended improvements in the energy level and the
nutrition. For yet another example, the operation module can
provide the electronic feedback on a display, and the operation
module can provide additional electronic information regarding the
actual performance of the selected invasive treatment on the
display including any one or more of a fluoroscopic image of the
patient, vital signs of the patient, neural monitoring outputs,
surgical techniques videos, camera feeds from outside a room where
the selected invasive treatment is being performed, power usage of
instruments, and controls for any one or more devices that gather
the additional electronic information and provide the additional
electronic information to the operation module. For still another
example, the operation module can provide feedback regarding a
position of the patient in a room where the selected invasive
treatment is to be performed. The feedback can provide guidance on
movement of the patient such that the position of the patient
matches a predetermined optimal position of the patient for
performance of the selected invasive treatment. The feedback can be
based at least one any one or more of images of the patient in the
room and images of the patient acquired prior to the patient being
located in the room. For another example, the operation module can
allow for user selection of anatomy of the patient to be shown on a
display in any one or more of a plurality of visualization options,
e.g., 3D images, holograms, and projections. For yet another
example, the operation module can show the electronic feedback on a
display and allows user selection of different information to be
shown on the display using a no-touch control operable by a user.
The no-touch control can include at least one of a data board, a
gesture-based control, and direct brain control. For still another
example, the comparing of the operation module can include
comparing an amount of spinal disc clearing of the stored
electronic simulation with an actual amount of spinal disc
clearing. For another example, the operation module can determine
an instrument needed for an upcoming aspect of the actual
performance of the selected invasive treatment and automatically
trigger sterilization and retrieval of the determined instrument.
For yet another example, the operation module can determine at
least one of a time length of retraction of a tissue during the
actual performance of the selected invasive treatment, an amount of
the tissue retraction, and an amount of pressure being placed on at
least one of tissue and nerves as a result of the retraction, and
the operation module can trigger an alarm if any one or more of the
time length reaches a predetermined threshold amount of time, the
amount of tissue retraction reaches a predetermined amount of
tissue, and the amount of pressure reaches a predetermined amount
of pressure. For another example, the comparing of the operation
module can include comparing a trajectory of an instrument in the
stored electronic simulation with an actual trajectory of the
instrument in the actual performance of the selected invasive
treatment, and if the actual trajectory differs from the
trajectory, the operation module can provide a warning indicating
that the trajectories differ. For yet another example, the
operation module can provide information regarding nerves of the
patient during in the actual performance of the selected invasive
treatment. The nerve information can include at least one of a
visual overlay of nerves on the patient and an augmented reality
view of the nerves.
[0035] The post-op module can have any number of variations. For
example, the post-op module can gather data for each medical
practitioner involved in the actual performance of the selected
invasive procedure in a period of time following the invasive
procedure. The invasive procedure can be performed in an operating
room, and the data can include an energy level of the medical
practitioner and nutrition of the medical practitioner. The post-op
module can compare the gathered data with data stored in the
storage unit regarding actual performance of invasive treatments in
the operating room so as to determine recommended improvements in
the energy level and the nutrition.
[0036] In another aspect, a medical method is provided that in one
embodiment includes the functions performed by the diagnosis and
treatment module, the pre-op module, the operation module, the
post-op module, and the recovery module.
[0037] In another embodiment, a medical method is provided that
includes receiving treatment plan data regarding a plurality of
patients. The treatment plan data includes a plan of medical
treatment corresponding to each of the patients. Each of the plans
has associated therewith at least one medical diagnosis in common
with all of the plans. The method also includes determining an
effectiveness of each of the plans, and determining a suggested
plan of medical treatment for a patient based on the determined
effectiveness. The patient has the at least one medical diagnosis.
The method also includes providing the suggested plan to a
user.
[0038] The method can vary in any number of ways. For example, the
method can include receiving compliance data regarding compliance
of the patients with their corresponding plans, and determining the
effectiveness can include determining based on the compliance data
an extent of each patient's compliance with their corresponding
plans. Determining the suggested plan can include choosing at least
a one of the plans having a highest level of compliance. For
another example, the plans for a first subset of the patients can
include a non-surgical treatment, the plans for a second subset of
the patients can include a surgical treatment, and determining the
suggested plan can include comparing outcomes of the non-surgical
treatments with outcomes of the surgical treatments. Determining
the suggested plan can include choosing at least a one of the plans
having a best outcome among the surgical treatments and the
non-surgical treatments. For yet another example, determining the
effectiveness can include determining an effect of each of the
plans on the at least one medical diagnosis, and determining the
suggested plan can include choosing at least a one of the plans
having a most desired effect on the at least one medical diagnosis.
For another example, the method can include receiving performance
data regarding performances of surgical procedures included in each
of the plans that include performance of the surgical procedure as
at least part of the medical treatment, and determining the
effectiveness can include choosing at least a one of the plans
based at least on the performance data. For yet another example,
providing the suggested plan can include showing the suggested plan
on a display.
[0039] In another embodiment, a medical method is provided that
includes storing a plurality of medical diagnoses and storing a
plurality of medical treatments. Each of the diagnoses has a
plurality of patient-specific factors associated therewith. The
patient-specific factors include at least symptoms. Each of the
treatments has one or more of the medical diagnoses associated
therewith. The method also includes storing an effectiveness of
each of the treatments as related to their associated one or more
medical diagnoses, receiving symptom data indicating a plurality of
symptoms experienced by a patient, determining which one or more of
the stored medical diagnoses are associated with the received
plurality of symptoms, providing the determined medical diagnoses
to a user, determining which one or more of the treatments are
associated with the determined medical diagnoses, and providing at
least one of the determined treatments to the user. The at least
one of the determined treatments has the highest effectiveness
associated therewith.
[0040] The method can have any number of variations. For example,
the stored effectiveness for each of the treatments can be based on
any one or more of compliances of previous patients with a
treatment plan associated with the treatment, an effect of the
treatment on the one or more medical diagnoses associated
therewith, an outcome a surgical procedure included as part of the
treatment, and compliances of previous patients with a post-surgery
treatment plan associated with the surgical procedure. For another
example, providing the determined medical diagnoses can include
showing the determined medical diagnoses on a display, and
providing the at least one of the determined treatments can include
showing the at least one of the determined treatments on the
display.
[0041] In another embodiment, a medical method is provided that
includes receiving plan data regarding a virtual performance of a
surgical procedure on a patient, and receiving performance data
regarding an actual performance of the surgical procedure on the
patient. The performance data is received in real time with the
actual performance of the surgical procedure. The method also
includes determining if the plan data varies from the performance
data. If the plan data is determined to vary from the performance
data, a warning is provided to a user, and the determining is
repeated for subsequent performance data received in real time with
the actual performance of the surgical procedure. The warning
includes an indication of the determined variance. If the plan data
is determined to not vary from the performance data, the
determining is repeated for subsequent performance data received in
real time with the actual performance of the surgical
procedure.
[0042] The method can have any number of variations. For example,
the method can include receiving plan data regarding a plurality of
virtual performances of the surgical procedure on a plurality of
patients, and receiving performance data regarding a plurality
actual performances of the surgical procedure on the plurality of
patients. The performance data is received in real time with the
actual performances of the surgical procedures. The method also
includes determining if the plan data regarding the plurality of
virtual performances varies from the performance data regarding the
plurality actual performances, determining if any one or more of
the determined variances are a same type of variance, and providing
a recommendation to a user performing another virtual performance
of the surgical procedure based on the one or more determined
variances determined to be the same type of variance. For another
example, the indication of the determined variance can include a
recommended course of action to match the actual performance of the
surgical procedure to the virtual performance of a surgical
procedure. For yet another example, the method can include
collating all of the determined variances of the plan data from the
performance data and of the plan data for the subsequent
performance data, and providing the collated determined variances
in a report. The report can be a paper report or an electronic
report. For yet another example, a type of the received performance
data can include at least one of data regarding movement of a
surgical instrument being used in the actual performance of the
surgical procedure, movement of staff present for the actual
performance of the surgical procedure, patient vital signs,
identification of a surgical instrument being used in the actual
performance of the surgical procedure, identification of staff
present in the actual performance of the surgical procedure, an
amount of tissue retraction, a duration of tissue retraction, and
one or more real time images of the patient acquired during the
actual performance of the surgical procedure. A type of the
received plan data can correspond to the type of the received
performance data. For still another example, the determined
variance can include at least one of a surgical instrument being
moved relative to the patient than in the actual performance of the
surgical procedure different than in the virtual performance of the
surgical procedure, a surgical implant being used in the actual
performance of the surgical procedure being implanted at a
different location within the patient than the surgical implant
used in the virtual performance of the surgical procedure,
different radiation exposures in the actual performance of the
surgical procedure and the virtual performance of the surgical
procedure, different lengths of tissue retraction time in the
actual performance of the surgical procedure and the virtual
performance of the surgical procedure, different pharmaceutical
administration to the patient in the actual performance of the
surgical procedure than in the virtual performance of the surgical
procedure, a different number of staff being present in the actual
performance of the surgical procedure than a number of virtual
staff present in the virtual performance of the surgical procedure,
a different duration of a step in the actual performance of the
surgical procedure than in the virtual performance of the surgical
procedure, a different surgical instrument being used in a step of
the actual performance of the surgical procedure than in the
virtual performance of the surgical procedure, and a step performed
in the virtual performance of the surgical procedure not having
been performed in the actual performance of the surgical procedure.
For another example, the warning can include at least one of an
audible sound, an illuminated light, a flashing light, a vibration
of a surgical instrument being used in the actual performance of
the surgical procedure, and a text warning on a display.
[0043] In another embodiment, a medical method is provided that
includes receiving post-surgery treatment plan data regarding a
plurality of patients. The post-surgery treatment plan data
includes a plan of medical treatment corresponding to each of the
patients. Each of the plans has associated therewith at least one
surgical procedure in common with all of the plans. The method also
includes determining an effectiveness of each of the plans, and
determining a suggested plan of medical treatment for a patient
based on the determined effectiveness. The patient has had the at
least one surgical procedure performed thereon. The method also
includes providing the suggested plan to a user.
[0044] The method can vary in any number of ways. For example, the
method can include receiving compliance data regarding compliance
of the patients with their corresponding plans, and determining the
effectiveness can include determining based on the compliance data
an extent of each patient's compliance with their corresponding
plans. Determining the suggested plan can include choosing at least
a one of the plans having a highest level of compliance. For
another example, determining the effectiveness can include
determining an effect of each of the plans on at least one medical
diagnosis, and determining the suggested plan can include choosing
at least a one of the plans having a most desired effect on the at
least one medical diagnosis. The patient has been diagnosed with
the at least one medical diagnosis. For yet another example,
providing the suggested plan can include showing the suggested plan
on a display.
[0045] In another aspect, a computer-readable medium is provided
and has stored thereon a program that when executed can cause a
computer to perform any of the methods.
BRIEF DESCRIPTION OF DRAWINGS
[0046] This invention will be more fully understood from the
following detailed description taken in conjunction with the
accompanying drawings, in which:
[0047] FIG. 1 is a schematic diagram of an embodiment of a computer
system;
[0048] FIG. 2 is a schematic diagram of an embodiment a diagnosis,
surgical planning, support, and management system;
[0049] FIG. 3 is a schematic diagram of an embodiment of a network
system including the diagnosis, surgical planning, support, and
management system of FIG. 2;
[0050] FIG. 4 is a schematic diagram of an embodiment of a
continuum of patient care for the diagnosis, surgical planning,
support, and management system of FIG. 2;
[0051] FIG. 5 is a perspective view of an embodiment of a client
terminal that allows user input of data to the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0052] FIG. 5A is a schematic view of an embodiment of a user
interface that allows user input of data to the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0053] FIG. 5B is a schematic view of another embodiment of a user
interface that allows user input of data to the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0054] FIG. 5C is a schematic view of yet another embodiment of a
user interface that allows user input of data to the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0055] FIG. 6 is a perspective view of another embodiment of a
client terminal that allows user input of data to the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0056] FIG. 7 is a perspective view of an embodiment of a bone
density marker system that provides bone density information to
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0057] FIG. 8 is a perspective view of yet another embodiment of a
client terminal that allows user input of data to the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0058] FIG. 9 is a perspective view of an embodiment of a simulated
surgical procedure display provided by the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0059] FIG. 10 is a perspective view of an embodiment of a
topographical mapping system that provides topographical mapping
information to the diagnosis, surgical planning, support, and
management system of FIG. 2;
[0060] FIG. 11 is a perspective view of an embodiment of a client
terminal in an OR setting that communicates with the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0061] FIG. 12 is a perspective view of another embodiment of a
client terminal in an OR setting that communicates with the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0062] FIG. 13 is a perspective view of yet another embodiment of a
client terminal in an OR setting that communicates with the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0063] FIG. 14 is a perspective view of an embodiment of a client
terminal showing surgical progress data received from the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0064] FIG. 15 is a perspective view of an embodiment of a client
terminal showing patient data received from the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0065] FIG. 16 is a perspective view of an embodiment of a client
terminal showing surgical instrument data received from the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0066] FIG. 17A is a perspective view of an embodiment of
projection system that communicates with the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0067] FIG. 17B is a perspective view of one of the projectors of
the projection system of FIG. 17A;
[0068] FIG. 18 is a perspective view of an embodiment of a motion
sensing system that communicates with the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0069] FIG. 19 is a perspective view of an embodiment of a direct
brain interface system that communicates with the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0070] FIG. 20 is a perspective view of an embodiment of a no-touch
data communication system that communicates with the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0071] FIG. 21 is a perspective view of an embodiment of a visual
position and orientation tracking system that communicates with the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0072] FIG. 22 is a perspective view of an embodiment of an
anatomical visualization for a spinal surgery provided by the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0073] FIG. 23 is a perspective view of an embodiment of a void
confirmation system that communicates with the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0074] FIG. 24 is a perspective view of an embodiment of an
instrument tracking system that communicates with the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0075] FIG. 25 is a perspective view of another embodiment of a
skin surface mapping and instrument tracking system that
communicates with the diagnosis, surgical planning, support, and
management system of FIG. 2;
[0076] FIG. 26 is a perspective view of an embodiment of an
instrument sorting system that communicates with the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0077] FIG. 27 is a perspective view of an embodiment of a client
terminal showing post-op surgical procedure data received from the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0078] FIG. 28 is a perspective view of an embodiment of a client
terminal showing post-op treatment plan data received from the
diagnosis, surgical planning, support, and management system of
FIG. 2;
[0079] FIG. 29A is a perspective view of an embodiment of a patient
on a bed in a surgical setting;
[0080] FIG. 29B is a series of perspective views of an embodiment
of a pedicle demonstrating vertebral body translation which
converts a pedicle trajectory from a first position to a second
horizontal or plumb position;
[0081] FIG. 30 is a top, partially transparent view of an
embodiment of a patient on a bed in a surgical setting with desired
vertebral angles;
[0082] FIG. 31 is a perspective view of an embodiment of a
fluoroscopic image of a lumbar spine of a patient in a baseline
position;
[0083] FIG. 32 is a perspective view of an embodiment of a
fluoroscopic image of the lumbar spine of the patient of FIG. 31,
the lumbar spine being in an initial surgical position;
[0084] FIG. 33 is a perspective view of an embodiment of a
fluoroscopic image of the lumbar spine of the patient of FIG. 32,
the lumbar spine moved from the initial surgical position to an
adjusted surgical position;
[0085] FIG. 34A shows a flowchart of an exemplary embodiment of
using a diagnosis and treatment module of the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0086] FIG. 34B shows another portion of the flowchart of FIG.
34A;
[0087] FIG. 35 shows a flowchart of another exemplary embodiment of
using a diagnosis and treatment module of the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0088] FIG. 36 shows a flowchart of another exemplary embodiment of
using a diagnosis and treatment module of the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0089] FIG. 37 shows a flowchart of another exemplary embodiment of
using a diagnosis and treatment module of the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0090] FIG. 38-1 shows a portion of a flowchart of an exemplary
embodiment of using a pre-op module of the diagnosis, surgical
planning, support, and management system of FIG. 2;
[0091] FIG. 38-2 shows another portion of the flowchart of FIG.
38-1;
[0092] FIG. 39A-1 shows a portion of a flowchart of another
exemplary embodiment of using a pre-op module of the diagnosis,
surgical planning, support, and management system of FIG. 2;
[0093] FIG. 39A-2 shows another portion of the flowchart of FIG.
39A-1;
[0094] FIG. 39B-1 shows another portion of the flowchart of FIG.
39A-1;
[0095] FIG. 39B-2 shows another portion of the flowchart of FIG.
39A-1;
[0096] FIG. 39B-3 shows another portion of the flowchart of FIG.
39A-1;
[0097] FIG. 39C shows another portion of the flowchart of FIG.
39A-1;
[0098] FIG. 40 shows a flowchart of another exemplary embodiment of
using a pre-op module of the diagnosis, surgical planning, support,
and management system of FIG. 2;
[0099] FIG. 41A shows a flowchart of an exemplary embodiment of
using an operation module of the diagnosis, surgical planning,
support, and management system of FIG. 2;
[0100] FIG. 41B-1 shows another portion of the flowchart of FIG.
41A;
[0101] FIG. 41B-2 shows another portion of the flowchart of FIG.
41A;
[0102] FIG. 41C shows another portion of the flowchart of FIG.
41A;
[0103] FIG. 42A shows a flowchart of another exemplary embodiment
of using an operation module of the diagnosis, surgical planning,
support, and management system of FIG. 2;
[0104] FIG. 42B shows another portion of the flowchart of FIG.
42A.
DETAILED DESCRIPTION
[0105] Certain exemplary embodiments will now be described to
provide an overall understanding of the principles of the
structure, function, manufacture, and use of the devices and
methods disclosed herein. One or more examples of these embodiments
are illustrated in the accompanying drawings. Those skilled in the
art will understand that the devices and methods specifically
described herein and illustrated in the accompanying drawings are
non-limiting exemplary embodiments and that the scope of the
present invention is defined solely by the claims. The features
illustrated or described in connection with one exemplary
embodiment may be combined with the features of other embodiments.
Such modifications and variations are intended to be included
within the scope of the present invention
[0106] Various systems and methods are provided for systems and
methods for surgical and interventional planning, support,
post-operative follow-up, and functional recovery tracking. In
general, a patient can be tracked throughout medical treatment
including through initial onset of symptoms, examination and
diagnosis, non-surgical treatment, surgical treatment, and recovery
from the surgical treatment. In one embodiment, a patient and one
or more medical professionals involved with treating the patient
can electronically access a comprehensive treatment planning,
support, and review system, e.g., using one or more web pages. The
system can provide recommendations regarding diagnosis,
non-surgical treatment, surgical treatment, and recovery from the
surgical treatment based on data gathered from the patient and the
medical professional(s), thereby helping to improve accuracy in
diagnosis and effectiveness of treatment. The system can manage the
tracking of multiple patients, thereby allowing for data comparison
between similar aspects of medical treatments, e.g., between
similar non-surgical treatments, and for learning over time through
continual data gathering, analysis, and assimilation to
decision-making algorithms. The system can therefore help improve
accuracy of diagnosis and effectiveness of treatment for multiple
patients by considering previously gathered data, including, e.g.,
historic success rates as measured in Health-Related Quality of
Life (HRQOL), utilization, and health/economic parameters,
regarding similar diagnoses and treatments in providing suggested
diagnoses and recommended treatments. The model can also facilitate
various tasks associated with surgical planning, inventory
planning, intra-operative support, post-surgery logistics, and
billing phases of patient treatment. The system can allow for
documentation and tracking of the progression of the patient
throughout at least some phases of the patient's treatment, and in
an exemplary embodiment all phases, which can be highly beneficial
to non-surgical and surgical treatment of the patient as well as
for informing decisions regarding non-surgical and surgical
treatments of other patients.
[0107] Computer System
[0108] The systems and methods disclosed herein can be implemented
using one or more computer systems, which are also referred to
herein as digital data processing systems.
[0109] FIG. 1 illustrates one exemplary embodiment of a computer
system 100. As shown, the computer system 100 can include one or
more processors 102 which can control the operation of the computer
system 100. The processor(s) 102 can include any type of
microprocessor or central processing unit (CPU), including
programmable general-purpose or special-purpose microprocessors
and/or any one of a variety of proprietary or commercially
available single or multi-processor systems. The computer system
100 can also include one or more memories 104, which can provide
temporary storage for code to be executed by the processor(s) 102
or for data acquired from one or more users, storage devices,
and/or databases. The memory 104 can include read-only memory
(ROM), flash memory, one or more varieties of random access memory
(RAM) (e.g., static RAM (SRAM), dynamic RAM (DRAM), or synchronous
DRAM (SDRAM)), and/or a combination of memory technologies.
[0110] The various elements of the computer system 100 can be
coupled to a bus system 112. The illustrated bus system 112 is an
abstraction that represents any one or more separate physical
busses, communication lines/interfaces, and/or multi-drop or
point-to-point connections, connected by appropriate bridges,
adapters, and/or controllers. The computer system 100 can also
include one or more network interface(s) 106, one or more
input/output (JO) interface(s) 108, and one or more storage
device(s) 110.
[0111] The network interface(s) 106 can enable the computer system
100 to communicate with remote devices, e.g., other computer
systems, over a network, and can be, for non-limiting example,
remote desktop connection interfaces, Ethernet adapters, and/or
other local area network (LAN) adapters. The IO interface(s) 108
can include one or more interface components to connect the
computer system 100 with other electronic equipment. For
non-limiting example, the IO interface(s) 108 can include high
speed data ports, such as universal serial bus (USB) ports, 1394
ports, Wi-Fi, Bluetooth, etc. Additionally, the computer system 100
can be accessible to a human user, and thus the IO interface(s) 108
can include displays, speakers, keyboards, pointing devices, and/or
various other video, audio, or alphanumeric interfaces. The storage
device(s) 110 can include any conventional medium for storing data
in a non-volatile and/or non-transient manner. The storage
device(s) 110 can thus hold data and/or instructions in a
persistent state, i.e., the value is retained despite interruption
of power to the computer system 100. The storage device(s) 110 can
include one or more hard disk drives, flash drives, USB drives,
optical drives, various media cards, diskettes, compact discs,
and/or any combination thereof and can be directly connected to the
computer system 100 or remotely connected thereto, such as over a
network. In an exemplary embodiment, the storage device(s) can
include a tangible or non-transitory computer readable medium
configured to store data, e.g., a hard disk drive, a flash drive, a
USB drive, an optical drive, a media card, a diskette, a compact
disc, etc.
[0112] The elements illustrated in FIG. 1 can be some or all of the
elements of a single physical machine. In addition, not all of the
illustrated elements need to be located on or in the same physical
machine. Exemplary computer systems include conventional desktop
computers, workstations, minicomputers, laptop computers, tablet
computers, personal digital assistants (PDAs), mobile phones, and
the like.
[0113] The computer system 100 can include a web browser for
retrieving web pages or other markup language streams, presenting
those pages and/or streams (visually, aurally, or otherwise),
executing scripts, controls and other code on those pages/streams,
accepting user input with respect to those pages/streams (e.g., for
purposes of completing input fields), issuing Hypertext Transfer
Protocol (HTTP) requests with respect to those pages/streams or
otherwise (e.g., for submitting to a server information from the
completed input fields), and so forth. The web pages or other
markup language can be in HyperText Markup Language (HTML) or other
conventional forms, including embedded Extensible Markup Language
(XML), scripts, controls, and so forth. The computer system 100 can
also include a web server for generating and/or delivering the web
pages to client computer systems.
[0114] In an exemplary embodiment, the computer system 100 can be
provided as a single unit, e.g., as a single server, as a single
tower, contained within a single housing, etc. The systems and
methods disclosed herein can thus be provided as a singular unit
configured to provide the various modules, display the various user
interfaces, and capture the data described herein. The singular
unit can be modular such that various aspects thereof can be
swapped in and out as needed for, e.g., upgrade, replacement,
maintenance, etc., without interrupting functionality of any other
aspects of the system. The singular unit can thus also be scalable
with the ability to be added to as additional modules and/or
additional functionality of existing modules are desired and/or
improved upon.
[0115] While some embodiments are described herein in the context
of web pages, it will be appreciated that in other embodiments, one
or more of the described functions can be performed without the use
of web pages and/or by other than web browser software. A computer
system can also include any of a variety of other software and/or
hardware components, including by way of non-limiting example,
operating systems and database management systems. Although an
exemplary computer system is depicted and described herein, it will
be appreciated that this is for sake of generality and convenience.
In other embodiments, the computer system may differ in
architecture and operation from that shown and described here.
[0116] Diagnosis, Surgical Planning, Support, and Management System
Generally
[0117] FIG. 2 is a schematic block diagram of one exemplary
embodiment of a diagnosis, surgical planning, support, and
management system 10. The system 10 can includes a plurality of
modules, discussed further below, which can each be implemented
using one or more digital data processing systems of the type
described above, and in particular using one or more web pages
which can be viewed, manipulated, and/or interacted with using such
digital data processing systems. The system 10 can thus be
implemented on a single computer system, or can be distributed
across a plurality of computer systems. The system 10 also includes
a plurality of databases, which can be stored on and accessed by
computer systems. It will be appreciated that any of the modules or
databases disclosed herein can be subdivided or can be combined
with other modules or databases.
[0118] Any of a variety of parties can access, interact with,
control, etc. the system 10 from any of a variety of locations. For
non-limiting example, as shown in an embodiment illustrated in FIG.
3, the system 10 can be accessible over a network 12 (e.g., over
the Internet via cloud computing) from any number of client
stations 14 in any number of locations such as a medical facility
16 (e.g., a hospital, an operating room (OR), a nurse's station, a
medical device distribution facility, a medical device company, a
hospital's sterilization, records, or billing departments, etc.), a
home base 18 (e.g., a patient's home or office, a surgeon's home or
office, etc.), a mobile location 20, and so forth. The client
station(s) 14 can access the system 10 through a wired and/or
wireless connection to the network 12. In an exemplary embodiment,
at least some of the client terminal(s) 14 can access the system 10
wirelessly, e.g., through Wi-Fi connection(s), which can facilitate
accessibility of the system 10 from almost any location in the
world. As shown in FIG. 3, the medical facility 16 includes client
stations 14 in the form of a tablet and a computer touch screen,
the home base 18 includes client stations 14 in the form of a
mobile phone having a touch screen and a desktop computer, and the
mobile location 20 includes client stations 14 in the form of a
tablet and a mobile phone, but the medical facility 16, the home
base 18, and the mobile location 20 can include any number and any
type of client stations. In an exemplary embodiment, the system 10
can be accessible by a client terminal via a web address and/or a
client application (generally referred to as an "app").
[0119] It will be appreciated that the system 10 can include
security features such that the aspects of the system available to
any particular user can be determined based on the identity of the
user and/or the location from which the user is accessing the
system. To that end, each user can have a unique username,
password, and/or other security credentials to facilitate access to
the system 10. The received security parameter information can be
checked against a database of authorized users to determine whether
the user is authorized and to what extent the user is permitted to
interact with the system, view information stored in the system,
and so forth. Exemplary, non-limiting examples of parties who can
be permitted to access the system 10 include patients, potential
patients, significant others, friends, and family members of
patients or potential patients, surgical technicians, imaging
technicians (e.g., x-ray technicians, MRI technicians, etc.),
surgeons, nurses, hospital administrators, surgical equipment
manufacturer employees, insurance providers, and operating room
directors.
[0120] FIG. 4 illustrates an exemplary embodiment of a medical
treatment continuum 22 throughout which the system 10 can
facilitate diagnosis and treatment of patients. A patient can be
tracked through a partial portion of the continuum 22 or through an
entirety of the continuum 22. In this way, the system 10 can be
effective for all patients, not just for patients treated with an
invasive procedure such as surgery, needle procedures, biopsy,
catheter based procedures, etc. As discussed herein, the system 10
can allow paths of an individual's medical treatment through all or
part of the continuum 22 to be compared and consolidated then
applied to patients with similar symptoms to diagnose and choose
the treatment that previously produced a best outcome for similarly
situated patients. The outcome can include technical, anatomic,
functional, and patient reported parameters. FIG. 4 also
illustrates how a number of patients in the continuum 22 is
typically greatest in a wellness and prevention phase of the
continuum 22, second greatest in a conservative therapy phase of
the continuum 22, third greatest in an interventional therapy phase
of the continuum 22, and least in surgical procedure and
post-surgery phases of the continuum 22. Thus, by comparing and
consolidating information regarding patients in the phases that
typically involve a larger number of patients than invasively
treated patients, the system 10 can help inform treatment of a
larger number of patients than systems that focus only on surgical
treatments and/or only on post-diagnosis. The continuum 22 also
shows how data from all of the phases can be received by the system
10, thereby allowing pooling of data that can inform subsequent
decisions in any one or more phases of the continuum 22, including
phases different from where the data was originally collected.
[0121] The system 10 can include a diagnosis and treatment module
200, a pre-op module 202, an operation module 204, a post-op module
206, and a recovery module 208. Any of the diagnosis and treatment
module 200, the pre-op module 202, the operation module 204, the
post-op module 206, and the recovery module 208 can be used
independently from one another and can be used in combination with
any one or more of the other modules 200, 202, 204, 206, 208. In an
exemplary embodiment, the diagnosis and treatment module 200, the
pre-op module 202, the operation module 204, the post-op module
206, and the recovery module 208 can be provided as a comprehensive
system that can track a patient throughout medical treatment
including through initial onset of symptoms, diagnosis,
non-surgical treatment, surgical and/or other invasive treatment,
and recovery from the invasive treatment. Each of the modules 200,
202, 204, 206, 208 is discussed further below in turn. Although
each of the modules 200, 202, 204, 206, 208 is illustrated in FIG.
2 as including a plurality of component modules, each of the
modules 200, 202, 204, 206, 208 can include any number of component
modules, e.g., one, two, three, etc., the same or different from
any of the other modules 200, 202, 204, 206, 208. Further, as
mentioned above, it will be appreciated that any of the modules
200, 202, 204, 206, 208, and any of their various component
modules, can be subdivided or can be combined with other modules,
including modules illustrated in FIG. 2 as being in different ones
of the modules 200, 202, 204, 206, 208.
[0122] The system 10 can also include a diagnosis and treatment
database 300 configured to be accessible by the diagnosis and
treatment module 200 and to store diagnosis and treatment data, a
pre-op database 302 configured to be accessible by the pre-op
module 202 and to store pre-op data, an operation database 304
configured to be accessible by the operation module 204 and to
store operation data, a post-op database 306 configured to be
accessible by the post-op module 206 and to store post-op data, and
a recovery database 308 configured to be accessible by the recovery
module 208 and to store recovery data. Each of the databases 300,
302, 304, 306, 308 is discussed further below in turn with respect
to their associated modules 200, 202, 204, 206, 208. Each of the
databases 300, 302, 304, 306, 308 can include any number of
component databases, e.g., one, two, three, etc., the same or
different from any of the other databases 300, 302, 304, 306, 308.
As mentioned above, it will be appreciated that any of the
databases 300, 302, 304, 306, 308, and any of their various
component databases, can be subdivided or can be combined with
other databases, including databases illustrated in FIG. 2 as being
in different ones of the databases 300, 302, 304, 306, 308. Any
portion of any of the databases 300, 302, 304, 306, 308 can be
configured to be accessed by any one or more of the modules 200,
202, 204, 206, 208. Although the system 10 in the illustrated
embodiment stores data in database(s), any of the systems disclosed
herein can store data in database(s) and/or in other data
organization structure(s).
[0123] Users of the system 10 can include patients and medical
practitioners involved with treating one or more of the patients.
In some embodiments, the system 10 can be accessible by users other
than patients and medical practitioners, such as by medical
administrators, e.g., billing administrators, inventory
controllers, etc. Different users can have access to different
portions of the system 10, as mentioned above regarding security
features. For non-limiting example, the system 10 can be configured
to allow patients to access only the diagnosis and treatment module
200 and the recovery module 208, to allow medical administrators to
access only the operation module 204, and to allow surgeons to
access all of the modules 200, 202, 204, 206, 208. A user can have
access to only a portion of a module, e.g., to only a subset of
component modules within any one or more of the modules 200, 202,
204, 206, 208.
[0124] Diagnosis and Treatment Module
[0125] The diagnosis and treatment module 200 can generally provide
users of the system 10 with an interface for managing patient
wellness and prevention and for managing patient treatment at least
until planning for any surgery begins. More particularly, the
diagnosis and treatment module 200 can receive patient-specific
data such as symptoms, provide diagnoses based on the
patient-specific data, suggest medical practitioners experienced
with particular diagnoses, provide conservative treatment options
(e.g., non-surgical treatments) for particular diagnoses, provide
coaching on reducing risk factors for pain through lifestyle
changes, and provide interventional therapy treatment options
(e.g., surgical treatments, needle procedures, biopsy, catheter
based procedures, etc.) and/or pharmacological treatments for
particular diagnoses. Indications of drugs and their potential
interactions with existing medications can also be provided. In
this way, the diagnosis and treatment module 200 can be configured
to assist patient diagnosis and treatment through a continuum
including patient onset of pain, patient arrival at a doctor, and a
decision to pursue an invasive treatment such as surgery. In one
embodiment, the diagnosis and treatment module 200 can be
implemented using one or more web pages which are configured to
receive user input and present information to a user. In an
exemplary embodiment, both patients and medical practitioners can
access at least a portion of the diagnosis and treatment module
200. In an exemplary embodiment, the diagnosis and treatment module
200 can be accessed by users via a web interface, e.g., by
connecting to the Internet via a client terminal and accessing a
specific web address, by launching an app on a client terminal that
accesses the system 10, etc. As mentioned above, the users can
wirelessly access the system 10, including the diagnosis and
treatment module 200.
[0126] The diagnosis and treatment module 200 can include a
diagnosis module 210, a treatment options module 212, a care
provider module 214, and a treatment compliance module 216. Each of
the modules 210, 212, 214, 216 is discussed further below in
turn.
[0127] As mentioned above, the diagnosis and treatment module 200
can be configured to read information from and write information to
the diagnosis and treatment database 300. The diagnosis and
treatment database 300 can include a diagnosis database 310, a
treatment database 312, and a care provider database 314. Various
ones of the diagnosis and treatment module's component modules 210,
212, 214, 216 can be configured to access one or more of the
diagnosis database 310, the treatment database 312, the care
provider database 314, and/or various other databases, e.g., the
pre-op database 302, the operation database 304, the post-op
database 306, and the recovery database 308. Each of the databases
310, 312, 314 is discussed further below in connection with various
ones of the diagnosis and treatment module's component modules 210,
212, 214, 216.
[0128] Diagnosis Module
[0129] The diagnosis module 210 can provide users of the system 10
with an interface for entering and evaluating symptoms and for
receiving preliminary diagnoses based on the entered symptoms. The
preliminary diagnoses can also be based on any one or more of prior
treatments received by the patient, on physical examination data
(e.g., signs noticed by a medical professional examining the
patient), images of the patient, laboratory test results for the
patient, patient demographic data, and/or on historical tests
(e.g., genetic testing). Basing preliminary diagnoses on symptoms
in addition to one or more other patient-specific factors can allow
the diagnosis module 210 to provide more customized and better
informed preliminary diagnosis information specific to a particular
patient. The diagnosis module 210 can be configured to allow
patients to enter their own symptoms for evaluation and possible
diagnosis and to allow medical professionals to enter symptoms for
their patients for evaluation and possible diagnosis. The diagnosis
module 210 can also be configured to allow patients to enter
previously received treatments for the symptoms, including
self-treatments (e.g., over the counter medicine, etc.) and
professionally-provided treatments. Each patient can be uniquely
identified in the system 10, e.g., by name, identification code,
etc., such that symptoms entered for a particular patient by the
patient and by other user(s) can be stored in the diagnosis and
treatment database 300, e.g., in the diagnosis database 310, as
being associated with the patient. The patient's Electronic Medical
Record (EMR) can be linked by their health care provider to the
diagnosis and treatment database 300. The symptoms and historical
treatments identified for a particular patient can be accessed at
any time in the future using the system 10, which can help
facilitate continued treatment and evaluation of the patient, e.g.,
by allowing severity of symptoms to be tracked over time as the
patient and/or other user(s) updates the system 10. Symptoms for a
patient can be stored in the diagnosis and treatment database 300,
e.g., in the diagnosis database 310, with a date and time stamp,
which can facilitate the continued treatment and evaluation of the
patient. Similarly, other data discussed herein as being related to
a particular patient can be stored in the diagnosis treatment
database 300, the pre-op database 302, the operation database 304,
the post-op database 306, and the recovery database 308 as being
associated with the patient and as having a date and time stamp.
The patient's EMR, historical treatments, images, lab results,
physical exam results, symptoms, etc., to the extent they are
provided to the system 10, can be compared to other patient data
included in the diagnosis and treatment database 300 to compile
outcome predictions based on retrospective results from treatment
results of patients with similar indications. This compilation can
allow medical care providers and patients to make more informed
treatment and procedural decisions.
[0130] The system 10 can allow users to submit symptoms in a
variety of ways. Other patient-specific factors can be submitted to
the system 10 similar to that discussed herein regarding submission
of symptoms. Patient-specific factors can be submitted to the
system 10 by a patient or other user, e.g., the patient's primary
care physician, a lab technician, etc. Additionally, the diagnosis
module 210 and other modules discussed herein can be configured to
consider patient-specific factors in making various determinations
similar to that discussed herein regarding the modules'
consideration of symptoms.
[0131] FIG. 5 illustrates one embodiment of symptom input to the
system 10 by a user 24 via a client terminal in the form of a touch
screen tablet 26. Although the touch screen tablet 26 is shown in
the illustrated embodiment, the system 10 can allow for symptom
selection in other ways, such as by other touch screen devices, by
other client terminals, by mouse selection, by drop-down text menu,
etc. The touch screen tablet 26 shows an interface allowing user
selection of area(s) of a body in which symptom(s) manifest, but
symptom(s) and their locations in the body can be identified and
entered by a user in other ways, such as by text, pointer device
selection (e.g., mouse clicking, touch via stylus pen, etc.),
drop-down menu, etc. The diagnosis module 210 can be configured to
provide the user with a variety of symptoms for selection based on
the user's selected area(s) of the body in which symptom(s)
manifest. The variety of symptoms can be stored in the diagnosis
database 310 for selection based on a user's input and for display
to the user. For non-limiting example, if a patient selects a hip
area as having pain, the diagnosis module 210 can be configured to
retrieve from the diagnosis database 310 one or more possible
additional symptoms associated with hip pain, e.g., swelling, pain
during movement, pain when stationary, stiffness following a period
of inactivity, etc., that the user can further select to help
better define the user's condition.
[0132] FIGS. 5A-5C illustrate one embodiment of a user interface 25
configured to be provided on a client terminal and to allow user
input of data to the system 10. The user interface 25 relates to
entry of input of data regarding back and neck pain, but as
mentioned above, data regarding any one or more symptoms can be
input into the system 10. As shown in FIG. 5A, the user interface
25 can be configured to allow a user to select one or more portions
of a body on a body chart where pain is being experienced. The body
chart can include a front view body chart 27 and a back view body
chart 29, each body chart 27, 29 providing predetermined areas that
can be selected by the user. As shown in FIG. 5B, for each selected
body portion, the user can be prompted to indicate a level of pain
experienced in that selected body portion by using a sliding scale
31 ranging from zero (near a smiling face graphic) indicating no
pain to ten (near a frowning face graphic) indicating extreme pain.
Levels of pain can be input in any number of other ways, such as by
entering a numerical level of pain from zero to ten in a text entry
field, etc. The sliding scale 31 can be provided in a pop-up
window, as shown in the illustrated embodiment, or can be a
separate screen on the client terminal. The user can also be
prompted to answer one or more questions about their symptoms, as
shown in FIG. 5C. Examples of questions include identification data
(e.g., name, birthdate, age, medical record number, etc.), "How
long have you had your symptoms?", "Which one of the following best
describes the amount of pain you have experienced during the past
six months?" (none, mild, moderate, moderate to severe, severe),
"Which one of the following best describes the amount of pain you
have experienced during the past one month?" (none, mild, moderate,
moderate to severe, severe), "During the past six months have you
been a very nervous person?" (no, a little, some, most of the time,
all of the time), "What is your current level of activity?"
(bedridden, primarily no activity, light labor and light sports,
moderate labor and moderate sports, full activities without
restriction), "How do you look in clothes?" (very good, good, fair,
bad, very bad), "Do you experience pain when at rest?", "What is
your current level of work/school activity?", "Does your pain limit
what you do around the house?", "Does your condition affect your
personal relationships?" (no, slightly, mildly, moderately,
severely), "Have you been a happy person in the past six months?",
"Would you have the same pain management again if you had the same
condition?" (definitely yes, probably yes, not sure, probably not,
definitely not), etc. In an exemplary embodiment, the questions can
help pinpoint location, quality, and duration of the symptoms;
precipitating events or circumstances; exacerbating and relieving
factors; and any changes over time.
[0133] FIG. 6 illustrates another embodiment of symptom input to
the system 10 by the user 24 via electronic image collection by a
client terminal in the form of a mobile phone 28. The user 24 can
launch an app on the mobile phone 28 configured to electronically
communicate with the diagnosis and treatment module 200, e.g.,
interface with the system 10 via the network 12 using electronic
signals transmitted wirelessly and/or using wired connection(s).
The app can be configured to capture data, e.g., one or more still
images and/or one or more videos, indicating one or more physical
characteristics of the patient 24, e.g., a range of motion of the
patient 24, an amount of swelling, skin discoloration, etc. The
captured data can be saved in the diagnosis database 310. The
captured data can be helpful in evaluating symptoms involving,
e.g., joint issues and back pain, and/or can be helpful in tracking
changes in the patient over time, e.g., scoliosis curve progression
can be monitored over time and/or predicted into the future as
pediatric patients grow. The mobile phone 28 can be stably
situated, e.g., via phone stand 30, to help provide stable images
to the system 10. The diagnosis and treatment module 200 can be
configured to prompt the user to collect specific images, e.g., one
or more images of the user from a certain angle, a video of the
user performing a certain task, a video of a user holding a certain
position for a certain amount of time, etc. The prompt can be based
on one or more factors, such as previously collected images of the
patient (e.g., want to collect images over time with each image
being from a same angle), preference of the user's primary care
physician (e.g., always urge video collection over still image
collection), the user's entered symptoms (e.g., ask the user to
capture an image of the user attempting to touch their toes if back
pain is submitted as a symptom), etc.
[0134] Although an app is used to collect data in the illustrated
embodiment, a person skilled in the art will appreciate that data
can be captured in other ways and that devices other than mobile
phones can be used to collect the data with or without running an
app. A person skilled in the art will appreciate that data can be
captured in a variety of ways, e.g., using a camera (standalone or
integrated into another device such as a mobile phone or tablet); a
video camera (standalone or integrated into another device such as
a mobile phone or tablet); one or more sensors (e.g., gyro,
accelerometer, global position system (GPS), etc.) on a smartphone,
in a skin patch (e.g., patches available from MC10 Inc. of
Cambridge, Mass.), integrated into smart clothing, or in additional
sensing or monitoring devices that can connect to the client
terminal via wireless or wired connection, etc.; any of a variety
of known motion capture apps or motion capture software; etc.
[0135] In another embodiment, a user, e.g., a patient, can use a
head-mounted neural mapping device, e.g., an accelerometer, under
medical supervision to collect and submit neural mapping data to
the diagnosis database 210. Neural mapping data can be helpful in
determining and quantizing pain levels of a patient. Over time, the
neural mapping data and the patient's self-described pain can help
the system 10 learn objective pain levels, e.g., normalize pain
levels to allow a more objective evaluation of pain.
[0136] By being accessible over a network, the system 10 can allow
users to enter symptom information to the diagnosis module 210 when
a patient is remote from a medical setting (e.g., doctor's office,
hospital, clinic, etc.) and when the patient is in a medical
setting. Allowing a patient to submit their own symptoms to the
system 10 can result in one or more benefits. A patient can better
determine whether and when it would be appropriate to see a medical
professional because the system 10 can provide a recommendation of
whether and when to visit a medical professional in person based on
the patient's specific symptoms, thereby saving both the patient's
and the medical professional's time. If and when a patient visits a
medical professional, the medical professional can access the
system 10 to evaluate the patient's symptoms even before the
patient personally discusses their symptoms with the medical
professional, which can allow the medical professional to better
focus their in-person time with the patient, e.g., ask more
informed questions, be prepared to perform certain tests, etc.
Having symptoms stored in the diagnosis and treatment database 300
can help prevent the patient from forgetting to mention certain
symptoms to a medical professional in person and/or from forgetting
particular onset and/or timing of certain symptoms because the
symptoms will already be logged in the system 10. The medical
professional can therefore be better able to provide diagnosis and
treatment information to the patient because the information can be
based on a more complete and accurate picture of the patient's
condition. The system 10 can capture transient symptoms, e.g.,
hives, spasms, etc., that may not manifest when the patient is at a
doctor's office or otherwise in direct observation of a medical
professional. These captured transient symptoms, e.g., recorded and
stored audio, video, and/or still image, can allow a medical
professional to more fully evaluate a patient's condition by being
able to directly observe the transient symptoms without having to
rely solely on a patient's memory and/or on a patient's
unintentionally inaccurate and/or medically imprecise description
of transient symptoms.
[0137] By allowing users other than the patient to submit symptoms
to the system 10 for a patient, the system 10 can allow for
symptoms to be logged that may be overlooked by a non-medically
trained person as not being significant and/or can ensure a more
complete record of symptoms. The system 10 can therefore have more
complete knowledge of a patient's symptoms and thus better analyze
a patient's condition so as to provide a more accurate diagnosis
and/or more effective treatment plan for the patient. The system 10
can allow users of the system other than the patient to link and/or
upload previously collected patient data, e.g., prior medical
history, demographics information, etc., to the system 10, which
can allow the system 10 to better analyze information regarding a
patient because more data can be taken into account for various
analyses. Exemplary embodiments of uploading data such as images
are described in more detail in U.S. patent application Ser. No.
13/603,452 entitled "Systems And Methods For Surgical Support And
Management" filed Sep. 5, 2012, which is hereby incorporated by
reference in its entirety.
[0138] The diagnosis module 210 can be configured to analyze
symptoms entered by a patient, determine at least one possible
diagnosis based on the entered symptoms, and provide the at least
one possible diagnosis to the user, such as by causing a display
screen (e.g., a screen of the same device the user used to enter
the symptoms) to show a list of the diagnos(i/e)s. The possible
diagnos(i/e)s can be provided to the user with a caution that the
diagnos(i/e)s are preliminary only and that a user must consult a
doctor for a complete evaluation and diagnosis.
[0139] The diagnosis module 210 can be configured to analyze the
symptoms for a patient entered by one or more users and determine
the at least one preliminary diagnosis in a variety of ways. In an
exemplary embodiment, the diagnosis database 310 can include a
plurality of possible diagnoses, each of the possible diagnoses
being associated with a plurality of symptoms. This diagnosis data
can be organized in any way, such as in a table. The diagnosis
module 210 can be configured to compare user-entered symptoms with
the plurality of possible diagnoses stored in the diagnosis
database 310 and determine which of the plurality of possible
diagnoses are associated with symptoms matching the user-entered
symptoms. The diagnosis module 210 can be configured to compare
gathered neural mapping data for a patient with pain level data
about the patient previously entered by another user, e.g., by the
patient, and/or with previously determined neural maps stored in
the diagnosis database 310. The diagnosis module 210 can thus be
configured to learn an objective way to measure pain, and to create
a pain thermometer based on data from a plurality of patients,
rather than rely on a particular patient's pain numbers.
Additionally, as mentioned above, the diagnosis module 210 can be
configured to analyze any one or more patient-specific factors in
addition to symptoms in determining a diagnosis.
[0140] The diagnosis module 210 can be configured to determine a
diagnosis based on a patient's entered patient specific-factors
matching predetermined attributes or criteria. Each of the
diagnoses in the diagnosis database 310 can be associated with
predetermined criteria. Each of the criteria can include a
plurality of attributes such that each of the diagnoses are
associated with a combination of attributes that define patients
having that diagnosis. In other words, the predetermined criteria
can define patient-specific factors associated with a diagnosis
such that if a patient's factors match the criteria, the diagnosis
module 210 can identify that diagnosis for the patient. The
predetermined criteria can also define patient-specific factors
that exclude a particular diagnosis such that if a patient has a
factor that matches the exclusion factor included in the criteria,
the diagnosis module 210 can exclude that diagnosis for the
patient. The predetermined criteria for a diagnosis can thus
include inclusion criteria (e.g., attributes associated with the
diagnosis) and exclusion criteria (e.g., attributes excluding the
diagnosis). The diagnosis module 210 can be configured to provide a
confidence level with a determined diagnosis based on the patient's
factors matching with the predetermined criteria. The confidence
level can reflect a number of the predetermined criteria that are
matched for a particular patient. In an exemplary embodiment, the
confidence level can be provided as a percentage of attributes
matched for a patient (e.g., 75% match, 95% match, 80% match, etc.)
and/or as a number of attributes matched (e.g., 7 of 8 attributes
matched, 18 of 18 attributes matched, etc.). If a patient matches
all a diagnosis's attributes, the diagnosis module 210 can be
configured to indicate that the patient is a "perfect" match.
Correspondingly, if a patient does matches most but not all a
diagnosis's attributes, the diagnosis module 210 can be configured
to indicate that the patient is not a "perfect" match but is a
"possible" match or, if more attributes are matched, a "likely"
match.
[0141] The diagnosis module 210 may determine that the user's
entered symptoms do not match any of the stored plurality of
possible diagnoses, e.g., no one of the plurality of possible
diagnoses includes all of the user's entered symptoms. In such a
case, the diagnosis module 210 can be configured to inform the user
that no matching diagnoses were located and/or the diagnosis module
210 can be configured to determine one or more "best guess"
diagnoses based on, e.g., which one or more of the stored possible
diagnoses match a majority of the user's entered symptoms.
[0142] The diagnosis module 210 can therefore be configured as a
preliminary diagnosis mechanism that collects various patient data,
can help inform a patient of one or more possible causes of their
symptoms, and can help inform medical practitioner(s) treating the
patient of possible diagnoses to consider upon evaluation of the
patient, either in person and/or upon review of the user's entered
data. Thus, even before a patient visits a medical care
practitioner in person, or even if a patient never visits a medical
care practitioner in person, the patient can receive information
regarding their symptoms, which can facilitate speedy treatment.
The diagnosis module 210 can also help inform medical practitioners
about conditions with which they have less familiarity with, which
can help train the medical practitioners, make their job easier,
and provide better outcomes through instant education of the
medical practitioners. The diagnosis module 210 can be configured
to determine and report differential diagnosis, with ranked
appropriate diagnoses and confidence levels for each assigned
diagnosis, which can help a medical professional make more informed
decisions regarding patient diagnosis and/or treatment. The
diagnosis module 210 can be configured to capture a plurality of
coexisting diagnosis, e.g. metastatic tumor and fracture, scoliosis
and myelopathy, etc. Since the diagnosis module 210 can capture all
ongoing treatments, therapies and medicines to which the patient
has been exposed, the potential for dangerous drug interaction or
hazardous interactions with different therapies can be avoided
through automated warnings provided by the system 10 to, e.g., a
surgeon, nurse, pharmacist, and/or patient.
[0143] The diagnosis module 210 can allow a medical practitioner to
manually enter diagnosis information for a patient to be stored in
the diagnosis database 310 for the patient. This manually entered
diagnosis information can be based on symptom data input to the
system 10 or can be based on other data and analysis, e.g., data
collected outside the system 10 and analyzed by the medical
practitioner. By allowing diagnosis information to be directly
entered into the system 10, the system 10 can help manage treatment
of the patient through a continuum of treatment following an
initial diagnosis. The system 10 can therefore be seamlessly
integrated into a medical practitioner's current practice, a
hospital setting, etc. in which at least some patients already have
diagnoses for various illnesses, injuries, and diseases. Similarly,
the system 10 can allow manual entry of other information mid-way
through a patient's diagnosis and/or treatment, such as a patient's
treatment plan, so as to allow seamless integration of the system
10 into a patient's medical care.
[0144] By way of example, the system 10 can be used in a spinal
context, such as to test for the presence of cytokines (such as
Fibronectin-aggrecan complex, FAC) and growth factors (such as
TNF-alpha or IL-8) in the intervertebral disc of patients, in
specifically DDD or herniated disc cases in the lumbar, thoracic,
or cervical spine. The system 10 can prompt a physician to run this
test as a result of the system's review of a patient's symptoms.
The result of the test can be stored in the diagnosis database 310
and used in the diagnosis of the patient and in recommending the
use of certain treatments such as epidural steroid injections,
e.g., Enbrel or Remicade (TNF antagonists). As the system 10
continually runs these tests on more patients, and then
subsequently tracks the test's validity in diagnosing the patient's
condition by relating it to the patient outcome of the chosen
surgical treatments for DDD and/or herniated disc, the system 10
will gain a more refined intelligence of when to prescribe the
test, and when to prescribe certain medications and/or treatments
(invasive or non-surgical) based on the results of the test. The
system 10 can also be configured to receive the raw data of the
test, and through the statistical power created by continually
comparing these granular results with chosen treatments and patient
outcomes, the system 10 can further refine the analysis of the
chemical components of the test and more accurately relate them to
diagnoses, treatments, and outcomes. Alternately, the system 10 can
be configured to record the DNA data for each patient in the
diagnosis database 310, provided by a sequencing test, and run an
algorithm that analyzes and compares the DNA markers for patients
with similar pain diagnoses. Over time, this continual comparison
will result in the system 10 identifying markers that predict
patients to be at a higher risk for certain spinal disorders. This
identification will help in the initial diagnosis phase to develop
an appropriate treatment plan based on the existence of these
high-risk markers in combination with the patient's symptoms. For
example, if there are clear markers that indicate that the
condition will only worsen with time and that surgical intervention
will be necessary, then a less invasive surgery can be done early
before the condition worsens and results in more pain and
disability. If the patient is lacking high risk markers, then a
more conservative treatment would be recommended as a first course
of action.
[0145] For another example, the diagnosis module 210 can include an
algorithm, alone or in combination with the treatment options
module 212, that can be configured to analyze inputs such as an MRI
or CT scan of a patient so as to automatically detect specific
features contained in inputs that are related to specific
pathologies. Based on the analysis, this auto diagnosis algorithm
can provide feedback to the user of the pathologic issue that has
been discovered for consideration in determining diagnosis, along
with treatment recommendations, as determined in concert with the
other system inputs. In an exemplary embodiment, the algorithm can
have pre-programmed pathologies to look for, such as collapsed disc
space (shorter than a determined height) and a loss of signal in
the spinal cord. These pre-programmed pathologies can have related
treatment methods predefined in the diagnosis module 210 and/or the
treatment options module 212. As the system 10 collects more data,
the system 10 can be able to compare these analyses and
recommendations to the functional outcomes across patients, and can
learn how accurate pre-programmed inputs to the system 10 were, and
adjust as necessary to increase the accuracy of the auto diagnosis
based on this result. The system 10 can be configured to perform
further analysis to autonomously develop its own criteria for
assessing the inputs (e.g., the MRI or CT scans) by using the data
collected in the diagnosis and treatments database 300 and/or the
recovery database 308 to find common anomalies between patients and
the treatments that are most successful in addressing them.
[0146] Treatment Options Module
[0147] The treatment options module 212 can provide users of the
system 10 with an interface for receiving one or more treatment
options based on the preliminary one or more diagnoses determined
by the diagnosis module 210. A user can receive treatment option(s)
for each of the determined preliminary diagnoses, or the treatment
options 212 module can allow the user to particularly select one or
more of the preliminary diagnoses to receive treatment option(s)
therefor from the system 10.
[0148] The treatment options module 212 can determine the treatment
option(s) in a variety of ways. In an exemplary embodiment, the
treatment database 312 can include a plurality of possible
treatment options, each of the possible treatment options being
associated with at least one possible diagnosis. This treatment
options data can be organized in any way, such as in a table. The
treatment options module 212 can be configured to assemble
composite patient data points in real time, until the search
crosses a predetermined threshold for meeting an optimal
constellation of findings that most perfectly match with a certain
treatment option. The treatment options module 212 can be
configured to screen for all known contraindications and relative
contraindications simultaneously. If key elements of these are
found to be unknown, the treatment options module 212 can be
configured to query the user to provide the missing data before
suggesting any treatment. The treatment options module 212 can be
configured to compare a possible diagnosis with the plurality of
treatment options stored in the treatment database 312 and
determine which of the plurality of possible treatment options are
associated with the possible diagnosis based on prior treatments
and outcomes that have been uploaded to and stored in the treatment
database 312. This comparison can be performed automatically by
automatically reviewing the stored data. The information loaded to
the system 10 regarding prior patients can include a plurality of
specific variables or attributes for each patient and treatment
type that can be compared and grouped in numerous combinations
automatically by the system 10. Examples of the variables include
patient age, height, weight, pain levels, scan images (e.g., MRI,
CT, x-ray, etc.), range of motion, lifestyle behaviors (e.g.,
smoking, exercise, etc.), bone density, disc degeneration, pain
locations, type of procedure performed, bone removed, disc removed,
implants used, pharmaceuticals administered, reduction in pain,
return to work, fusion rate, and functional outcome. Collection of
the specific variables for each patient can allow the system 10 to
automatically and continually review the data and discover trends
in the variables between patients and relate these trends to
patient type, procedure type, and functional outcomes. These
relationships can be evaluated by the system 10 through multiple
algorithms in the diagnosis and treatment module 210 to provide
more accurate recommendations of treatments for the patient and
their symptoms to result in an optimized outcome.
[0149] The treatment options module 212 can be configured to
determine a treatment using predetermined criteria similar to that
discussed above regarding the diagnosis module 210 using
predetermined criteria to determine a diagnosis.
[0150] The treatment options module 212 can be configured to cause
a display screen (e.g., a screen of the same device the user used
to enter the symptoms) to show a list of the possible treatment
option(s). The possible treatment option(s) can be provided to the
user with a caution that the possible treatment option(s) are
preliminary only and that a user must consult a doctor for a
complete evaluation and treatment plan. The possible treatment
option(s) can be provided to the user with historic success rates
of each of the possible treatment option(s). The historic success
rates can be stored in the treatment database 312 for each of the
treatment options and can be manually entered. Alternatively or in
addition, the historic success rates can be based on data collected
by the system 10 regarding a plurality of patients, e.g., HRQOL,
health economic data, etc., such that the system 10 can act as a
feedback loop system in which previously collected data regarding
treatments received by actual patients can inform treatment options
suggested to future patients. The possible treatment option(s) can
be provided to the user with educational resources for at least one
of the options, e.g., links to informational web pages stored in
the system 10 (e.g., in the treatment database 312), links to third
party educational websites, lists of or links to journal articles
or books, educational video of a surgical procedure that is stored
in the system 10 (e.g., in the treatment database 312), links to
medical device product brochures (e.g., brochures stored
electronically in the system 10), etc.
[0151] In some embodiments, the treatment options module 212 can
provide coding and reimbursement information for each of the
suggested treatment options. Providing such information can
facilitate educated decision-making about which of the treatment
options to pursue (if any).
[0152] In some embodiments, the treatment options module 212 can be
configured to consider one or more factors other than patient
symptoms in determining treatment option(s) to suggest for a
patient. Considering such factors can allow a potential success
rate of various treatment options to be considered by the treatment
options module 212 in suggesting particular treatment options for a
patient. Such factors can include any one or more of a patient's
age, medical practitioner treatment preferences previously logged
in the treatment database 312, a patient's bone density, a
patient's medical history, prior surgery performed on the patient,
discography, a compliance rate of the patient with prior
non-surgical treatments, leak rate studies, patient images (e.g.,
x-rays, magnetic resonance imaging (MRI) images, x-ray computed
tomography (CT) scans, etc.), test results data from lab tests,
etc.
[0153] FIG. 7 illustrates an embodiment of obtaining accurate bone
density information for a patient using a CT scanning machine 32
and a bone density marker 34. The bone density marker 34 can
include a first material having a first density .rho..sub.1 on one
side, e.g., right side, of the marker 34 and a second material
having a second density .rho..sub.2 next to the first material on
an opposite side, e.g., left side, of the marker 34. The marker 34
can be placed on and/or under a patient scanned by the CT machine
32. By knowing the densities .rho..sub.1, .rho..sub.1 of the marker
34, a correlation can be made to the grey scale output of the CT
scan. Densities of any pixel in the CT scan can therefore be
determined. The patient's bone density can therefore be determined
by analyzing pixels showing bone in the CT scan. The treatment
options database 210 can be configured to consider the patient's
bone density data in determining suggested treatment options for
the patient, e.g., suggest treatment options with very low impact
exercise if a patient has very low bone density, suggest no
surgical treatments if bone density is too low, etc.
[0154] The possible treatment options suggested by the treatment
options module 212 can include non-surgical treatment options
(e.g., diet adjustments, exercise regimens, medications, etc.) and
invasive treatment options such as surgical treatment (e.g.,
specific surgical procedures), needle procedures, biopsy, and
catheter based procedures. In an exemplary embodiment, only
non-surgical treatment(s) can be initially suggested to a user of
the system 10. In this way, a conservative treatment can be pursued
before a more radical, typically more costly treatment such as
surgery is pursued. If one or more of the non-surgical treatments
are pursued and are determined to unsatisfactorily address a
patient's problem(s), then the treatment options module 212 can be
configured to suggest one or more invasive treatment options. The
suggestion invasive treatment options can each include procedure
type and, if appropriate, implant options. The treatment options
module 212 can be configured to suggest the one or more invasive
treatment options upon request by a user, e.g., when a medical
practitioner requests non-conservative treatment options for a
particular patient, and/or can be configured to suggest the one or
more invasive treatment options when a trigger event occurs, e.g.,
after a predetermined threshold amount of time passes from
commencement of a non-surgical treatment for a patient after which
the patient has not shown a predetermined amount of improvement. By
way of non-limiting example, the treatment options module 212 can
be configured to analyze data gathered by the diagnosis module 210
and/or the treatment compliance module 216, discussed further
below, and determine whether the patient's mobility has improved by
a certain degree after a certain amount of time as indicated by
reported pain levels and/or analysis of captured images. Before the
treatment options module 212 suggests one or more invasive
treatment options following determination that a non-surgical
treatment is not achieving a desired outcome, the treatment options
module 212 can be configured to first suggest one or more other
non-surgical treatments.
[0155] By suggesting treatment option(s) to a user, the diagnosis
and treatment module 200 can allow the user to receive and analyze
information that may be outside their area of medical expertise.
For non-limiting example, a general medical practitioner such as a
patient's primary care physician (PCP) may not be very familiar
with specific spine injuries or deformities. The diagnosis and
treatment module 200 can allow the PCP to enter a patient's spinal
symptoms (e.g., to the diagnosis module) and receive a suggested
treatment (e.g., from the treatment options module 212) for the
spine-related symptoms. The PCP can therefore provide speedier,
more detailed diagnosis information to the patient, as well as
direct the patient to a specialist and/or advise appropriate care,
more quickly, and likely more accurately, than if the PCP had to
rely on traditional diagnosis and treatment assistance tools such
as print or electronic books, print or electronic articles, and
consultation with colleagues. The PCP can still consult the
traditional diagnosis and treatment assistance tools. Additionally,
the PCP can become better informed about spinal issues through use
of the diagnosis and treatment module 200 for the patient with
spine-related symptoms, which can help the PCP train residents,
educate colleagues, educate patients, and treat future patients
having similar symptoms.
[0156] The treatment options module 212 can include a patient
consent of treatment form where password protected signature
approval is obtained from the patient noting a full understanding
of options and agreement to provider prescribed treatment(s). This
form and signature can be stored in the patient record of the
diagnosis and treatment database 300 and can be linked to the
patient's EMR.
[0157] Care Provider Module
[0158] The care provider module 214 can provide users of the system
10 with an interface for receiving a recommendation of one or more
medical practitioners to treat a patient based on one or more of
the preliminary one or more diagnoses determined by the diagnosis
module 210, the one or more treatment option(s) determined by the
treatment options module 212, and the patient's geographic
location. The care provider database 314 can include data regarding
a plurality of medical practitioners, each of the medical
practitioners being associated with at least one geographic
location, at least one area of medical practice, at least one
previously performed surgical procedure, and/or at least one
previously provided medical treatment. This care provider data can
be organized in any way, such as in a table.
[0159] The care provider module 214 can be configured to compare at
least one of the preliminary diagnoses determined by the diagnosis
module 210, the treatment option(s) determined by the treatment
options module 212, and the patient's geographic location with the
data stored in the care provider database 314 to determine one or
more medical practitioners associated with the preliminary
diagnoses determined by the diagnosis module 210, the treatment
option(s) determined by the treatment options module 212, and/or
the patient's geographic location so as to be appropriate for the
patient to consult for further medical information and/or
treatment. The care provider module 214 can be configured to cause
a display screen (e.g., a screen of the same device the user used
to enter the symptoms) to show a list of the possible care
provider(s). The list can include information regarding the care
provider(s) such as name, address, gender, phone number, affiliated
hospital, any accepted insurance plans, website, and/or area of
medical specialty. The care provider module 214 can be configured
to provide access to outcomes for affiliated hospitals and for
physicians performing the potential treatments. The outcomes can be
stored in the care provider database 314. The outcomes can be
provided for review by, e.g., the patient, the patient's family,
the patient's caregiver, the patient's primary care physician, etc.
The care provider module 214 can therefore assist patients in
locating a medical practitioner near the patient and/or with
particular skill related to the patient's possible diagnosis and/or
possible treatment.
[0160] Treatment Compliance Module
[0161] The treatment compliance module 216 can provide users of the
system 10 with an interface for tracking patient compliance with a
treatment plan. The treatment plan can be one of the suggested
treatment options suggested by the treatment options module 212,
can be one of the suggested treatment options suggested by the
treatment options module 212 as modified by a medical practitioner,
or can be a treatment plan entered into the system 10 by a medical
practitioner without assistance of the treatment options module
212. The treatment plan can be stored in the treatment database
312. The treatment compliance module 216 can thus allow monitoring
and management of a patient's treatment, which can help the
patient's doctor evaluate the patient's progress and/or can help
determine whether and when modifications to the treatment plan may
be necessary, such as by adjusting the treatment plan (e.g.,
changing dietary requirements, changing a frequency of doctor
check-ups, etc.) or replacing the treatment plan (e.g., a
non-surgical treatment) with another treatment plan (e.g., a
surgical treatment).
[0162] Patients and users other than patients can submit data to
the treatment compliance module 216 for storage in the treatment
database 312. Data can therefore be received by the treatment
compliance module 216 whether the patient is or is not in a medical
setting and can be received throughout the patient's treatment,
including times other than when the patient visits or consults a
medical practitioner. More accurate and more timely data regarding
treatment plan compliance can therefore be gathered and
analyzed.
[0163] Patient compliance response to medicinal treatments can be
monitored, e.g., by a patient's treating physician, by viewing
compliance data stored in the treatment database 312, which can
allow dose level changes to be made more readily by, e.g., the
treating physician. Simple at-home diagnostic tools can be used to
monitor components within blood, urine or other fluids. This
at-home diagnostic tool information can allows the patient's
physician to adjust medicinal dosages to the individual patient.
The treating physician can change the dose of the medicine to the
needs of the patient based upon the information tracked and
recorded. Other at home tools can be additionally or alternatively
monitored; such as results of self-administered ultrasound images,
photographs of incision sites, microscopic photos of areas of
concern, etc. These other at-home tools can be uploaded to the
patient's record in the treatment database 312, where the data can
be accessed and reviewed by, e.g., the patient's surgeon.
[0164] Users can submit data to the treatment compliance module 216
similar to that discussed above regarding submission of data to the
diagnosis module 210. Non-limiting examples of compliance data that
can be gathered by the treatment compliance module 216 include
exercise performed, medication taken, daily diet, physical therapy
attended/performed, physiological data such as heart rate, patient
geographic location, pain, neurologic tracking, bone alignment
(e.g., spine curvature, etc.), and patient movement (e.g.,
mobility, gait, walking speed, flexibility, muscular strength,
posture, range of motion, joint movement, etc.). The treatment
compliance module 216 can be configured to accept manual entry of
compliance data by a user, e.g., submission of types and lengths of
physical therapy, and to accept automatically gathered compliance
data, e.g., smartphone or bracelet location and movement tracking
data. The treatment compliance module 216 can be configured to
automatically gather data at predetermined time intervals, e.g.,
every sixty minutes, every twenty-four hours, every Sunday morning,
etc., which can help allow for more accurate comparison of data
gathered at different times and/or on different days. Additionally
or alternatively, the treatment compliance module 216 can be
configured to automatically gather data upon detection of a trigger
event, such as use of a pedometer, e.g., automatically gather
pedometer data when the patient walks/runs so as to increase the
pedometer's count. The treatment compliance module 216 can be
configured to prompt a user for specific compliance data and/or
prompt the user to enter compliance data at specific dates and/or
times. The treatment compliance module 216 can be configured to
allow for scanning of medications taken and patient compliance data
acquisition at times correlated with medication intervals, e.g.
directly before, one hour after, two hours after, four hours after,
eight hours after, etc.
[0165] The treatment compliance module 216 can be configured to
analyze received compliance data to determine a compliance level
and/or a success rate of the treatment overall and/or per symptom.
The compliance level and/or the success rate can help a medical
practitioner and/or the treatment compliance module 216 determine
whether modification of a patient's treatment plan is
necessary.
[0166] The treatment compliance module 216 can be configured to
compare received treatment compliance data for a patient with
historic compliance data for other patients who underwent similar
treatment to help determine the effectiveness of the treatment for
the patient. The comparison can allow the treatment compliance
module 216 to determine whether a patient is adequately following
the treatment plan or is lagging behind historical benchmarks
achieved by other patients undergoing the treatment. The comparison
can also allow the treatment options module 212 to evaluate
treatment options for future patients because if a treatment is
historically shown to be problematic for any one or more reasons
(e.g., difficulty in achieving patient compliance, slow progress in
addressing symptoms, expensive, lack of insurance payments, etc.)
or shown to be particularly effective for any one or more reasons
(e.g., patient mobility consistently increases, non-surgical
treatment usually not followed by surgery, etc.), the treatment
options module 212 can be more likely (for particularly effective
treatments) or less likely (for problematic treatments) to
recommend the treatment for future patients.
[0167] Because the treatment compliance module 216 can be
configured to simultaneously and continuously receive information
regarding multiple patients, the diagnosis and treatment module 200
can continually analyze received data to help determine efficacy of
a particular patient's treatment plan. The diagnosis and treatment
module 200 can thus determine that a particular patient's treatment
plan should be modified based on another set of patients' data
indicating low or high effectiveness for a particular treatment
aspect, such as a specific exercise performed daily. In other
words, the diagnosis and treatment module 200 can learn from other
patients' experiences that the present patient's treatment could
benefit from a modification, e.g., perform a specific exercise once
every other day instead of once daily, cease performance of a
particular exercise, decrease salt intake, wear a knee brace 24/7
instead of only while sleeping, etc. The diagnosis and treatment
module 200 can be configured to suggest the modification of the
patient's treatment plan to the patient's care provider, e.g., by
providing an alert (e.g., email message, text message, instant
message, phone call, etc.) to the care provider indicating that
modification of the patient's treatment plan is recommended. The
care provider can review the modification, e.g., by logging onto
the system 10, and determine whether to modify the patient's
treatment plan. Alternatively, the diagnosis and treatment module
200 can be configured to automatically modify the patient's
treatment plan and inform the patient via an alert as to the
modified treatment plan. Usually, however, a care provider would
review a modification to check its appropriateness for the
particular patient before the diagnosis and treatment module 200
automatically modifies the patient's treatment plan and informs the
patient of the change.
[0168] The treatment compliance module 216 can be configured to
provide feedback to the patient regarding their compliance, which
can help ensure that a patient complies with the plan as much as
possible and/or can help show the patient that the plan is
effectively treating the symptom(s) or that the symptom(s) are not
dissipating, in which case the patient can be prompted to contact
their care provider for consultation. The compliance feedback can
be provided in a variety of ways. Non-limiting examples of
compliance feedback include a percentage indicating degree of
compliance with all plan aspects; a model of bone alignment over
time; a graph of mobility over time; connection with or comparison
to other patients with similar symptoms, diagnoses, and treatment
plans as a way to compare progress and provide motivation to the
patient to comply with their treatment plan by being inspired by
the progress of others in their peer group; etc.
[0169] Pre-Op Module
[0170] The pre-op module 202 can generally provide users of the
system 10 with an interface for planning surgery, e.g., doctor's
office pre-op planning, operating room (OR) pre-op planning, and
patient pre-op planning. More particularly, the pre-op module 202
can allow surgeons to electronically perform three-dimensional (3D)
simulated surgeries on virtual models of patients to test surgical
ease and/or potential surgical outcomes before actually performing
the surgical procedure. The simulated surgeries can include
variations of the same surgical procedure on a patient so as to try
different surgical instruments and/or different surgical
strategies. The pre-op module 202 can also facilitate logistical
surgical planning such as equipment ordering and supply, OR
scheduling, and personnel scheduling. The pre-op module 202 can
also facilitate the logistics of preparing the patient for surgery,
such as by managing patient pre-op requirements and activities
before and after the patient arrives at the hospital. In this way,
the pre-op module 202 can be configured to assist pre-op planning
and management through a continuum from a decision to pursue
surgery to the patient's arrival at an OR for surgery. In one
embodiment, the pre-op module 202 can be implemented using one or
more web pages which are configured to receive user input and
present information to a user. In an exemplary embodiment, both
patients and medical practitioners can access at least a portion of
the pre-op module 202.
[0171] The pre-op module 202 can include a surgical procedure
module 218, an equipment management module 220, a scheduling module
222, and a patient preparation module 224. Each of the modules 218,
220, 222, 224 is discussed further below in turn.
[0172] As mentioned above, the pre-op module 202 can be configured
to read information from and to write information to the pre-op
database 302. The pre-op database 302 can include a procedure
database 316, an inventory database 317, and a catalog database
318. Various ones of the pre-op module's component modules 218,
220, 222, 224 can be configured to access one or more of the
procedure database 316, the inventory database 317, the catalog
database 318, and/or various other databases, e.g., the diagnosis
and treatment database 300, the operation database 304, the post-op
database 306, and the recovery database 308. Each of the databases
316, 317, 318 is discussed further below in connection with various
ones of the pre-op module's component modules 218, 220, 222,
224.
[0173] Surgical Procedure Planning Module
[0174] The surgical procedure planning (SPP) module 218 can provide
users of the system 10 with an interface for electronically
performing 3D simulated surgeries. In an exemplary embodiment, only
surgeons authorized to perform surgery can access the SPP module
218. The procedure database 316 can be configured to store a record
of a performed simulated surgery, e.g., a video of the simulated
surgery, an inventory of surgical instruments used in the simulated
surgery, statistics regarding the simulated surgery (e.g., a total
length of surgery time, a length of a particular portion of the
procedure, an amount and/or exact location of bone and/or soft
tissue removed from the virtual patient, etc.), annotations or
notes added by the user performing the simulated surgery, etc. The
simulated surgery can therefore be used in the future for reference
and/or analysis by the performer of the simulated surgery, by
residents for training purposes, by staff involved with an actual
surgical procedure corresponding to the simulated surgery, and/or
by other users of the system 10, such as during and/or after
performance of an actual surgical procedure corresponding to the
simulated surgical procedure, as discussed further below regarding
the operation module 204 and the post-op module 206.
[0175] The SPP module 218 can allow a user to select a surgical
procedure to simulate. The user can simulate any number of surgical
procedures, thereby allowing the user to experiment with procedures
that the user may never have performed before or may only rarely
perform. The procedure database 302 can include a collection of
surgical procedures from which the user can select the surgical
procedure. The procedure database 302 can include data related to
each of surgical procedures in the collection, which can allow the
SPP module 218 to provide suggestions and options to the user based
on the user's selection of a particular surgical procedure. The SPP
module 218 can be configured to recommend an optimized plan for the
selected surgical procedure. In an exemplary embodiment, the
optimized plan can be provided to the user before commencement of
the simulated surgery and can be accessible by the user throughout
performance of the simulated surgery. The SPP module 218 can be
configured to develop the optimized plan based on a plurality of
factors, e.g., data stored in the procedure database 316 (and/or in
any other database) regarding previously performed actual surgical
procedures and outcomes corresponding to the selected surgical
procedure performed by the user and/or other users, data regarding
the patient on which the simulated surgery will be actually
performed, one or more goals identified by the user as being a
surgical outcome goal, etc.
[0176] By way of non-limiting example, the SPP module 218 can be
configured to provide a menu of surgical instruments to the user
customized to the surgical procedure selected by the user (e.g., a
menu including surgical instruments used in actual surgical
procedures of a same type as the selected simulated procedure
previously performed by the user and/or other users in the past),
an estimated cost of the selected surgical procedure based on
previously performed actual surgical procedures of a same type as
the selected simulated procedure, one or more professional
educational resources about the selected simulated surgical
procedure (e.g., links to external websites; an estimated costs of
the selected surgical procedure for each different equipment and/or
staff selection made by the user; links to manuals, videos, images,
and/or other informational data stored in the catalog database 318;
and identification of colleagues of the user (e.g., surgeons
working in the same hospital as the user) who have previously
performed an actual surgical procedure of a same type as the
selected simulated procedure and are available for consultation;
etc.); identification of surgical support staff associated with the
user (e.g., staff working in the same hospital as the user) who
have assisted with an actual surgical procedure of a same type as
the selected simulated procedure. Exemplary embodiments of
providing educational support to users are described in more detail
in U.S. patent application Ser. No. 13/603,452 entitled "Systems
And Methods For Surgical Support And Management" filed Sep. 5,
2012.
[0177] The SPP module 218 can be configured to allow a user to save
a selected list of surgical instruments, implants, and/or auxiliary
equipment including hardware (e.g., monitors, scope, fluoro, etc.),
and disposables (e.g., tubing, drapes, sensors, sharps, etc.) in
the procedure database 316 that can be displayed to the user each
time the user decides to perform a simulated surgery of a selected
type or of any type. In some embodiments, a selected list of
surgical instruments in the procedure database 316 can be saved for
use by a plurality of users, e.g., users who all work at the same
hospital, which can help ensure that only instruments actually
available for use by surgeons at the hospital are selected for use
in a simulation. Any lists saved in the procedure database 316 can
be modified or deleted at any time.
[0178] The SPP module 218 can be configured to suggest one or more
alternates s for one or more selections by the user for use in the
selected surgical procedure. Using surgical instruments as an
example, the suggested alternate(s) can be instrument(s) similar to
the selected instrument as determined by previous correlations made
between different surgical instruments, e.g., categorizing each
surgical instrument by type, size, which actual surgical procedures
the instrument was previously used in by the user and/or other
users, etc. The suggested alternate(s) may be previously unused or
unknown to the user. The user can thus be informed of newly
available instruments, of instruments that may make the procedure
easier to perform, and of instruments that may be less costly than
the selected instrument. The inventory database 317 can store data
(e.g., a table) regarding a plurality of actual surgical
instruments available for use by the user in an actual surgery. The
suggested one or more alternate surgical instruments can be based
on the actual availability of instruments as indicated in the
inventory database 317.
[0179] FIG. 8 illustrates an embodiment of a menu including
surgical instruments and implants 36 used in actual surgical
procedures of a same type as the selected simulated procedure that
the SPP module 218 can display to a user 38. A client terminal on
which the menu is displayed and on which the simulated procedure
can be performed by the user 38 is shown in the illustrated
embodiment as a tablet 40, but as mentioned above, any client
terminal can be used to access the system 10. Each of the surgical
instruments and implants 36 can be a 3D model of an actual surgical
instrument available for use in an actual surgical procedure.
Information about each of the instruments and implants 36 can be
shown on the display and/or available by selecting one of the
instruments and implants 36, e.g., by clicking on or hovering a
selection tool over an instrument. The instrument information can
be stored in the catalog database 318. Non-limiting examples of
information about instruments, implants, and auxiliary equipment
include cost, size, availability in the user's hospital inventory,
manufacturer, indication as to whether the user previously used the
instrument in a previous actual surgical procedure, and whether
additional views of the instrument are available. Although the menu
is shown in FIG. 8 as a pictorial menu, the menu can be presented
in any way, such as all text, all pictorial, or a combination of
text and images. Additionally, one or more informational resources,
e.g., links to product brochures, links to educational videos of
products in use, identification of previous surgical procedure(s)
using the menu item that were performed by the user, etc., can be
provided for any one or more of the menu items.
[0180] The SPP module 218 can be configured to model the patient on
which the selected simulated surgical procedure is to be performed.
In other words, the SPP module 218 can be configured to create a
virtual patient modeled on an actual patient. The virtual patient
can be based on data stored in the system 10 (such as data
regarding the actual patient stored in the diagnosis and treatment
database 300, e.g., patient weight, x-ray images, CT images, MRI
images, ultrasound images, BMI, genetic test results, visual images
of the patient, etc.) and/or based on typical patient data stored
in the system 10. The simulated surgery can thus be performed on a
model as close to the actual patient as possible, helping to allow
the simulation to train the user as much as possible and helping to
provide reliable outcomes of the surgery.
[0181] FIG. 9 illustrates an embodiment of a simulated surgical
procedure display 42. A vertebra is circled in the display 42 for
ease of identification of a surgical target 44.
[0182] A simulated surgical procedure display can include one or
more user options configured to provide enhanced visualization of
the procedure. Non-limiting examples of such options include 3D
(e.g., the user can choose 3D display and wear 3D glasses to
properly see the 3D display), holograms, and topographical maps.
FIG. 10 illustrates an embodiment of a topographical mapping system
46 including a pin table 48 configured to facilitate visualization
of 3D data on a 2D display device 50. The pin table 48 can include
a plurality of pins 48a each configured to automatically adjust in
height to show 3D data based on the 3D model of the patient in the
SPP module 218, thereby allowing, e.g., visualization of the
deformity and correction. The pins 48a can be covered in a flexible
sheet to enhance visualization of the preoperative, intra, and post
operative 3D geometry.
[0183] The simulated surgery can allow the user to simulate the
selected surgical procedure from beginning to end. Aspects of the
selected surgical procedure that can be simulated can include one
or more of an access point on the patient, surgical instruments
used in the procedure, a path through and/or retraction of tissue
and nervous structures, bone removal, soft tissue removal, tissue
and structure movement, correction, movement due to indirect
decompression, and placement of all implants. The user can save the
simulated procedures at various points throughout the simulation,
which can allow the user to repeat aspects of the procedure more
than once to perfect technique, to test performance of different
surgical products, to test the suitability of different access
points, and/or to achieve other goals.
[0184] The SPP module 218 can be configured to analyze various
aspects of the simulated surgical procedure in real time with
performance of the simulation. For non-limiting example, the SPP
module 218 can be configured to monitor an amount of radiation the
patient, surgeon, and OR staff could be exposed to during the
surgery and, optionally, tally a cumulative total radiation
exposure for the patient including the simulated surgery and actual
prior radiation exposure as well as future predicted exposures.
Monitoring radiation exposure can help encourage reduction of the
patient's radiation exposure and help ensure that the patient is
not exposed to radiation beyond an acceptable level within a
certain period of time. For non-limiting example, the SPP module
218 can be configured to compare drug use during the simulated
procedure with known allergies of the patient and with known drug
interactions, thereby helping to reduce chances of drugs adversely
affecting the patient during or after surgery. For yet another
non-limiting example, the SPP module 218 can be configured to
perform predictive volumetric modeling of soft tissue movement,
stretch, removal (e.g., of a herniated disc), and change based on
each step of the simulated procedure. The user can thus be able to
see in real time with the simulation how tissue and other
structures will move based on each step of the procedure. During
the simulated procedure, the SPP module 218 can be configured to
use this predictive modeling to show where tissue and other
structures are predicted to be, allowing for navigation around
them. The SPP module simulation can utilize historical surgical and
literature data to predict neural responses and/or changes based
upon a predicted amount of retraction and/or decompression
preformed. When the simulation is complete, the SPP module 218 can
be configured to analyze the procedure for projected results, e.g.,
potential healing, potential increase in patient mobility after "X"
amount of time, amount of correction, etc. The user can thus
consult the projected results and decide whether to revise the
surgery, such as if the projected results are less than the user
would like and/or expect.
[0185] The SPP module 218 can facilitate the planning of revision
surgeries. Using a spinal surgical procedure as an example, patient
information regarding initial implant product, position, bony
ingrowth or ongrowth, etc. can be reviewed prior to surgery. The
approach to remove the initial implant, the optimal sizing of the
replacement implant, and the need for additional instrumentation
(e.g., instrument set of the initial product or bone removal tools)
can be incorporated in the surgical plan for the implant
revision.
[0186] When the user completes a simulated surgical procedure, the
user can mark the procedure as being complete. Marking the
simulation as being complete can signal to the SPP module 218 that
pre-op planning by the system 10 for an actual surgical procedure
corresponding to the simulated surgical procedure can begin.
Throughout performance of the simulated surgical procedure, the SPP
module 218 can allow the user to save progress of the simulation,
but these saves can be marked as incomplete simulations in the
procedure database 316. The user can choose to perform a simulation
all at once, or the user can save a partially complete simulation
and resume the saved simulation at a later date/time. A user can
choose to never complete a partially finished simulation. The SPP
module 218 can be configured to incorporate historical patient
growth data to further depict structural changes over patient's
lifetime. This incorporation can be especially helpful with
patients having variable and changing anatomies, e.g., young
scoliosis patients with variable and changing curvatures. Users of
the system 10 can run a predicted life changes module to assess
potential future changes and assist in planning and refining the
surgical procedure.
[0187] The SPP module 218 can be available to users inside and
outside the OR. In other words, a user can perform a simulation
using the SPP module 218 outside the OR, e.g., before surgery is
even scheduled, and/or inside the OR, e.g., as immediate prep
before a scheduled surgery. FIG. 11 illustrates an embodiment of a
user 52 accessing the system 10 in an OR via a client terminal in
the form of a computer including a processor (not shown), a display
screen 54, and a keyboard 56. In the illustrated embodiment, the
user 52 is simulating performance of a spinal procedure, but as
mentioned above, the system 10 can be used to simulate other types
of surgical procedures.
[0188] Equipment Management Module
[0189] The equipment management module 220 can provide users of the
system 10 with an interface for managing equipment used in surgery,
such as surgical implants and surgical instruments. In an exemplary
embodiment, only medical administrators (e.g., hospital inventory
managers, etc.) and medical personnel (e.g., surgeons authorized to
perform surgery, etc.) can access the equipment management module
220.
[0190] The equipment management module 220 can be configured to
determine whether actual inventory as reflected in the inventory
database 317 can meet the needs of actual surgery based on the
completed simulated surgery (e.g., a simulation marked as
complete). In alternative (e.g., if no simulated surgery has been
performed) or in addition to basing the determination on the
completed simulated surgery, the equipment management module 220
can be configured to determine whether actual inventory as
reflected in the inventory database 317 can meet the needs of
actual surgery based on typical requirements for the selected
surgical procedure and/or on specific requirements input by a user
for the surgical procedure, e.g., a surgeon's preference to use
medical devices manufactured by a specific company. The equipment
management module 220 can be configured to compare virtual surgical
instruments used by a user in a completed simulated surgery with
actual surgical instruments available for use by the user in an
actual surgical procedure corresponding to the simulation. As
mentioned above, the inventory database 317 can store data
regarding a plurality of actual surgical instruments available for
use in actual surgeries. The equipment management module 220 can
determine whether each of the virtual surgical instruments used in
the completed simulated surgery is available in actual inventory as
indicated in the inventory database 317. The SPP module 218 can be
configured to allow a user to indicate that one or more extra
surgical instruments need to be available in an OR during
performance of an actual surgical procedure corresponding to a
simulated surgical procedure, e.g., an additional implantable
screw, a plurality of additional sutures, etc. The equipment
management module 220 can be configured to include these requested
extra surgical instruments in its determination of available actual
inventory.
[0191] The equipment management module 220 can be configured to
reserve actual surgical instruments and actual auxiliary equipment
in inventory for use in the actual surgical procedure by marking
the actual surgical instruments corresponding to the used virtual
surgical instruments, the actual auxiliary equipment corresponding
to the used virtual auxiliary equipment, and the requested extra
surgical instruments as "reserved" in the inventory database 317.
Inventory available to the user, e.g., inventory of a hospital, can
thus be kept up to date for upcoming surgeries performed by the
user and by any other medical professionals working from the same
inventory as the user.
[0192] The equipment management module 220 can be configured to
order actual surgical instruments and auxiliary equipment (e.g.,
from a medical device distributor or a medical device company) for
use in the actual surgical procedure if the actual surgical
instruments or actual auxiliary equipment are not available in
inventory as indicated by the inventory database 317. The equipment
management module 220 can be configured to order custom implants
(e.g., from a medical device company) that are manufactured for use
with a specific patient. Any pre-configuration of surgical supplies
such as surgical instruments (e.g., contouring of spinal rods in
accordance with the pre-op plan) and graft material (e.g., volume
and type of a specific graft material) can be ordered by the
equipment management module 220. As will be appreciated by a person
skilled in the art, custom implants can be designed and ordered in
a variety of ways. For non-limiting example, methods and
apparatuses for customizing an intervertebral implant including an
initial step of obtaining a 3D anatomy are described in further
detail in U.S. application Ser. No. 11/150, 468 (published as U.S.
Pat. Pub. No. 2006/0282020) entitled "Customizing An Intervertebral
Implant" filed Jun. 13, 2005. Generally, pre-op 3D anatomy of a
patient can be obtained in a variety of ways, e.g., using a CT
scanning machine, and can be stored in the system 10, e.g., in the
diagnosis database 310 as discussed further below. The 3D image(s),
e.g., a plurality of images from different angles, can be
subsequently evaluated at any time by a surgeon or other medical
staff to determine an appropriate custom implant for the patient,
which can then be ordered for availability during surgery.
[0193] The equipment management module 220 can also be configured
to track the status of open orders for actual surgical instruments,
for custom implants, and for pre-configuration. The equipment
management module 220 can thus help ensure that instruments are
available when needed for surgery and that surgery need not be
rescheduled and/or delayed merely due to surgical tools being
unavailable. Exemplary embodiments of ordering and managing
inventory are described in more detail in U.S. patent application
Ser. No. 13/603,452 entitled "Systems And Methods For Surgical
Support And Management" filed Sep. 5, 2012.
[0194] Scheduling Module
[0195] The scheduling module 222 can provide users of the system 10
with an interface for managing personnel (e.g., surgical support
staff, sales representatives, etc.) and hospital space used in
relation to the surgery (e.g., an OR, a patient prep room, a
patient hospital recovery room, etc.). In an exemplary embodiment,
only medical administrators (e.g., hospital inventory managers,
etc.) and medical personnel (e.g., surgeons authorized to perform
surgery, etc.) can access the scheduling module 222.
[0196] The scheduling module 222 can be configured to determine
whether available personnel and available hospital space as
reflected in the inventory database 317 can meet the needs of
actual surgery based on the completed simulated surgery (e.g., a
simulation marked as complete). In alternative (e.g., if no
simulated surgery has been performed) or in addition to basing the
determination on the completed simulated surgery, the scheduling
module 222 can be configured to determine whether actual inventory
as reflected in the inventory database 317 can meet the needs of
actual surgery based on typical requirements for the selected
surgical procedure and/or on specific requirements input by a user
for the surgical procedure, e.g., a surgeon's preference to work
with specific support personnel. The scheduling module 222 can be
configured to determine if available inventory has been autoclaved
and sterile. The scheduling module 222 can determine whether each
of the hospital rooms needed for the surgery (e.g., an OR, a prep
room, a patient recovery room, etc.) are available in actual
inventory as indicated in the inventory database 317, and/or the
scheduling module 222 can determine whether each of the surgical
staff members needed for the surgery (e.g., a sales representative,
an anesthesiologist, etc.) are available in actual inventory as
indicated in the inventory database 317. The SPP module 218 can be
configured to allow a user to indicate specific hospital space
and/or personnel preferences for performance of an actual surgical
procedure. The scheduling module 222 can be configured to include
these specific preferences in its determination of available actual
inventory. The SPP module 218 can be configured to store a user's
preferences so the user does not have to repeatedly enter the same
preferences.
[0197] The scheduling module 222 can be configured to reserve one
or more hospital spaces (e.g., rooms) for use in the actual
surgical procedure by marking the hospital spaces as "reserved" for
a specific date and time in the inventory database 317. Similarly,
the scheduling module 222 can be configured to schedule one or more
medical staff members to be present for the actual surgical
procedure by marking the one or more medical staff member's
schedule (e.g., in one or more electronic calendars accessible to
the medical staff members) as being "reserved" for a specific date
and time in the inventory database 317. Hospital space and
personnel available to the user can thus be kept up to date for
upcoming surgeries performed by the user and by any other medical
professionals working from the same hospital space and/or personnel
pool as the user.
[0198] Exemplary embodiments of scheduling personnel and hospital
space are described in more detail in U.S. patent application Ser.
No. 13/603,452 entitled "Systems And Methods For Surgical Support
And Management" filed Sep. 5, 2012.
[0199] Patient Preparation Module
[0200] The patient preparation module 224 can provide users of the
system 10 with an interface for preparing a patient for a scheduled
surgical procedure. The patient preparation module 224 can prepare
the patient through a continuum of at-home patient preparation to
arrival at the OR for the surgical procedure. In this way, the
patient preparation module 224 can help the patient prepare at home
for the surgery so the patient is more likely to arrive at the
hospital on time and with any necessary pre-surgery requirements
met, and can help ensure that the patient is appropriately prepared
for the surgery while at the hospital prior to the patient's
arrival at the OR.
[0201] The patient preparation module 224 can be configured to
provide at-home, pre-surgery patient preparation to a user, e.g.,
to a patient scheduled for surgery. In an exemplary embodiment, the
patient preparation module 224 can be configured to provide at
least one reminder to the user regarding any pre-surgery
requirements, such as a start day and time for fasting, day(s) and
time(s) to ingest particular medication(s), day and time to arrive
at the hospital, any preoperative blood test which must be
completed, bodily samples taken, etc. The reminder(s) can be
provided to the user in any number of ways, as will be appreciated
by a person skilled in the art, such as by email, phone call, a
mobile device app, etc. The patient preparation module 224 can be
configured to allow the user to select one or more modes of
reminder delivery. In an exemplary embodiment, the system 10 can
prompt the user to select one or more modes of reminder delivery
when the user initially establishes an account with the system 10,
such as by prompting the user to enter at least one of an email
address, a home phone number, a mobile phone number, an instant
message account, etc. to which the system 10 can provide reminders,
notifications, alerts, etc. If the user used the system 10 during
treatment, the user can receive surgery prep reminders in the same
way the user received treatment reminders, e.g., alerts from the
treatment compliance module 216. In this way, by the time the user
is preparing for a scheduled surgery, use of the system 10 can be
familiar to the user, which can help ease the stress of surgery and
help ensure that the patient is appropriately informed and reminded
of any necessary pre-surgery procedures to be undertaken by the
patient when medical personnel may not necessarily be with the
patient to provide guidance.
[0202] The patient preparation module 224 can be configured to
provide pre-surgery patient support by monitoring a patient
scheduled for surgery from when the patient arrives at the hospital
to when the patient arrives at the OR for the surgery. In an
exemplary embodiment, the patient preparation module 224 can be
configured to monitor the patient. The patient can be monitored in
a variety of ways, such as by a smart chip embedded in a bracelet,
necklace, gown, ID tag, etc. that the patient can wear. The patient
preparation module 224 can be configured to monitor the patient's
vital signs, location in the hospital, and status. This monitored
information can allow the patient preparation module 224 to, e.g.,
trigger preparation of a room for the patient (e.g., using the
patient's current location to trigger preparation of a next room
for the patient), to alert medical personnel if the patient
requires immediate attention (e.g., due to change in vital signs),
and to allow for scheduling and/or inventory adjustments in the
inventory database 317 if the patient's surgery is determined to be
delayed based on the patient's presence in a certain location a
certain amount of time before a scheduled surgery start time. This
monitored information can allow the patient preparation module 224
to perform an automated pre-op check to ensure that the surgery to
be performed matches the planned surgery, e.g., surgery on the
correct side or correct spinal level(s). The monitoring performed
by the patient preparation module 224 can be continued
intra-operatively as needed to record vital signs, and can be
combined with a multitude of other monitors that are conventionally
used in an OR. All of these outputs can be collected by the
operation database 304 of the system 10 throughout the procedure in
order to be added to the patient's record for inclusion in
analysis.
[0203] Operation Module
[0204] The operation module 204 can generally provide users of the
system 10 with an interface for enhancing performance of a surgical
procedure in an OR (or other location) and for gathering data for
future analysis. More particularly, the operation module 204 can
allow surgeons to consult a 3D simulated surgery performed and
saved via the pre-op module 202, which can help an actual surgical
procedure efficiently and effectively achieve predetermined
outcomes. The operation module 204 can provide feedback regarding
performance of the actual surgical procedure versus the previous
simulated surgical procedure during performance of the actual
surgical procedure, which can allow for mid-course corrections
and/or can help inform surgical staff of their surgical duties. The
operation module 204 can also provide informational materials
during performance of the surgical procedure, such as instrument
use manuals or videos, which can help ensure that the surgical
procedure is performed properly. The operation module 204 can also
track various aspects of the surgical procedure, e.g., instrument
use, personnel activity, patient radiation exposure without the
patient having to wear a radiation monitoring device such as a
dosimeter. patient vital signs, etc., which can allow for
mid-course corrections, help inform surgical staff of their
surgical duties, and/or facilitate post-op analysis of the surgical
procedure by the post-op module 206, as discussed further below.
The information tracked by the operation module 204 can also be
used by the system 10, e.g., by the recovery module 208, to
facilitate patient recovery and continued treatment post-surgery,
as discussed further below. The information tracked by the
operation module 204 can also be used by the system 10, e.g., by
the diagnosis and treatment module 200 and/or the pre-op module
202, in recommending and/or planning future surgeries involving the
patient and/or other patients in circumstances similar to the
patient on which the surgical procedure was performed. In this way,
the system 10 can become smarter over time in various ways, such as
by analyzing and recommending effective treatments in view of
historical surgical outcomes, by providing recommended surgical
strategies in view of a particular surgeon's historical performance
in certain types of surgeries and/or with certain types of surgical
instruments, and/or by providing recommended surgical strategies in
view of multiple different surgeons' historical performance in
certain types of surgeries and/or with certain types of surgical
instruments.
[0205] In one embodiment, the operation module 204 can be
implemented using one or more web pages which are configured to
receive user input and present information to a user. In an
exemplary embodiment, medical practitioners can access at least a
portion of the operation module 204 while patients cannot access
the operation module 204 at all.
[0206] The operation module 204 can include a plan tracking module
226, a procedure analysis module 230, an education module 228, an
equipment tracking module 232, an OR analysis module 234, and a
personnel tracking module 236. Each of the modules 226, 228 230,
232, 234, 236 is discussed further below in turn.
[0207] As mentioned above, the operation module 204 can be
configured to read information from and to write information to the
operation database 304. The operation database 304 can include a
products and procedures database 320, an OR database 322, an
equipment database 324, and an ethnography database 326. Various
ones of the operation module's component modules 226, 228 230, 232,
234, 236 can be configured to access one or more of the products
and procedures database 320, the OR database 322, the equipment
database 324, the ethnography database 326, and/or various other
databases, e.g., the diagnosis and treatment database 300, the
pre-op database 302, the post-op database 306, and the recovery
database 308. Each of the databases 320, 322, 324, 326 is discussed
further below in connection with various ones of the pre-op
module's component modules 226, 228 230, 232, 234, 236.
[0208] In an exemplary embodiment, an OR has a single user
interface configured to display information from the system 10 for
consultation during a surgical procedure performed in the OR. The
user interface can be located in the OR, or can be in a nearby area
visible from the OR. FIG. 12 illustrates an embodiment of an OR
setting in which the system 10 can be accessed via a client
terminal in the form of a computer including a processor (not
shown), a display screen 58, and a keyboard 60. In the illustrated
embodiment, a surgeon 62 and medical support personnel 64 can all
view the display screen 58, which can help all OR personnel track
the procedure, be better informed of their duties, and help quickly
notice any anomalies. FIG. 13 illustrates another embodiment of an
OR setting in which the system 10 can be accessed via a client
terminal in the form of a computer including a processor (not
shown) and a display screen 66 located at a position easily seen
from all or nearly all positions within the OR by a surgeon 68 and
medical support personnel 70.
[0209] Various types of data gathered and/or analyzed by the system
10 can be displayed on a user interface and/or otherwise made
available to medical personnel in the OR, such as by other visual
indicator (e.g., by blinking light on a surgical instrument, etc.),
motion (e.g., by vibration of a surgical instrument, etc.), or
sound (e.g., by audio beep from a speaker in communication with the
system 10, etc.). By providing non-auditory feedback alone or in
combination with visual feedback, the feedback can be less likely
to be lost or overlooked in a noisy OR environment.
[0210] FIGS. 14-16 illustrate embodiments of various types of data
that can be selectively displayed on a user interface accessible in
the OR. FIG. 14 illustrates a user interface 76 showing data
indicating a progress of the surgery as gathered by the system 10
including a running total case time (e.g., a continually updated
time length of the surgery), a total amount of patient blood loss,
and a running total amount of spinal disc removal (e.g., a
continually updated amount of spinal disc removed from the patient
during the surgery). The progress data can help the surgery stay on
schedule, help ensure safety of the patient (e.g., by considering
whether the patient's blood loss reaches an unsafe level), and help
the surgery meet its goals (e.g., by considering whether a desired
amount of tissue is removed from the patient). Other, non-limiting
examples of data indicating a progress of the surgery as gathered
by the system 10 include an amount of bone removed from the
patient, an amount of tissue and/or bone needed to be removed for
graft (e.g., as indicated in a pre-op plan), endplate preparation
(e.g., through endoscopic view and/or smart tools), implant
placement (e.g., computer guided rod contouring in-situ), an amount
of correction achieved, and pain/health of nerves. FIG. 15
illustrates a user interface 78 showing data indicating patient
information, thereby helping to ensure patient safety. The patient
information includes patient vital signs in the illustrated
embodiment. Other, non-limiting examples of patient information
that the system 10 can be configured to display in the OR include
pre-op patient images (e.g., x-rays, CT scans, etc.). FIG. 16
illustrates a user interface 80 showing instrument information in
the form of a list of instruments used in the surgical procedure
and a running total amount of time each of the instruments has been
used in the surgical procedure. Other, non-limiting examples of
instrument information that the system 10 can be configured to
display in the OR include camera views of one or more instruments,
instrument navigation, and instrument specifications and/or manuals
stored in the equipment database 324. The system 10 can be
configured to display other types of information in the OR, such as
education materials, as discussed further below with respect to the
education module 228.
[0211] Although the illustrated embodiments of FIGS. 12 and 13 each
include only one display for the system 10 in an OR, any number of
displays for the system 10 can be provided in an OR. Providing a
plurality of displays can allow more information to be easily
accessible to medical personnel in the OR at any given time, can
help focus medical personnel by allowing for different medical
personnel to have dedicated displays providing information most
useful for their particular job, and/or can reduce surgeon fatigue
by allowing the surgeon to position themselves differently than if
the displays were not available. Additionally, any one or more
displays for the system 10 in the OR can be configured to display a
plurality of views, e.g., have picture-in-picture capability (e.g.,
two different camera angles of the same surgical site) and/or
provide overlays of data (e.g., overlaid tissue layers that can be
peeled away one or more at a time to expose underlying
layer(s)).
[0212] The system 10 can be configured to allow different data
displays to be accessed on demand in the OR, e.g., a data display
of a saved simulation plan and/or a comparison of a saved
simulation with the actual procedure being performed, patient vital
sign data, surgical procedure metrics, etc. In an exemplary
embodiment, the system 10 can be configured to project digital keys
(e.g., a keypad projected on or near the patient including keys)
configured to be tapped to change display on the user interface
and/or effect other system controls such as requesting that a
specific medical staff member be paged to the OR, requesting an
instrument from an instrument tray, rewind a simulation shown on a
display, etc.
[0213] FIG. 17A illustrates an embodiment of a projection system
configured to facilitate projection onto an irregular screen
surface such as on a patient in the OR or on another irregular
surface such as an instrument tray or a drape. The projection
system can include a plurality of projectors 136 configured to
project an image onto an irregular screen surface 138. Each of the
projectors 136 can be configured to be in communication with a CPU
(not shown) of the system 10 so as to be configured to transmit
information to and receive information from the CPU. The CPU can be
in communication with at least one cloud server of the system 10
such that the CPU and/or a processor in communication with the
cloud server(s) can perform data processing. Other CPUs discussed
herein can be similarly configured to communicate with cloud
server(s). Each of the projectors 136 in the illustrated embodiment
is identical to one another, although projectors in the system can
vary from one another. FIG. 17B illustrates one of the projectors
136 in closer detail. The projector 136 can include an RGB
projector 136a configured to project RGB images, an IR sensor 136b
configured to sense infrared signals, and an IR projector (dot and
rectangle) 136c configured to project infrared images. Using IR can
allow the projectors 136 to constantly align with one another and
track the surface 138, which can allow for constant updating and
good quality projection. Single viewer perspective tracking the
surface 138 can allow for sub-surface projection allusions. The dot
projection of the IR projector 136c can be used for surface
mapping, and the rectangle projection of the IR projector 136c can
be used for multi-projection overlap seaming. All of the projectors
136 can be synchronized to be in rectangle projection mode at once
and then each take a turn in dot mode for surface mapping. The CPU
can be configured to control the rectangle and dot modes of the
projectors 136.
[0214] In another exemplary embodiment, the system 10 can be
configured to allow selective switching between the different
displays via no-touch controls. In this way, medical personnel can
quickly receive data without compromising sterility and without
having to change their position relative to the patient and without
having to free their hands from instrument(s) and/or other surgical
duties. No-touch controls can be similarly used for other system
instructions, e.g., begin projection of digital keyboard,
requesting that a specific medical staff member be paged to the OR,
requesting an instrument from an instrument tray, rewind a
simulation shown on a display, etc. Non-limiting examples of
no-touch controls include motion sensing (e.g., swiping a hand in
the air mimicking a page turn to cause a next display screen to be
displayed on the user interface as if turning a page in a book),
eye movement tracking (e.g. looking at a specific location or
combination of locations in the spatial field either alone), voice
recognition (e.g., speaking a certain key term or key phrase to
cause a certain display to be shown on the user interface), and
direct brain interface (e.g., via electroencephalography (EEG)
sensors and event related potential ERP techniques including but
not limited to use of P300, slow cortical response, and neural
network based training methods). No-touch controls can also be used
in any combination, e.g., looking at a specific location in a
spatial field room and speaking a specific activation word. A
specific activating location in the visual field can be dynamic and
part of a computer controlled display device.
[0215] FIG. 18 illustrates an embodiment of a motion sensing system
configured to allow no-touch control of the system 10. The motion
sensing system can include a projector 82 and an infrared (IR) and
RGB camera 84 configured to gather data related to movement of a
person in the OR. The gathered data can be transmitted to a central
processing unit (CPU) 86 that is part of the system 10, the CPU 86
being configured to analyze the received data to determine if
display on a user interface, such as a data board 83, should
change. The data board 83 can include a flat surface that can be
tracked for position by the camera 84, and can have selected images
displayed on the surface thereof. The user can touch the projection
on the data board 83 of a virtual input device, such as a button,
to which the system can respond as having read the user's finger
motion, position, and projected image as a command. The no-touch
controls can facilitate communication of orders from a surgeon to
OR staff. In the illustrated embodiment, the CPU 86 can be coupled
to a laser pointer 87 configured to communicate orders to OR staff
by directing OR staff to a specific needed instrument from among a
plurality of instruments on a tray 89 by laser pointing to the
needed instrument. The laser pointer 87 can be coupled to a
movement mechanism, e.g., a rotation mount 85, configured to move
in response to instructions received from the CPU 86, e.g.,
instructions to rotate a certain amount in a certain direction to
cause the laser pointer 87 to point to the needed instrument on the
tray 89. The laser pointer 87 can include a camera (not shown)
configured to provide visual confirmation on the user interface
that the laser pointer 87 has pointed to the needed instrument,
which can allow the user providing the instruction to visually
confirm the instruction.
[0216] FIG. 19 illustrates an embodiment of a direct brain
interface system, such as the EPOC Neuroheadset (available from
Emotiv Systems of San Francisco, CA), configured to allow no-touch
control of the system 10. The direct brain interface system can
include a plurality of EEG sensors 88 configured to be position on
a head of a user 90, e.g., a surgeon. The EEG sensors 88 can be
configured to transmit data to a CPU 92 that is part of the system
10, the CPU 92 being configured to analyze the received data to
determine if display on a user interface 94 should change.
Additionally or alternatively, the CPU 92 can be configured to
analyze the received data to determine if one or more pieces of OR
equipment 96 (e.g., surgical tools, lights, tables, etc.) need
adjustment and, if so, to cause such adjustment to occur (e.g., dim
a light, turn on a light, zoom in a camera, adjust table height,
etc.). OR equipment can be connected to the direct brain interface
system by a programmable processor, such as an Arduino.
[0217] FIG. 20 illustrates an embodiment of a no-touch data
communication system configured to provide information hands-free
to a user 140 of the system 10. The no-touch data communication
system can be configured to allow the user 140 to control receipt
of information from the system 10 through movement. In other words,
the system 10 can transmit different information to the user 140
based on the movement of the user 140. Additionally, the no-touch
data communication system can be configured for single-person use
so as to allow the selected information to be transmitted uniquely
to the user 140 such that one or more other users of the system 10
in the OR can have their own no-touch data communication system,
which can allow each user to select the information that would be
most helpful for their particular task at hand. The no-touch data
communication system can, however, be configured to transmit the
same information to a plurality of users based on movement control
of the one user 140. The no-touch data communication system can
include a transparent lens head mounted display 142 configured to
be mounted on a head of the user 140. The transparent lens head
mounted display 142 can be equipped with orientation tracking such
that when the transparent lens head mounted display 142 is mounted
on the head of the user 140, the user's head movements can control
which information is displayed to the user 140. The transparent
lens head mounted display 142 can be configured to communicate with
a CPU 144 of the system 10, thereby allowing the information
displayed by the transparent lens head mounted display 142 to be up
to date in real time. In an exemplary embodiment, the motion of the
user's head, e.g., turning and/or raising of the head, can allow
the user 140 to see different data in different spherical zones
146. Each of the spherical zones 146 can display a different type
of data, e.g., information regarding OR equipment, pre-op data,
patient vital signs, informational feed regarding surgical steps,
visualization of the surgical site with tissue layer(s) overlay,
etc. In another embodiment, the motion of the user's head, e.g.,
turning and/or raising of the head, can cause the CPU 144 to cause
projection of different data onto the patient and/or other
surface.
[0218] Plan Tracking Module
[0219] The plan tracking module 226 can provide users of the system
10 with an interface for tracking progress of an actual surgical
procedure in a surgical setting, e.g., in an OR. The progress of an
actual surgical procedure can be tracked against a typical
performance of the surgical procedure stored in the products and
procedures database 320 and/or tracked against a 3D simulated
surgery performed via the pre-op module 202 and saved in the
procedure database 316. The typical performance of the surgical
procedure can be pre-programmed, e.g., a saved demonstration
version of the surgical procedure performed under laboratory or
test conditions, or the typical performance of the surgical
procedure can be aggregated from previous actual performances of
the surgical procedure tracked by the system 10 and stored in the
products and procedures database 320. The previous actual
performances of the surgical procedure can be by a specific surgeon
(e.g., the surgeon performing the actual surgical procedure), by
surgeons at a specific hospital (e.g., the same hospital as where
the actual surgical procedure is being performed), or by surgeons
at multiple hospitals registered with the system 10. In an
exemplary embodiment, the progress of an actual surgical procedure
can be tracked against a 3D simulated surgery performed via the
pre-op module 202 and can be saved in the procedure database 316 to
allow the surgeon performing the procedure to follow
previously-made decisions regarding the surgery, e.g., timing of
the procedure's steps, medical devices used in the procedure,
amount of patient tissue to remove, etc., since, as discussed
above, the surgeon performing the actual surgical procedure can
electronically simulate the surgery using the system 10. The system
10 can allow a user to pull up a simulation saved in the procedure
database 316, thereby allowing the simulation to be visible and/or
accessible in an OR.
[0220] The plan tracking module 226 can be configured to assist
with surgical setup of a patient and one or more instruments to be
used in surgery on the patient. The plan tracking module 226 can be
configured to facilitate positioning of a patient for surgery.
Because a patient's inner anatomy does not always align with
spatial references of an operating room (or other area in which
surgery is performed), and usually does not so align, it can be
difficult for surgical staff to align the patient in a desirable
position relative to the surgeon for performance of a specific
surgical procedure. Numerous angles and asymmetries of the
patient's inner anatomy, which differ between different patients,
can result in lengthy pre-surgery evaluation of a specific
patient's inner anatomy using techniques such as x-ray, fluoroscopy
C-arm, and MRI, lengthy pre-surgery planning for the patient's
position during surgery based on the evaluation, and lengthy manual
positioning of the patient in the operating room (or other surgical
area) based on the pre-surgery plan. Hidden anatomical structures,
such as spinal elements, cannot be easily seen in an orthogonal
sense as there are no cornerstones to align or columns to true.
Repeated x-rays, and hence repeated radiation exposure, and/or
invasive dissections are often traditionally needed to establish a
frame of reference for a surgical task to use as its substructure
during surgery. Traditional alignment using a gravity vector
reference using robotics and image guidance are expensive, time
consuming, and require steep learning curves and/or specialized
user operators. Additionally, although apparatuses exist that can
be used by surgical staff to assist in positioning a patient, these
apparatuses are traditionally complicated and require a high level
of user involvement. The plan tracking module 226 can be configured
to automate patient positioning, which can reduce complexity of
patient processing, reduce chances of surgical instruments being
advanced into a patient at an unsafe and/or undesired trajectory,
improve access to a surgical site by optimizing a patient's
position, save time over manual patient adjustment, and/or reduce
an amount of pre-surgery radiation and/or invasive pre-surgery
dissections to determine proper patient positioning. Positioning
the patient using the plan tracking module 226 can thus provide
enhanced safety, enhanced ergonomics, and unfettered patient
positioning with enhanced patient comfort, pressure relief, and
surgical staff ease of use.
[0221] For some surgical procedures, such as spinal surgeries in
which a trajectory of lateral approach can be very precisely
determined so as to access a target vertebra while avoiding nerve
damage, a patient's position can be of particular importance to the
surgery's duration and ultimate success. During lateral interbody
surgery, for non-limiting example, it can be advantageous to align
a representative plane of a superior endplate of a patient's
inferior vertebra to vertical plumb, and it can be advantageous to
align a mid frontal plane of the patient's interbody space to
vertical plumb. In other words, it can be advantageous to position
a center of the patient's vertebral disc, as well as endplates of
the vertebrae, straight down from a perspective of a surgeon
performing the surgery. Implantation of one or more percutaneous
screws while a patient remains in a lateral position is a
non-limiting example of a spinal surgical procedure in which
precise patient positioning is important. Lining up a patient's
pedicle 160 for direct horizontal pedicle screw placement can be at
about a 30.degree. rotation, as shown in FIGS. 29A and 29B. FIG.
29B shows the pedicle 160 in an initial position, e.g., at
30.degree., on the left, and in a rotated position, e.g., at
0.degree. (horizontal), on the right.
[0222] The plan tracking module 226 can be configured to match the
patient's position with a pre-surgery plan, e.g., a plan indicated
in a saved simulated surgery or a plan for a typical procedure of a
same type as the surgery being performed. The matching can be
achieved in a variety of ways, such as through patient
mapping/registration and/or through video tutorials. In an
exemplary embodiment, the plan tracking module 226 can be
configured to begin patient positioning assistance with a video
tutorial saved in the products and procedures database 320. The
patient positioning assistance can continue using
positioning/navigation technology, e.g., Microsoft Kinect, that can
track actual position of the patient versus the pre-surgery plan.
As the patient is moved, the plan tracking module 226 can be
configured to compare the patient's actual position to images of
the patient and to the pre-surgery plan and can be configured to
provide feedback on how to move the patient to the proper position
as defined in the pre-op plan. The images of the patient can
include previously gathered images, e.g., fluoroscopy, MRI, or CT
images stored in the diagnosis database 310, and/or images gathered
in real-time with the positioning, e.g., skin surface mapping,
fluoroscopy, ultrasound, or intraoperative CT images. The patient
can be imaged throughout the procedure in real time to help ensure
that the patient is properly positioned during the procedure.
Because the system 10 can help the patient be properly positioned
according to surgeon instructions as indicated in the saved
simulation, the surgeon need not necessarily be present in the OR
when the patient is positioned by one or more medical personnel.
The positioning time can be tracked by the plan tracking module 226
and can be recorded by the product and procedures database 320,
which can help show improvements in efficiency over time and/or
after additional training of OR staff.
[0223] FIG. 21 illustrates an embodiment of a visual position and
orientation tracking system configured to gather real time images
of a patient in an OR. The illustrated system includes a
fluoroscopy system, but as will be appreciated by a person skilled
in the art, other visual position and orientation tracking systems
can be used. The system can include one or more augmented reality
markers 72 configured to be recognized by an RGB (red, green, and
blue) or RGB-D (red, green, and blue plus depth) camera 74. The
marker(s) 72 can be positioned on and/or near the patient to track
position of the patient and fluoroscopy frame. The camera 74 can be
configured to communicate with a CPU 75 of the system 10, which can
cause image(s) gathered by the camera 74 to be displayed on a
display 73.
[0224] The plan tracking module 226 can be configured to
continually provide feedback to the one or more medical personnel
positioning the patient, such as instruction as to how much to move
a patient in a certain direction and an indication when the patient
is in a position matching the pre-surgery plan, which can help
ensure that the patient is properly positioned in the OR prior to
start of the surgery. Because the system 10 can allow electronic
tracking and positioning of patients, numerous different patient
positions can be accommodated, such as more traditional recumbent
positions and less traditional standing positions.
[0225] In another exemplary embodiment, the plan tracking module
226 can be configured to facilitate patient positioning using
automated bed movement. A person skilled in the art will appreciate
that movement of a "bed" discussed herein includes movement of any
operating surface on which a patient can be positioned for surgery,
such as a table, a platform, etc., and is not necessarily a
traditional bed. The plan tracking module 226 can be configured to
cause translation and/or rotation of the bed, with the patient
thereon, to position the patient in a desired position for surgery.
FIG. 30 illustrates an embodiment of a patient 156 on a bed 158 at
desired L2-L3, L3-L4, and L4-L5 angles, shown with arrows, as
positioned using the plan tracking module 226. As shown, the bed
158 can include a plurality of discrete sections each configured to
move relative to the other discrete sections, which can allow for
more precise positioning of various portions of the patient 156 on
the bed 158.
[0226] The plan tracking module 226 can be configured to cause the
bed translation and/or rotation in a variety of ways. In an
exemplary embodiment, X-Y-Z axis data for the bed can be
transmitted to the system 10, and the plan tracking module 226 can
be configured to use the received X-Y-Z data to determine an amount
and direction of movement for the bed to position the patient
thereon in a desired position for surgery. The X-Y-Z axis data for
the bed can be gathered in a variety of ways. For non-limiting
example, a plurality of two-dimensional (2D) and/or 3D images can
be gathered using one or more types of imaging, e.g., imaging
capable of rendering spatial coordinates such as radiograph,
ultrasound, commuted tomography, magnetic resonance, etc., using
one or more electromagnetic capture devices. The plan tracking
module 226 can be configured to process the 2D images and/or the 3D
images to derive X-Y-Z movement commands for bed positioning. The
plan tracking module 226 can be configured to process the images in
a variety of ways, such as by establishing a relation between the
image data and coordinates of the bed. The relation can be
established in any number of ways, as will be appreciated by a
person skilled in the art, such as by using a calibration frame
positioned within the imaging area combined with real time
measurements of the frame's orientation to a known coordinate on
the bed's frame and image capture device frame. Additionally, the
plan tracking module 226 can be configured to compare image capture
data to previously received data such as a known CT data set.
[0227] A majority of desired coordinates are vector quantities. The
vector quantities, such as planar endplate orientations, midpoints,
and trajectory angles, are independent of scalar calibration. Thus,
the plan tracking module 226 can be configured to accurately
process coordinate data without accurate unit values within the
image frames of reference because angles (vectors) do not change
based on scale.
[0228] As will be appreciated by a person skilled in the art, the
plan tracking module 226 can determine how to repeatedly and
accurately spatially position the bed in a variety of ways, such as
by using motion control processing or software. For non-limiting
example, for a spinal surgery using a trajectory of lateral
approach that begins on the L3/L4 spinal level, the surgeon and/or
other surgical staff can input this level to the plan tracking
module 226, e.g., using an input device such as a keyboard in
communication with a processor in communication with the plan
tracking module 226. The plan tracking module 226 can then analyze
an initial image of the patient and initial bed coordinates to
cause the bed to be moved so as to position the patient in a
desired position for the surgeon to begin the procedure on the
L3/L4 spinal level. Then, if the surgeon desired to move to another
area of the patient, such as the L4/L5 level, an updated input can
reposition the patient in position for the surgeon to begin the
procedure on the L4/L5 spinal level, as patient position is
different for different lateral approaches. The updated input can
be input to the plan tracking module 226 after the patient has been
positioned in the first position, which can allow for the surgeon
to make in-surgery decisions as appropriate, or the updated input
can be input at the same time as the first input, which can help
save time after the patient has been partially operated on and is
more vulnerable to surgical complications than prior to being
incised. Additionally, in surgery using a lateral approach, it can
be advantageous to back up laterally-performed surgery with
posterior instrumentation. If two sets of implants are to be
implanted in the patient, a surgeon and/or other surgical staff
traditionally must remove the patient from the lateral position in
which the lateral surgery was performed and reposition the patient
in a prone position in which the posterior surgery can be
performed. Physically repositioning the patient mid-surgery in this
way can be time consuming and can be awkward for surgical staff due
to surgical instrumentation, surgical accessories, etc. on or in
the patient during the repositioning. The plan tracking module 226
can allow for the patient to be automatically repositioned from the
lateral position to a modified lateral position where posterior
instrumentation trajectories are of a direct horizontal nature, or
conversely to a modified prone position where desired trajectories
are plumb, thereby saving time and reducing complexity of the
surgical procedure. The plan tracking module 226 can thus be
configured to move the patient to an initial position for surgery
and to move the patient to one or more subsequent positions during
the surgery, thereby allowing for different aspects of the surgical
procedure to be performed on the patient at different angles that
are each safe, appropriate, and convenient for the performing
surgeon.
[0229] The plan tracking module 226 can be pre-programmed with a
desired patient position for one or more specific surgical
procedures, e.g., spine procedures such as anterior lumbar
interbody fusion (ALIF), extreme lateral interbody fusion (XLIF),
etc. The plan tracking module 226 can thus be programmed to "know"
a desired position for a patient when a specific surgical procedure
is input to the system 10 by a user as being for the patient. The
plan tracking module 226 can thus be configured to automatically
position the patient in the pre-programmed desired patient position
using real time images of the patient indicating a current position
of the patient, which the plan tracking module 226 can analyze in
spatial coordinates relative to the desired patient position to
determine an amount of translational and/or rotational movement of
the bed to desirably position the patient.
[0230] FIGS. 31-33 illustrate an embodiment of pre-surgery images
that can facilitate automatic patient positioning using the plan
tracking module 226. The images of FIGS. 31-33 are fluoroscopy
images, but as discussed above, other types of images can be
obtained to assist with patient positioning in the OR (or other
surgical area). Fluoroscopic images can be gathered in real time in
an OR using a C-arm, as will be appreciated by a person skilled in
the art. Although the images of FIGS. 31-33 are spinal images that
can assist in automatic positioning a patient for spinal surgery,
the plan tracking module 226 can be configured to analyze images
and automatically position a patient for surgeries on other parts
of the body.
[0231] FIG. 31 illustrates an embodiment of a baseline image as a
fluoro image of a patient's lumbar spine without an attempt to
align the patient on a bed in any particular position relative to
an operative center. In other words, the surgical staff can
initially position the patient on the bed in a generally lateral
position without careful precision as to the patient's position
because the patient's position will be subsequently, automatically
adjusted, unless the unlikely situation occurs where the patient is
accurately initially positioned. The baseline image can facilitate
anatomical recognition by the plan tracking module 226, as
discussed further below. FIG. 32 illustrates an embodiment of a
fluoro image including anatomical recognition performed by the plan
tracking module 226 for a first input position. The anatomical
recognition in FIG. 32 includes vertebral levels, e.g., L2, L3,
etc., and endplate perimeter geometry 154. The endplate perimeter
geometry is shown in FIG. 32 at the L3/L4 level to reflect an
initial level for surgery input to the plan tracking module 226 as
being the L3/L4 level. The plan tracking module 226 can also be
configured to identify high crest for any of the vertebral levels.
The plan tracking module 226 can perform the anatomical recognition
in a variety of ways. For non-limiting example, the plan tracking
module 226 can compare the baseline image of FIG. 30 with
pre-stored anatomical data stored in the operation database 304
(and/or any other database). The pre-stored anatomical data can be
data for a generic patient, e.g., anatomical textbook data, or can
be actual anatomical data aggregated from a plurality of previously
gathered images of actual patients. The plan tracking module 226
can be configured to filter the baseline image to create outlines,
which can facilitate comparison of the baseline image with the
pre-stored anatomical data to determine features in the baseline
image, e.g., an endplate, a pedicle, etc. For non-limiting example,
algorithms to perform such analysis include image guided surgery
calibration algorithms, such as those discussed in U.S. Pat. No.
7,130,676 entitled "Fluoroscopic Image Guided Orthopaedic Surgery
System With Intraoperative Registration" issued Oct. 31, 2006, and
European Pat. No. 1028659 entitled "Virtual Representation Of A
Bone Or Bone Joint" issued Feb. 18, 2004. Based on the pre-stored
data in which various anatomical parts, e.g., levels of vertebra,
are pre-identified, the plan tracking module 226 can be configured
to identify various anatomical parts in the first input position.
FIG. 33 illustrates an embodiment of a fluoro image
post-positioning, e.g., with the patient having been automatically
moved to the initial position, e.g., the bed has been translated
and/or rotated as discussed above. In the illustrated embodiment,
the bed has been moved to position the patient slightly anterior of
the disc center at L3/L4. The post-positioning fluoro image can, as
shown in FIG. 33, include the anatomical recognition performed by
the plan tracking module 226 including the vertebral levels, e.g.,
L2, L3, etc., and the endplate perimeter geometry 154. The plan
tracking module 226 can be configured to repeatedly adjust the
patient's position to arrive at the desired patient positioning,
with repeated fluoro images being gathered in real time to assist
the plan tracking module 226 in analyzing the patient's actual
position on the bed.
[0232] Movement of the bed can be performed in any one or more of
the X, Y, and Z dimensions depending on the initial position of the
bed and the desired position of the bed relative to the initial
position of the bed. Additionally, the movement can be
translational and/or rotational in any of the X, Y, and Z
dimensions.
[0233] The bed can be configured to move in a variety of ways. In
an exemplary embodiment, one or more servo motors and one or more
positioning sensors can be coupled to the bed. The plan tracking
module 226 can be configured to transmit instructions to the servo
motor(s) to translate and/or rotate the bed in a certain amount in
any one or more of the X, Y, and Z dimensions to align desired
targets with vertical plumb or horizontal level or an angle
therebetween, and to place the desired targets on center. By
adjusting position of the patient by adjusting position of
something on which the patient rests (the bed), the system 10 can
help reduce chances of accidental patient repositioning during
surgery because the bed can provide a stable surface on which the
patient rests without straps, slings, supports, etc. holding up
part(s) of the patient that could accidentally loosen, shift, or
otherwise slip during surgery. The servo motor(s) can be coupled to
one or more jigs coupled to the bed such that actuation of one or
more of the motor(s) can cause movement of one or more the jig(s),
thereby adjustment an alignment of the bed, and hence an alignment
of a patient on the bed. The sensor(s) can sense position of the
bed and/or the jig(s) and transmit the sensed data to the system
10, which can analyze the data to ensure that the bed, and hence
the patient, has been properly positioned. In an embodiment of
spinal surgery, a center of a disc can be moved directly on target,
or a center of a pedicle can be aligned on axis and with a user
input, e.g., a user's push of a key on a keypad in communication
with the system 10, a center of an opposite pedicle.
[0234] In another exemplary embodiment, one or more inflatable
braces can be coupled to the bed. The brace(s) can be configured to
be selectively inflated and deflated independent of any other
braces coupled to the bed. The brace(s) can be coupled to the bed
in locations in which the brace(s) can interact with a patient on
the bed such that inflating any of the braces can cause movement of
the patient. The brace(s) can thus be configured to facilitate
positioning of the patient on the bed. Depending on an amount of
inflation/deflation, inflating/deflating the brace(s) can cause the
patient to move different amounts, thereby allowing for relatively
precise adjustment of the patient's position on the bed. Similar to
that mentioned above regarding the servo motor, by adjusting
position of the patient by adjusting position something on which
the patient rests (the brace(s)), the system 10 can help reduce
chances of accidental patient repositioning during surgery because
the bed and brace(s) can provide a stable surface on which the
patient rests without straps, slings, supports, etc. holding up
part(s) of the patient that could accidentally loosen, shift, or
otherwise slip during surgery.
[0235] The brace(s) can have a variety of sizes, shapes, and
configurations. In an exemplary embodiment, the brace(s) can be
formed from a biocompatible, flexible, radiolucent material. The
brace(s) can be coupled to the bed in any way, such as by being
integrally formed therein, by being included in a slipcover placed
over/around the bed, or by being attached to the bed or cover
thereon with a securing element such as Velcro or glue. If the
brace(s) are configured to be removably and replaceably coupled to
the bed, such as with Velcro, the bed can include a diagram or
other markings thereon to indicate placement of the brace(s)
thereon. The markings can be generic, e.g., be for any surgical
procedure, or can be customized for particular surgical procedures,
e.g., be color coded with different colors indicating position of
brace(s) for different surgical procedures. The brace(s) can be
inflated with any one or more types of fluid. The fluid, in an
exemplary embodiment, is surgically safe such that in the unlikely
event of brace leakage, the fluid cannot harm the patient or
surgical staff.
[0236] The system 10, e.g., the procedure analysis module 230
discussed further below, can be configured to determine an amount
of time it takes to position the patient, e.g., from the system's
start of the video tutorial to the system's determination that the
patient's position matches the pre-surgery plan. The determined
amount of time can be saved in the operation database 304, e.g., in
the OR database 322. In alternative or in addition to determining
an amount of time it takes to position the patient, the system 10,
e.g., the personnel tracking module 236, can be configured to
register (e.g., identify and log) the one or more medical personnel
who help position the patient and to track movement of the one or
more medical personnel who help position the patient, as discussed
further below. The determined amount of time and/or the information
regarding the medical personnel can be analyzed to develop metrics
that can be later viewed and tracked by one or more users, such as
the surgeon who performed the surgery and administrators at the
hospital where the surgery was performed, to help drive learning
and best practices.
[0237] Similar to that discussed above regarding facilitating
patient position, the plan tracking module 226 can be configured to
facilitate positioning of one or more surgical instruments before a
surgical procedure begins. Also similar to that discussed above
regarding facilitating patient position, the plan tracking module
226 can be configured to match one or more instruments' position
with a pre-surgery plan (e.g., using positioning/navigation
technology and/or imaging), and the system 10 (e.g., the equipment
tracking module 230, discussed further below) can be configured to
determine an amount of time is takes to position each instrument,
register (e.g., identify and log) the instruments as being present,
and/or to track movement of the registered instruments. The
instrument movement can be tracked and logged as distinct motions,
e.g., insertion and removal of the instrument into the surgical
space; actions of the instruments such as removal of bone, movement
of tissue, insertion of material (e.g., a bone screw, interbody
cage, biologic, combination treatment, etc.), etc.; etc. The
determined amount of time and/or the information regarding the
instruments can be analyzed to develop metrics that can be later
viewed and tracked by one or more users, such as the surgeon who
performed the surgery and administrators at the hospital where the
surgery was performed, to help drive learning and best practices
and/or to determine instrument effectiveness.
[0238] The plan tracking module 226 can be configured to provide
feedback regarding a surgical procedure throughout actual
performance the surgical procedure as measured against at least one
model, e.g., a saved simulated procedure and/or a pre-programmed
procedure. The feedback can be provided visually (e.g., on a
display device, by lights, etc.), by motion (e.g., by vibration,
etc.) and/or by sound (e.g., by audio beep, etc.). The feedback can
include data including a progress of the actual surgical procedure
as measured against the model. The feedback can allow a surgeon
and/or other medical personnel involved with the surgical procedure
to continually validate and confirm that the steps being taken in
the surgery line up with a saved pre-op plan and/or with
convention. Should the actual procedure deviate from the model
within a certain, predetermined degree of tolerance, the plan
tracking module 226 can be configured to trigger an alert, e.g., a
visual, auditory, and/or motion signal, indicating the deviation.
Different alarms can be used by the plan tracking module 226 to
indicate different deviations, e.g., a first signal for a skipped
step, a second signal for an incorrect instrument being used, a
third signal for a planned instrument being missing from the OR, a
fourth signal for not enough tissue and/or bone removed from the
patient, a fifth signal for too much tissue and/or bone removed
from the patient, a sixth signal indicating unexpected patient
vital sign(s), a seventh signal indicating an instrument has
entered an undesirable area of the anatomy based on the pre-op
plan, etc. In an exemplary embodiment, the plan tracking module 226
can be configured to predict deviation from the model within a
certain, predetermined degree of tolerance and trigger the alert
before the surgery has gone too far off-model or too close to a
higher risk or incorrect area of the patient.
[0239] In response to an alert, the system 10 can allow a user,
e.g., the surgeon, to access the surgical procedure planning module
218 to modify the saved simulation for the surgical procedure. In
this way, the surgeon can prepare a plan on the fly with
consideration to unexpected circumstances that arise during the
procedure and/or to test different surgical techniques and/or
medical devices prior to actually performing the techniques and/or
actually using the medical devices. The modified simulation can be
performed, saved, and later accessed similar to that discussed
above.
[0240] Procedure Analysis Module
[0241] The procedure analysis module 230 can provide users of the
system 10 with an interface for evaluating progress of the surgical
procedure. Key metrics of progress for payers, providers, and
regulators can be gathered by the procedure analysis module 230 to
facilitate billing and regulatory compliance. Non-limiting examples
of progress data that the procedure analysis module 230 can gather
and/or analyze and provide to a user of the system 10 include
anatomical information, nerve information, pain information, a
running total case time, a total amount of patient blood loss,
spinal disc removal information, an amount of bone removed from the
patient, and an amount of tissue and/or bone removed for graft. The
progress data can be selectively displayed on a display device as
discussed above. The surgical procedure planning module 218 can be
configured to similarly provide data to a user performing a
surgical simulation so as to help correct any potential problems
before an actual surgery is even performed.
[0242] The provided anatomical information can include information
regarding tissue (e.g., soft tissue), bone, nerves, intervertebral
disc material, etc. The procedure analysis module 230 can be
configured to provide anatomical information in a variety of ways.
In an exemplary embodiment, the procedure analysis module 230 can
be configured to provide a layered anatomical visualization on a
display device. The anatomical visualization can be a generic
visualization of a typical patient, or the anatomical visualization
can be specifically based on the patient, similar to that discussed
above regarding modeling of the patient for pre-op electronic
simulation. The anatomical visualization can show all tissue types
(e.g., soft tissue, bone, vessels, nerves) to help facilitate
navigation around them in actual performance of the surgery. FIG.
22 illustrates one embodiment of an anatomical visualization for a
spinal surgery in which a bone layer, a vessel layer, and a nerve
layer are displayed, with a soft tissue layer hidden. The different
layers can be selectively hidden and displayed. For surgery in
another area of a patient's body, e.g., knee surgery, a different
part of a patient can be shown, e.g., a portion of a leg. In some
embodiments, the different layers can be selectively projected,
printed, or overlaid onto the patient to facilitate identification
of the patient's anatomical structures to help identify "safe"
zones and avoid injury to the patient.
[0243] Using nerves as an example of the procedure analysis module
230 providing anatomical information, nerve tractography
technologies such as Diffusion Tensor Imaging (DTI) or MRI with
specialized sequences can be used to determine a 3D shape and
location of the nerves by registering water content. The shape and
location of the nerves is sensed by MRI unit, which also registers
one or more fiducials on the patient. This image can be loaded into
the system 10, allowing the image to be merged with the 3D
anatomical model based on the reference location in space provided
by the fiducial(s). This fusion can allow the system 10 to display
the nerves overlaid on the bony anatomy in one or both of pre-op
planning and in the OR. Additional OR sensing technologies can help
to locate the nerves during surgery, such as a nerve sensing or
stimulating probe using conventional triggeredEMG or triggeredMMG
technology for nerve localization that can be tracked by the
navigation system in order to generate spatial information about
the nerve location in real time as the probe is moved during the
procedure. This can accommodate tissue movement associated with
patient positioning and operative manipulations. This navigable
nerve sensing probe can be configured in a grid pattern rather than
a single instrument, thereby allowing multiple sensing and
stimulating points over the nerve. These multiple sensing and
stimulation points can result in determining the distance to the
nerve, and through software analysis and conduction theory, can
reconstruct the size and shape of the nerve. Because the grid
pattern is navigated, its location in space is known, and as a
result the location of the nerve in space is known and can be
merged to the 3D representation of the patient in the OR navigation
system, thereby allowing visual navigation around the nerves as
well as the bony structures, even as they are moved along with the
muscle tissue or retracted during access.
[0244] In one exemplary embodiment, the procedure analysis module
230 can be configured to provide visualization of patient anatomy
(e.g., bones, nerve roots, vascular structures, etc.) using
augmented reality. The procedure analysis module 230 can be
configured to provide an augmented reality imaging system that can
overlay computer generated imagery onto one or more physical
objects, e.g., a patient, a table, a drape, etc., that can be
visualized by a user, e.g., a surgeon or other surgical staff. In
an exemplary embodiment, the computer generated imagery can be
overlaid on a patient, which can facilitate identification of
various anatomical structures of the patient, including those
structures that are hidden behind one or more other anatomical
structures such that their location can be discerned from the
imagery without actually being visible to the user. The imagery can
be overlaid in an surgical setting, e.g., an OR, which can
facilitate performance of a surgical procedure by providing
visualization of patient anatomy that would otherwise not be
visible. The surgery can thus be performed with improved accuracy
and confidence because a more complete picture of a patient's
anatomy can be provided in real time with surgery. The procedure
analysis module 230 can be configured to overlay the imagery in 3D
with depth perception, which can provide intuitive visualization of
3D objects that cannot be so visualized using a traditional 2D
display device, e.g., a computer monitor, and that are more
naturally viewed in 3D. The overlaid imagery can also be easily
viewed by a user from different angles, such as by the user moving
his/her head, walking around, etc. The augmented reality imaging
system can allow the surgeon and/or other surgical staff in a
surgical setting to focus on the patient rather than on an external
display device.
[0245] The procedure analysis module 230 can be configured to
provide the augmented reality imaging system in a variety of ways.
In an exemplary embodiment, the procedure analysis module 230 can
be configured to analyze gathered images of a patient to generate a
3D model of the patient's anatomy based on the images. The images
can include previously gathered images, e.g., fluoroscopy, MRI, or
CT images stored in the diagnosis database 310, and/or images
gathered in real-time, e.g., fluoroscopy, ultrasound, or
intraoperative CT images. The generated 3D model can be stored in
the system 10, such as in the procedure database 316. The procedure
analysis module 230 can be configured to register the generated 3D
model to one or more reference markers mounted on a physical
object, e.g., on a patient in an OR or other surgical setting. The
registration can be performed automatically by the procedure
analysis module 230, or the registration can be manually triggered
by a user, e.g., via a no touch data communication system similar
to that discussed above with respect to FIG. 20. The reference
marker(s) can be similar to the augmented reality markers 72
discussed above with reference to FIG. 21. In an exemplary
embodiment, a plurality of reference markers can be mounted on the
patient, such as by adhering the markers to the patient using a
biocompatible adhesive that allows removal of the markers from the
patient. The procedure analysis module 230 can be configured to
track the reference marker(s) mounted on the physical object to
determine a correct location to display the generated 3D model with
respect to the physical object.
[0246] A surgeon and/or other surgical staff can wear a
stereoscopic viewing device, such as a head-mounted stereoscopic
viewing device similar to the head mounted display 142 discussed
above with reference to FIG. 20. The stereoscopic viewing device
can be a see-through device, or it can be an opaque display. If the
stereoscopic viewing device is an opaque display, the stereoscopic
viewing device can include a video camera configured to capture a
view in front of the device's wearer so that the wearer isn't
"blind." The procedure analysis module 230 can be configured to
track the stereoscopic viewing device to help determine where to
overlay the generated 3D model in a location where it can be
visualized by the wearer of the stereoscopic viewing device. The
procedure analysis module 230 can be configured to use the
stereoscopic viewing device to overlay the generated 3D model on
the physical object, e.g., the patient, in an anatomically correct
location. In other words, the procedure analysis module 230 can be
configured to project the generated 3D model of anatomy in a
location corresponding to the patient's actual anatomy. As the
wearer of the stereoscopic viewing device moves around, the
procedure analysis module 230 can be configured to automatically
adjust the generated 3D model in real time so that the generated 3D
model is always overlaid in the anatomically correct location. The
wearer can thus use the generated 3D model as a supplement to
ordinary visualization (either directly in the case of a
transparent viewing device, or with the aid of the video camera in
the case of an opaque device) to allow visualization of anatomy
that would otherwise not be visible to the wearer.
[0247] The procedure analysis module 230 can be configured to
overlay information other than anatomical information. The
procedure analysis module 230 can be configured to calculate the
additional overlaid information based on the patient images
previously gathered and/or gathered in real time. The additional
overlaid information can include, for non-limiting example, a
recommended trajectory for implant implantation (e.g., a
recommended implantation trajectory for a pedicle screw),
dimensions of anatomy (e.g., dimensions of pedicles/vertebral
bodies), a distance between various anatomical structures (e.g., a
distance from one pedicle to an adjacent pedicle), and/or an
estimated position and orientation of an implanted implant. The
dimensions of anatomy can help a surgeon and/or other surgical
staff determine an appropriate size of an implant to use with a
patient, such as an appropriate screw size. The distance between
various anatomical structures can help a surgeon and/or other
surgical staff determine an appropriate sized implant to connect
multiple anatomic structures, such as a length of spinal rod to
span multiple vertebra. The estimated position and orientation of
the implanted implant can help a surgeon and/or other surgical
staff determine a location of the implant when the implant is
otherwise not visible, e.g., if the implant is radiolucent and not
visible in a gathered image of the patient. Methods and apparatuses
of estimating the position and orientation of an implant are
described in more detail in U.S. application Ser. No. 13/488,827
entitled "Methods and Apparatus For Estimating The Position And
Orientation Of An Implant Using A Mobile Device" filed Jun. 5,
2012, which is incorporated by reference in its entirety.
[0248] Nerve information provided by the procedure analysis module
230 can include information gathered by the procedure analysis
module 230 regarding, e.g., nerve health, nerve stretch, and pain
levels. The procedure analysis module 230 can be configured to
gather data regarding a time length of tissue retraction, an amount
of the tissue retraction, and/or an amount of pressure being placed
on tissue and/or nerves as a result of the retraction. The
procedure analysis module 230 can gather such information using,
e.g., sensors attached to a retractor and monitoring nerve
diameter, RT Automatic Atlas Segmentation (available from Brainlab
Corporation of Feldkirchen, Germany), etc. RT Automatic Atlas
Segmentation, for example, can be used in pre-op planning to
determine the pathway through nervous tissue with allowable stretch
when compared to a library of nerve tension and post-op pain
levels, e.g., a library stored in the procedure database 316, and
can be used again during the surgical procedure to predict tissue
movements without re-imaging the patient. Final imaging can compare
a projected movement of the tissues to actual movement of the
tissues, and the system 10 can be configured to record this
relationship in the OR database 322, thereby improving the system's
predictive algorithms through continual learning. If tissue is
retracted during surgery for too long, the patient can feel pain
following surgery. The procedure analysis module 230 can therefore
analyze the gathered data to determine if the tissue retraction
should be released and/or readjusted to help avoid future patient
pain. The procedure analysis module 230 can be configured to
determine that retraction should be released and/or readjusted
based on a variety of factors, such as clinical study data, data
previously gathered by the system 10 regarding lengths, locations,
and durations of retraction in previously performed surgical
procedures, and/or data previously gathered by the system 10
regarding pain levels of patients following surgeries. The
procedure analysis module 230 can be configured to provides
notification of the pain levels to the user during the surgery. The
system 10 can thus be configured to correlate retraction lengths,
locations, and durations with patient pain and learn over time so
as to allow the procedure analysis module 230 to determine when
tissue has been retracted improperly and/or for too long. In some
embodiments, the procedure analysis module 230 can be configured to
cause automatic release or readjustment of tissue retraction upon
determination that retraction should be released or readjusted,
such as when the instrument performing the retraction is coupled to
a movement mechanism that can be electronically controlled by the
system 10. Similarly, in some embodiments, the procedure analysis
module 230 can be configured to mechanically prevent a retractor
from applying too much pressure, e.g., through the use of one or
more clutches. Instruments can be provided that can sense tissue
segmentation through the use of ultrasound and provide the system
10 with feedback on the instrument's location in a desired tissue
plane.
[0249] Spinal disc removal information gathered, analyzed, and/or
provided by the procedure analysis module 230 can include, e.g., a
running total amount of spinal disc removal and chemical content of
disc material. The chemical content of disc material can be
measured by the procedure analysis module 230 and analyzed to
calculate appropriate dosing of medication.
[0250] FIG. 23 illustrates an embodiment of a void confirmation
system of the procedure analysis module 230 configured to indicate
how much intervertebral disc material has been removed from a
patient's spine. It can be difficult to see how much disc material
has been removed, and where it has been removed from. The void
confirmation system can allow for electronic measurement of disc
removal and electronic confirmation of where disc material has been
removed, thereby providing better information than can typically be
gathered by visualization. The void confirmation system can include
at least one sensor 126 and at least one emitter 128. The sensor(s)
126 can be, e.g., a spherical IR or ultrasonic sensor or a sonar
depth sensor. The sensor(s) 126 and the emitter(s) 128 can be
introduced into the disc space. The sensor(s) 126 can be configured
to gather data regarding a volume of unobstructed disc space, and
the emitter(s) 128 can be configured to transmit the gathered data
to a CPU 130 of the system 10. The system 10, e.g., the procedure
analysis module 230, can be configured to analyze the received data
and determine an amount of disc material that has been removed from
the patient based on a comparison of the received data with
previously gathered data, e.g., pre-op image data indicating a
geometry of the patient's disc space. The procedure analysis module
230 can additionally or alternatively be configured to analyze
received data for endplate thickness and/or density variations. The
CPU 130 can be configured to display results of the analysis on a
display 132. Although disc removal is shown in the illustrated
embodiment, other material removed from the patient, such as tissue
and bone, can be similarly electronically confirmed.
[0251] The OR analysis module 234 can be configured to track
placement of implant trials (e.g., in pre-op planning) and
placement of actual implants. The position of the implants and
trials can be tracked using any one or more methods, such as
navigation systems that use infrared or visual cameras;
electromagnetic, radiofrequency, and microwave sensors attached to
or embedded in the implants or trials (e.g., embedded sensors
available from CardioMEMS, Inc., Atlanta, Ga.); etc. Embedded
sensors can be used after implantation as well, such as to
non-invasively collect data related to bone growth rate, forces
acting on the implant, and position of the implant through wireless
connection with an external interface device. Additionally or
alternatively, the embedded sensors can be used to control the
implants through via the system 10 and/or other external control
device. For example, an implant in the form of an adjustable height
interbody device can be instructed to increase or decrease its
height at multiple segments in order to provide better balance or
contact with the endplate to promote spinal alignment and bone
growth.
[0252] Education Module
[0253] The education module 228 can provide users of the system 10
with an interface for requesting and/or receiving informational
materials during performance of a surgical procedure. By providing
access to informational materials in an OR, questions can be
quickly answered and the surgery can proceed with minimal delay and
without any medical personnel having to leave the OR to obtain the
information.
[0254] The informational materials can include video conferencing
capability and/or educational resources as discussed above
regarding the SPP module 218, such as materials stored in the
catalog database 318. The education module 228 can allow users of
the system 10 to access the informational materials in any way,
such by using no-touch controls, as discussed above. The system 10
can be configured to allow access to informational materials
regardless of the information displayed on a display device of the
system 10 at any particular time.
[0255] Video conferencing can be available to bring at least one
external third party, e.g., a physician, a family member of the
patient, technical staff, a resident, an expert on a certain aspect
of the surgical procedure, etc.) into communication with medical
personnel in the OR. The system 10 can therefore allow for remote
viewing of one or more surgical procedures being performed, which
can help provide training, help hospital administrators with
scheduling, and/or help keep family members of the patient informed
about the surgery. Data regarding the surgical procedure that can
be accessed remotely can be limited based on a type of user
accessing the system, e.g., more access for residents, less access
for family members, etc. In an exemplary embodiment, a remote
access app configured to run on a mobile phone, tablet computer,
etc. can be configured to allow family members of the patient to
remotely access the system 10 to receive updates regarding progress
of the surgical procedure, e.g., a timeline or progress report
mapping a percentage of progress of the actual surgical procedure
against the pre-op plan for the procedure, thereby helping to keep
family members automatically informed about the surgery's progress
regardless of whether the family members are located at the
hospital or not. Additionally, the app can be available for
download to personal device(s) and/or available on a device issued
temporarily to family members at the hospital, thereby allowing
family members to access the system 10 who may not otherwise have a
device at the hospital that is appropriate to access the system
10.
[0256] Equipment Tracking Module
[0257] The equipment tracking module 232 can provide users of the
system 10 with an interface for managing equipment used in a
surgical procedure. The equipment tracking module 232 can manage
equipment by registering, tracking, and ordering equipment.
[0258] In an exemplary embodiment, equipment can be registered and
tracked throughout a surgical procedure such that at any given time
during the procedure (including when a patient may not necessarily
be present, such as during setup and clean up), the equipment
tracking module 232 can be configured to gather data regarding
instrument(s) present in the OR and in a sterile configuration. The
equipment tracking module 232 can therefore be configured to help
manage efficient use of instruments in a surgical procedure being
performed and, through subsequent analysis by the post-op module
206 of data gathered by the equipment tracking module 232, help
improve efficiency, lower costs of future surgical procedures,
facilitate billing, and maximize reimbursement. The equipment
tracking module 232 can additionally or alternatively be configured
to track registered instruments in sterilization, which can help
ensure that cleaning and sterility have been performed before
instruments are used in the OR, help assess quality of
sterilization, help reload instruments trays more quickly, and help
assist in set scheduling based on case requirements in the pre-op
plan for the surgical procedure.
[0259] The equipment tracking module 232 can be configured to
gather various types of data regarding instruments used in the OR.
Non-limiting examples of data that the equipment tracking module
232 can be configured to gather include an identification of which
and how many surgical instruments are present in the OR at any
given time, how long each surgical instrument is in use during the
surgical procedure, number of instrument passes/exchanges, misuse
of instruments, loading and acceleration data, instrument damage,
amount of power consumed by instruments, and out of instrument
specification conditions. The system 10 can be configured to
provide instant feedback to the user on instrument use through a
display screen or feedback directly from the instrument, e.g.
light, vibration, etc. Examples of instrument use feedback include
misuse of the instrument, excessive force levels, or a damaged or
non-functional instrument.
[0260] Equipment can be registered and tracked in a variety of
ways, such as by using one or more optical and/or infrared cameras
in the OR. The camera(s) can be configured to detect an instrument
and compare gathered data regarding the detected instrument with
equipment data stored in the equipment database 324 to register the
instrument as a certain type of instrument, e.g., a scalpel, a
retractor, etc., and/or as a unique instrument, e.g.,
identification by bar code on the instrument, identification by
smart chip or radio frequency identification (RFID) tag embedded in
or otherwise attached to the instrument, etc. In this way, every
instrument used in the procedure and/or present in the OR can be
identified, which can facilitate tracking during the procedure and
facilitate use analysis (including non-use) in post-op analysis of
the procedure.
[0261] One embodiment of an instrument tracking system can include
an augmented reality tracking system, similar to that discussed
above regarding FIG. 21. The augmented reality marker(s) 72
configured to be recognized by the RGB camera 74 can be used to
track position and navigation of instruments.
[0262] FIG. 24 illustrates an embodiment of an instrument tracking
system including a magnetic based tracking system 100, such as
Razer Hydra hardware available from Razer USA Ltd. of Carlsbad,
Calif.. The magnetic based tracking system 100 can be configured to
communicate with a CPU 98 of the system 10, which can cause a data
related to gathered tracking data to be displayed on a display 102,
e.g., a list of all instruments currently in use. The magnetic
based tracking system 100 can be coupled to at least one camera,
e.g., a visual camera or an infrared camera, which can be
configured to calibrate a location of the magnetic based tracking
system 100 and use the electromagnetic tracking of the magnetic
based tracking system 100 to navigate instrument(s) without
requiring line of sight to the instrument from the camera(s).
Whether used in conjunction with the magnetic based tracking system
100 or not, the camera(s) can be configured to record movement of
the instrument(s), which can be stored in the equipment database
324 for later analysis, e.g., analysis performed by the post-op
surgery feedback module 238 discussed further below.
[0263] FIG. 25 illustrates an embodiment of a skin surface mapping
and instrument tracking system including a positioning/navigation
technology system, similar to that discussed above patient
positioning assistance using positioning/navigation technology such
as Microsoft Kinect. The positioning/navigation technology system
can include one or more markers 118 configured to be recognized by
one or more IR cameras 116. The marker(s) 118 can be positioned on
and/or near the patient to facilitate tracking motion of an
instrument 120 used relative to the patient. The marker(s) 118 can
additionally or alternatively facilitate detection of a skin
surface of the patient, determination of bone locations mapped to
pre-op image(s) of the patient, and tracking of medical personnel
motion and/or posture. The IR camera(s) 116 can be configured to
communicate with a CPU 122 of the system 10, which can cause
image(s) gathered by the camera(s) 116 to be displayed on a display
124. Fluoroscopy can be used for verification. Although only one
instrument 120 is shown in the illustrated embodiment, more than
one instrument can be tracked similarly to the instrument 120.
[0264] The equipment tracking module 232 can be configured to
anticipate future instrument needs during a surgical procedure and
trigger an instruction to retrieve the instrument(s) identified as
being needed and, if necessary, prepare the retrieved instrument(s)
for imminent use. The equipment tracking module 232 can be
configured to determine what instrument will next be needed based
on any number of factors, such as on previously gathered data
stored in the procedure database 316 and/or the products and
procedures database 320 regarding previously performed surgical
procedures of a same type as the surgical procedure being
performed, on the surgical procedure's pre-op plan as indicated in
a simulation saved in the procedure database 316, and/or on the
flow of the surgical procedure performed thus far. The equipment
tracking module 232 can be configured to identify all next-needed
instruments, or the equipment tracking module 232 can be configured
to determine which instrument(s) are critical to the surgical
procedure based on their frequency of use in previously performed
surgical procedures of a same type as the surgical procedure being
performed and only trigger an instruction for the critical
instrument(s). In an exemplary embodiment, the equipment tracking
module 232 can be configured to trigger an instruction for all
next-needed instruments, regardless of their actual or calculated
criticality to the procedure.
[0265] The triggered instruction can take any number of forms, such
as by identifying an instrument for a medical staff member to
retrieve and/or prepare for the surgeon. The identification can be
achieved in any number of ways, such as by displaying the
instrument on a display screen with a notation that the instrument
is needed now or in "X" amount of time, laser pointing to the
instrument on an instrument tray, lighting up the instrument's
location on an instrument tray, etc.
[0266] In some embodiments, retrieval of instruments can be
automated, such as by a robotic scrub tech or vending machine/tool
changer configured to provide each successive instrument. The
robotic scrub tech or vending machine/tool changer can be
configured to pick up each successive needed instrument, pass the
instrument through a sterile field (e.g., flash sterilization,
chemical sterilization, etc.), and deliver the sterilized
instrument to a scrub tech. The robotic scrub tech or vending
machine/tool changer can thus help reduce instrument sterilization
costs because only instruments used are sterilized, rather than
sterilizing an entire instrument set. The robotic scrub tech or
vending machine/tool changer can be configured to receive a
triggered instruction from the equipment tracking module 232 such
that only instruments identified as being needed as sterilized on
as as-needed basis.
[0267] As mentioned above, the equipment tracking module 232 can be
configured to verify cleanliness and/or sterilization of
instruments in the OR. In an exemplary embodiment, both cleanliness
and sterilization can be verified. The equipment tracking module
232 can be configured to verify cleanliness and sterilization in a
variety of ways, such as by using a built-in ultraviolet light and
an optical camera configured to recognize instruments. The
equipment tracking module 232 can additionally or alternatively be
configured to determine when a non-sterilized instrument has
breached the sterile field of the OR, e.g., by registering the
instrument and identifying the instrument as not being noted in the
equipment database 324 as having passed through sterilization, and
if so, to trigger an alert to user(s) of the system 10 in the OR.
The equipment tracking module 232 can be configured to provide a
warning, e.g., a visual warning on a display, etc., may if a
sterile instrument has been removed from the sterile field.
[0268] As also mentioned above, the equipment tracking module 232
can be configured to help reload instruments trays more quickly,
since time is often wasted in refilling trays after cleaning
instruments in central sterilization. The equipment tracking module
232 can facilitate reload of instruments trays in a variety of
ways. FIG. 26 illustrates an exemplary embodiment of an instrument
sorting system configured to allow the equipment tracking module
232 to help reload instruments trays more quickly. The instrument
sorting system can include an IR and RGB camera 104 configured to
gather data regarding an instrument 108 and communicate the
gathered data to a CPU 106 of the system 10. The CPU 106, e.g., the
equipment tracking module 232 executed by the CPU 106, can be
configured to analyze the received data to identify the instrument
108 and provide instructions as to which instrument tray 110 and
where in the instrument tray 110 the instrument 108 should be
placed (if placement of the instrument 108 in the tray is relevant,
e.g., if the instrument 108 is not the only instrument on or to be
on the tray 110). The CPU 106 can provide the instruction in a
variety of ways. In the illustrated embodiment, the CPU 106 can be
coupled to a laser pointer 112 configured to communicate orders to
medical personnel by directing medical personnel to the specific
tray 110 by laser pointing to the tray 110 and/or a specific
location on the tray 110. The laser pointer 112 can be coupled to a
movement mechanism, e.g., a rotation mount 114, configured to move
in response to instructions received from the CPU 106, e.g.,
instructions to rotate a certain amount in a certain direction to
cause the laser pointer 112 to point to tray 110 and/or a specific
location on the tray 110. The laser pointer 112 can include a
camera (not shown) configured to provide visual confirmation on a
user interface that the laser pointer 112 has pointed to the tray
110, which can allow a user to visually confirm the instruction.
Although only one instrument 108 is shown in the illustrated
embodiment, the IR and RGB camera 104 can be configured to gather
data regarding a plurality of instruments, and the CPU 106 can be
configured to analyze data regarding the plurality of instruments
and provide tray instructions regarding the plurality of
instruments.
[0269] The equipment tracking module 232 can be configured to
trigger maintenance/sharpening/lubrication/recalibration/disposal
cycles of instruments tracked by the equipment tracking module 232.
In an exemplary embodiment, when the equipment tracking module 232
registers an instrument is registered as being used in a surgical
procedure, the equipment tracking module 232 can cause the
scheduling module 222 to determine whether the instrument needs to
undergo maintenance/sharpening/lubrication/recalibration/disposal,
e.g., if the instrument has been used a certain predetermined
number of times as indicated by running tally of uses in surgery
detected by the system 10, and if so, to schedule the
maintenance/sharpening/lubrication/recalibration/disposal. In this
way, the equipment tracking module 232 can help ensure that
instruments are maintained in their best possible condition. The
equipment tracking module 232 can be configured to provide data on
instrument use to a product manufacturer. Examples of the provided
data include number of instrument uses, instrument failure,
maintenance and calibration cycles of instruments, and real-time
complaint reporting. The equipment tracking module 232 can be
configured to verify that all instruments and disposables have been
removed from the surgical site and are not remaining in the
patient.
[0270] OR Analysis Module
[0271] The OR analysis module 234 can be configured to provide
users of the system 10 with an interface for gathering ethnographic
information regarding a surgical procedure. The system 10 can thus
be configured to analyze each surgical procedure on the basis of
one or more factors such as instrument use efficiency, personnel
efficiency, and patient health, as well as be configured to
aggregate data regarding multiple surgical procedures so as to
learn trends over time. Individual analysis of surgical procedures
can help predict outcomes of the procedure and/or can help the
surgeon establish best practices and learn from previous experience
on a personal, confidential level as evaluated by the system 10
acting as a neutral third party. Aggregated data can help hospital
administrators develop a cost per hour for OR time, which can allow
the hospital to improve efficiency and lower costs.
[0272] The OR analysis module 234 can be configured to review data
collected over multiple surgical procedures, and can be configured
to group the data according to one or more factors such as
performing surgeon, procedure type, patient demographic,
instruments and implants used, duration, etc. The data can include
parameters such as anatomic, physiologic, ergonomic, temporal,
spatial, and biomechanical parameters. The system 10, e.g., the
post-op module 206, can be configured to perform an analysis on the
collected data through one or more algorithms to generate potential
new innovations to the surgical procedure, such as a combining of
steps, introduction of a new tool from a different procedure,
adjustment of a physical location of OR staff or equipment, etc.
These generated innovations can then be available for review by
users of the system 10, e.g., a user planning a new surgical
procedure, and can be integrated into future cases. The system 10
can be configured to record when the innovation was used and can be
configured to track the outcomes of these procedures to compare
against the outcomes from similar patients/procedures before the
innovation was used. The system 10 can be configured to determine
through comparison how effective the innovation was, resulting in
further learning of the system 10 on how and when to generate the
most effective innovations. This analysis can also help the system
10 determine if it would be beneficial to continue recommending
this innovation to users and eventually include it as a
standardized part of the procedure or to remove it due to its lack
of effectiveness.
[0273] The system 10 can be configured to automatically,
continually gather data throughout every surgical procedure at an
OR in which the system 10 is set up, e.g., by camera (still image
and/or video image), audio recording, motion sensor, etc., thereby
allowing for seamless data gathering largely transparent to medical
personnel in the OR. The OR analysis module 234 can be configured
to coordinate this data gathering. The system 10, e.g., the post-op
module 206 discussed further below, can thus be configured to
automatically generate efficiency reports at a user-set frequency,
e.g., for every procedure, for all procedures performed in one day
at a hospital, for every "X" number of a certain type of procedure
performed, etc., which can facilitate analysis and use of the data
gathered by the system 10.
[0274] Multiple technologies present in an OR can be integrated
with the system 10, thereby allowing centralized management and
monitoring of multiple technologies. The technologies can be
modular, as mentioned above, thereby allowing scaling of the system
10 to hospitals, clinics, etc. of largely varying size and
resources, and/ allowing the various technologies to be upgraded,
replaced, and/or maintained without requiring shutdown of the
entire system 10. The OR analysis module 234 can be configured to
provide a user interface allowing selective operation and/or user
settings of any one or more of the technologies at a given time,
thereby allowing for modular and personalized control of the
various technologies. Non-limiting examples of technologies that
can be integrated with the system 10 can include neural monitoring
outputs, educational information (e.g., surgical technique videos,
etc.), imaging (e.g., CT, fluoroscopy, ultrasound, etc.),
navigation, neural monitoring, lighting, cameras (e.g., endoscope,
microscope, feeds from outside the OR, etc.), power usage of
instruments, energy devices (e.g., bovie, bipolar, harmonic
devices, etc.), powered tools (e.g., burr, drill, etc.), video
outputs (e.g., output video to OR screens), projected images,
heads-up displays (e.g., in microscope, loupes, glasses, etc.),
connection to a hospital network, vital sign monitoring, robotic
control (e.g., control of instruments through pre-planned navigated
space such as disc-clearing robots, etc.), remote viewing of the
system 10, anesthesia, full room decontamination activated after
case completion and timed by the scheduling module 222, etc. The
technologies can be linked virtually through the system 10, e.g.,
through a central interface and processor residing in the OR
analysis module 234. The system 10 can be configured to manage and
display the inputs and outputs of each technology on a common
display and input device, or they can be physically combined into
one central unit, where each technology physically plugs in to the
unit in a rack system or comes as an integrated part of the system
from the manufacturer. This physically integrated unit can allow
for simplification of systems and/or allow for a reduction in the
amount of wires and carts in the OR, and can be scaled in the
number of technologies present as needed, or technologies can be
added using plug-and-play technology to meet the needs of the
surgical case or location of the unit. The technologies can be
configured to interface through a standardized operating system of
the system 10 that can allow seamless compatibility and integration
of newly developed or applied technologies.
[0275] Personnel Tracking Module
[0276] The personnel tracking module 236 can provide users of the
system 10 with an interface for managing and tracking medical
personnel involved in a surgical procedure. As mentioned above, one
or more medical personnel present in the OR can be registered and
tracked, such as a surgeon, first assistance, scrub tech, and any
other surgical staff. In an exemplary embodiment, the medical
personnel can be tracked throughout the surgical procedure such
that at any given time during the procedure (including when the
patient may not necessarily be present, such as during setup and
clean up), the personnel tracking module 236 can be configured to
gather data regarding medical personnel present in the OR. The
personnel tracking module 236 can therefore be configured to
determine which and how many medical personnel are present in the
OR at any given time and how long each of the medical personnel are
present in the OR during the surgical procedure. In an exemplary
embodiment, medical personnel are registered and tracked by the
personnel tracking module 236, and surgical instruments are
registered and tracked by the equipment tracking module 232,
thereby helping to provide a more complete picture of the surgical
procedure for analysis, which can help improve performance of
future surgical procedures.
[0277] The medical personnel can be registered and tracked in a
variety of ways, similar to that discussed above regarding
equipment tracking by the equipment tracking module 232, such as by
using one or more of optical and/or infrared cameras in the OR,
smart clothing monitors, sensors in instruments, motion capture,
and body sensors. Non-limiting examples of types of personnel data
that the personnel tracking module 236 can be configured to gather
include physiological data (e.g., heart rate, eye movement, time to
perform each step in a surgical procedure, body temperature (e.g.,
via infrared measurement, laser measurement, contact sensors,
etc.), posture, fatigue, effort/force applied to instruments (e.g.,
as indicators of stress), etc.), an identification of which and how
many medical personnel are present in the OR at any given time, how
long each medical personnel member is present during the surgical
procedure, number of personnel changes, personnel injury, radiation
exposure (e.g., without medical personnel each having to wear a
radiation monitoring device such as a dosimeter), etc. The
personnel data can relate to patient outcome, as analyzed by the
post-op module 206 discussed further below, so gathering and
analyzing personnel data can help hospitals plan better (e.g., make
changes to OR staff, leave more time between cases, schedule more
frequent and/or longer breaks, etc.) and achieve better patient
outcomes. The personnel data can also help indicate if particular
staff are particularly skilled at a certain surgical procedure
and/or certain aspects of a surgical procedure, which can help
identify potential training candidates who can instruct others as
to their technique.
[0278] The personnel tracking module 236 can be configured to
anticipate future personnel needs during a surgical procedure and
trigger an instruction to page, call, email, or otherwise request
the presence of a specific type of medical staff member or a
specific individual identified as being needed in the OR. The
personnel tracking module 236 can be configured to determine which
personnel will next be needed based on any number of factors, such
as on previously gathered data stored in the procedure database 316
and/or the products and procedures database 320 regarding
previously performed surgical procedures of a same type as the
surgical procedure being performed, on the surgical procedure's
pre-op plan as indicated in a simulation saved in the procedure
database 316, and/or on the flow of the surgical procedure
performed thus far. The instruction can indicate an estimated
amount of time before the requested personnel is needed in the OR.
The personnel tracking module 236 can thus allow medical personnel
to maximize use of their time outside the OR by being called to the
OR when they are needed. In other words, unnecessary wait time
outside the OR can be minimized. Unexpected scenarios arising
during the surgery that require additional medical personnel can
also be more quickly addressed by the personnel tracking module 236
being configured to request additional medical personnel in real
time without anybody currently present in the OR having to leave
the OR or even free their hands or leave their current location in
the OR.
[0279] The tracking of personnel can be used as a reminder to staff
to continue to use standard infection prevention methods. For
example, patient interactions can be monitored such that when
moving from one room to another a reminder (e.g., a blinking light
on a wrist band, etc.) can activate to make the staff aware that
hand washing and/or other appropriate infection prevention methods
are suggested.
[0280] Similar to that discussed above regarding the equipment
tracking module 232, the personnel tracking module 236 can be
configured to determine when a non-sterilized personnel member has
breached the sterile field of the OR, e.g., by registering the
personnel member and identifying the instrument as not being noted
in the ethnography database 326 as having passed through
sterilization, and if so, to trigger an alert to user(s) of the
system 10 in the OR.
[0281] The personnel tracking module 236 can communicate with the
scheduling module 222 to help drive OR personnel flow in multiple
ORs and allow for automatic rescheduling if medical personnel
become unavailable due to, e.g., an unexpected duration of a
surgical procedure. The personnel tracking module 236 can thus also
allow for more efficient determination of when to start prepping
patient, transferring them etc. based on personnel availability.
This can lead to the development of cost per hour of OR time,
and/or the tracking of how the efficiencies reduce the OR time and
therefore cost. The cost per hour of OR time and the efficiencies
can be stored in the OR database 322 and/or the equipment database
324.
[0282] The personnel tracking module 236 can be configured to
gather data regarding registered OR personnel even when the OR
personnel are outside the OR and are not actively involved in a
case. Non-limiting examples of "outside" data that the personnel
tracking module 236 can be configured to gather include nutrition
and energy level. Collection of the "outside" data can help the
system 10 determine if and how various factors affect case
outcomes, and make recommendations for personal changes (e.g.,
changes in behavior, rest, nutrition, case scheduling, etc.) to
improve outcomes. The personnel data can be made available by the
system 10 only to the user about which the personnel data was
gathered, which can help ensure privacy and help ensure that team
morale is not affected, and/or the personnel data can be made
available (anonymously or non-anonymously) to users other than the
user about which the personnel data was gathered, which can allow
for more broad-based data trend analysis.
[0283] Post-Op Module
[0284] The post-op module 206 can generally provide users of the
system 10 with an interface for analyzing a performed surgical
procedure and managing patient post-op treatment. More
particularly, the post-op module 206 can allow a surgeon to review
data gathered and analyzed by the operation module 204 regarding
surgeries performed by the surgeon, which can help a surgeon
evaluate his/her performance for efficiency, future improvements,
etc., and/or can help a hospital or other care facility evaluate
surgery logistics such as personnel needs, surgical instrument
inventories, OR use times, etc. The post-op module 206 can also
analyze the data gathered and analyzed by the operation module 204
to help improve future recommendations of the diagnosis and
treatment module 200 regarding effective treatments, and/or help
improve future recommendations of the pre-op module 202 regarding
simulated surgeries using instruments and/or personnel similar to
previously performed surgeries. The post-op module 206 can also
suggest post-op treatment options for the patient and can manage
the patient's post-op treatment. In this way, the post-op module
206 can be configured to assist with post-op planning and analysis
through a continuum from an end of surgery to the patient's
discharge instructions. The post-op module 206 can be configured to
compares physical, functional , HRQOL, and health economic data
describing an actual outcome to predicted values for each parameter
that were predicted by the pre-op module 202 during planning. The
post-op module 206 can be configured to detect and analyze any
variances and can be configured to modulate future predictive
models using the detected and analyzed variances.
[0285] In one embodiment, the post-op module 206 can be implemented
using one or more web pages which are configured to receive user
input and present information to a user. In an exemplary
embodiment, both patients and medical practitioners can access at
least a portion of the post-op module 206.
[0286] The post-op module can be used as an educational tool for
potential patients with regard to the expectations of
post-operative care, post-operative pain, etc.
[0287] The post-op module 206 can include a surgery feedback module
238, a post-op treatment module 240, a post-op patient care module
242. Each of the modules 238, 240, 242 is discussed further below
in turn.
[0288] As mentioned above, the post-op module 206 can be configured
to read information from and write information to the post-op
database 306. The post-op database 306 can include a treatment plan
database 328. Various ones of the post-op module's component
modules 238, 240, 242 can be configured to access one or more of
the treatment plan database 328 and/or various other databases,
e.g., the diagnosis and treatment database 300, the pre-op database
302, the operation database 304, and the recovery database 308. The
treatment plan database 328 is discussed further below in
connection with the post-op module's component modules 238, 240,
242.
[0289] Surgery Feedback Module
[0290] The surgery feedback module 238 can provide users of the
system 10 with an interface for analyzing a performed surgical
procedure. In an exemplary embodiment, only medical administrators
and medical personnel can access the surgery feedback module 238.
Some aspects of the surgery feedback module 238, such as video of
the surgery or comparison between the actual surgical procedure and
a pre-op plan, can be accessible to only the performing surgeon,
which can help prevent damage to team morale and help protect
privacy. The surgery feedback module 238 can, however, be
configured to allow the performing surgeon to make aspects of the
surgery feedback module 238 that are accessible to only the
performing surgeon available to one or more other users of the
system 10, e.g., residents, insurance providers, etc., which can
help facilitate training and/or billing.
[0291] Various types of data gathered and/or analyzed by the system
10 during and before a surgical procedure can be displayed on a
user interface and/or otherwise made available to users of the
system 10. FIG. 27 illustrates an embodiment of a user interface
148 showing various types of data related to a previously performed
surgical procedure. The user interface 148 shows three images of a
surgical site captured at a same time from three different
perspectives provided by the navigation software with actual
post-op images of the implant placement. Another portion of the
user interface 148 (top right quadrant) shows a patient x-ray of
the surgical site. By allowing the user to view different data and
to compare the pre-op planned placement with the actual post-op
result simultaneously, the user can better evaluate success of the
surgical procedure, including compliance of the surgery with the
pre-op plan.
[0292] Different types of data can be displayed to a user other
than the information shown on the user interface 148, such as time
durations of certain steps of the surgical procedure, a total time
duration of the surgical procedure, information gathered by the
equipment tracking module 232 regarding equipment used in the
surgical procedure, information gathered by the personnel tracking
module 236 regarding personnel involved with the surgical
procedure, a saved pre-op simulation, still or moving image data of
all or a portion of the surgical procedure captured by the
procedure analysis module 230, tissue removal data gathered by the
procedure analysis module 230, pre-op images of the patient stored
in the diagnosis database 310, the patient's pre-op treatment
compliance stored in the treatment database 312, etc. The surgery
feedback module 238 can thus allow each user to evaluate performed
surgical procedures in a way most informative and useful for that
particular user.
[0293] For non-limiting example, a hospital administrator may be
concerned with personnel issues to help plan future scheduling of
personnel for future surgeries, so the hospital administrator may
request that the surgery feedback module 238 provide personnel data
gathered during the surgical procedure by the personnel tracking
module 236 but not other data gathered by the operation module 204
during the surgical procedure. The hospital administrator may thus
be able to determine various personnel issues from the performed
surgical procedure and/or from a plurality of performed surgical
procedures, such as which types of medical personnel may be
redundant in a certain type of surgical procedure, which types of
medical personnel should be scheduled at certain times for certain
surgeries, whether any particular medical staff member is involved
with over "X" number of failures, etc.
[0294] For another non-limiting example, the performing surgeon may
be most concerned with tracking of the actual surgical procedure
against the pre-op plan and may thus request a report from the
surgery feedback module 238 indicating deviations of the actual
surgical procedure against the pre-op plan. The deviations can be
presented as percentage compliance with respect to factors such as
goal outcomes, time differences, differences in surgical
instruments used, differences in angles of trajectory, differences
in patient blood loss, measures against validated procedures (e.g.,
measures against defined steps that have been shown over time to be
effective surgical steps through the continual analysis of patient
outcomes proving the superior efficacy and safety of these defined
steps), etc., so the surgeon can make decisions such as possible
changes to make in future surgical procedures, requests for
additional educational materials to be available for future
surgical procedures, issues to address in the patient's post-op
treatment, notes for possible follow-up surgery, etc.
[0295] For another non-limiting example, an insurance administrator
may be concerned with a surgeon's compliance with validated
procedures and/or specific measures such as reduced re-operations
or lower infection rates because the more a surgeon follows
validated procedures and complies with specific measures over time,
the lower the surgeon's insurance rates could become because the
surgeon has been proven to follow validated procedures and complied
measures. Similarly, the insurance administrator may be concerned
with a surgeon's success rate because the higher a surgeon's
success rate, the lower the surgeon's insurance rates could become
because the surgeon has been proven to perform effective surgeries.
The insurance administrator may therefore request, e.g., a measures
against validated procedures report from the surgery feedback
module 238 for review by the insurance administrator and/or an
insurance carrier. The measures against validated procedures report
can be customized by user selection to be over a certain period of
time for a certain surgeon and/or a certain type of surgery, to
include the last "X" number of surgeries performed by a particular
surgeon or group of surgeons at a particular hospital, etc.
[0296] The surgery feedback module 238 can be configured to
generate one or more post-op reports summarizing the surgery
performed. The report can be a brief, one page or less report
showing a snapshot of the surgery, which can help quickly inform
and/or remind medical practitioners of the surgery performed on a
patient and/or help a patient accurately describe the surgery to
third parties, such as their PCP, family members, and airport
security (who may need, e.g., precise information regarding
implants in the patient or medication prescribed to the patient).
Each post-op report generated can be targeted to a particular user,
such as the performing surgeon, the patient's PCP, or the patient.
A post-op report generated for a medical practitioner such as the
performing surgeon or the patient's PCP can include medically
precise information regarding the surgery and/or the patient, such
as the type of surgery performed, the medical devices implanted in
the patient, date of the surgery, the medications administered to
the patient, projected success rate of the surgery based on
historic success rates of the surgery and the patient's particular
surgery, etc. A post-op report generated for a patient can include
information that is less medically precise than on a report for a
medical practitioner, such as the medical devices implanted in the
patient, date of the surgery, type of procedure performed, list of
medications administered during the procedure, a total time length
of the procedure, a projected reimbursement by the patient's
insurance, name of and contact information for the performing
surgeon, name of and contact information for the hospital or other
facility at which the surgery was performed, etc. Post surgical
results and metrics stored in the operation database 304 and/or in
the recovery database 308, such as length of stay, infection rate,
fusion rate, blood loss, etc., can be tracked by the hospital
and/or surgeon and can be used to drive patient awareness around
quality of care and/or used with payers to help support
reimbursement negotiations.
[0297] Any of the modules discussed herein can be configured to
generate a report similar to the post-op report summarizing the
data gathered and/or analyzed by the particular module, which can
help keep medical practitioners and patients informed throughout
the patient's care.
[0298] Post-Op Patient Care Module
[0299] The post-op patient care module 242 can provide users of the
system 10 with an interface for managing and analyzing a patient's
in-hospital post-surgery care. The post-op patient care module 242
can be configured to provide one or more one or more recommended
post-op care options based on the efficacy of the surgery as
analyzed by the surgery feedback module 238 and/or as indicated by
manual input from the performing surgeon and/or other user of the
system 10. None, some, or all of the recommended post-op care
options can be followed, but by providing a full range of post-op
care options, the post-op patient care module 242 can help prevent
any post-op care decisions from being overlooked or
under-appreciated for a particular patient. Non-limiting examples
of post-op care options can include medication types and
frequencies of dosage, length of post-op hospital stay, appropriate
hospital unit for patient stay post-surgery, appropriate diet for
post-op hospital stay, frequency of vital sign measurements, and
post-op imaging (x-rays, CT scan, etc).
[0300] The post-op patient care module 242 can be configured to
determine post-op care options in a variety of ways. Similar to
that discussed above regarding the treatment options module 212 and
the treatment database 312, the post-op patient care module 242 can
be configured to compare pre-op and op data for a particular
patient with post-op care options stored in the treatment plan
database 328 and determine which of the plurality of possible
post-op care options are associated with the patient's diagnosis
(as stored in the diagnosis database 310), the patient's
demographics (as stored in the diagnosis database 310), the
patient's current level of radiation exposure, the patient's care
provider (as not all care options may be available at the patient's
current location, so transfer of the patient may be appropriate as
part of the patient's post-op care), the type of surgery performed
on the patient (as stored in the treatment database 312 and/or the
products and procedures database 320), and/or the surgery's
effectiveness (as stored in the treatment database 312 and/or the
products and procedures database 320). The post-op patient care
module 242 can be configured to cause a display screen to show a
list of the possible post-op care option(s). The possible post-op
care option(s) can be provided to the user with a caution that the
possible post-op care option(s) are preliminary only and that the
user should consider the patient's circumstances in determining a
post-op care plan. The possible post-op care option(s) can be
provided to the user with historic success rates of each of the
possible post-op care option(s). The historic success rates can be
stored in the treatment plan database 328 for each of the post-op
care options and can be manually entered. Alternatively or in
addition, the historic success rates can be based on data collected
by the system 10 regarding a plurality of patients such that the
system 10 can act as a feedback loop system in which previously
collected data regarding post-op care treatments received by actual
patients can inform post-op care options for future patients. The
possible post-op care option(s) can be provided to the user with
educational resources for at least one of the options, e.g., links
to informational web pages stored in the system 10 (e.g., in the
treatment plan database 328), links to third party educational
websites, lists of or links to journal articles or books, links to
medical device product brochures (e.g., brochures stored
electronically in the system 10), etc.
[0301] In some embodiments, the post-op patient care module 242 can
provide coding and reimbursement information for each of the
suggest post-op care options. Providing such information can
facilitate educated decision-making about which of the post-op care
options to pursue (if any).
[0302] By suggesting post-op care option(s) to a user, the post-op
patient care module 242 can allow the user to receive and analyze
information that may be outside their area of medical expertise.
The post-op patient care module 242 can allow the user to become
quickly informed about unfamiliar aspects of the patient's case
(e.g., a specific abnormal surgical outcome or with a particular
new medication) by recommending particular post-op care options to
address unfamiliar as well as familiar aspects of the patient's
case, which can facilitate swift, effective treatment of the
patient and/or facilitate education of the user and the user's
colleagues to which the user may discuss the unfamiliarities.
[0303] Post-Op Treatment Planning Module
[0304] The post-op treatment planning module 240 can provide users
of the system 10 with an interface for receiving one or more
post-op treatment plan options based on the post-op care of the
patient and on the efficacy of the surgery as analyzed by the
surgery feedback module 238 and/or as indicated by manual input
from the performing surgeon and/or other user of the system 10.
None, some, or all of the recommended post-op treatment plan
options can be followed, but by providing a full range of post-op
treatment plan options, the post-op treatment planning module 240
can help prevent any post-op treatment decisions from being
overlooked or under-appreciated for a particular patient.
Non-limiting examples of post-op treatment plan options can include
medication types and frequencies of dosage, type and duration of
physical therapy, type and duration of occupational therapy,
at-home exercise types and frequency, appropriate timing of
follow-up doctor visits, and appropriate at-home diet.
[0305] The post-op treatment planning module 240 can be configured
to determine post-op treatment plan options in a variety of ways.
In an exemplary embodiment, the treatment plan database 328 can
include a plurality of possible post-op treatment options, each of
the possible post-op treatment options being associated with at
least one possible diagnosis. This post-op treatment options data
can be organized in any way, such as in a table. Similar to that
discussed above regarding the treatment options module 212 and the
treatment database 312, and the post-op patient care module 242,
the post-op treatment planning module 240 can be configured to
compare pre-op data, op data, and post-op care data for a
particular patient with post-op treatment options stored in the
treatment plan database 328 and determine which of the plurality of
possible post-op treatment options are associated with the
patient's diagnosis (as stored in the diagnosis database 310), the
patient's demographics (as stored in the diagnosis database 310),
the patient's current level of radiation exposure, the patient's
care provider (as not all care options may be available from the
patient's doctor), the patient's post-op care, the type of surgery
performed on the patient (as stored in the treatment database 312
and/or the products and procedures database 320), and/or the
surgery's effectiveness (as stored in the treatment database 312
and/or the products and procedures database 320).
[0306] The post-op treatment planning module 240 can be configured
to cause a display screen to show a list of the possible post-op
treatment option(s). The possible post-op treatment option(s) can
be provided to the user with a caution that the possible post-op
treatment option(s) are preliminary only and that a user should
consider the patient's circumstances in determining a post-op
treatment plan. The possible post-op treatment option(s) can be
provided to the user with historic success rates and/or with
projected outcome scenarios of each of the possible post-op
treatment option(s). The historic success rates can be stored in
the treatment plan database 328 for each of the post-op treatment
options and can be manually entered. Alternatively or in addition,
the historic success rates can be based on data collected by the
system 10 regarding a plurality of patients such that the system 10
can act as a feedback loop system in which previously collected
data regarding post-op treatments received by actual patients can
inform post-op treatment options suggested to future patients. The
possible post-op treatment option(s) can be provided to the user
with educational resources for at least one of the options, e.g.,
links to informational web pages stored in the system 10 (e.g., in
the treatment plan database 328), links to third party educational
websites, lists of or links to journal articles or books, links to
medical device product brochures (e.g., brochures stored
electronically in the system 10), etc. The projected outcome
scenarios can be based on one or more factors, such as historic
outcomes, the patient's demographics, the patient's lifestyle, the
patient's compliance with pre-surgery treatment as gathered by the
treatment compliance module 216 and stored in the treatment
database 312, etc.
[0307] In some embodiments, the post-op treatment planning module
240 can provide coding and reimbursement information for each of
the suggest post-op treatment options. Providing such information
can facilitate educated decision-making about which of the post-op
treatment options to pursue (if any).
[0308] The possible treatment options suggested by the post-op
treatment planning module 240 can include non-surgical treatment
options (e.g., diet adjustments, exercise regimens, medications,
etc.) and surgical treatment options (e.g., specific surgical
procedures). In an exemplary embodiment, only non-surgical
treatment(s) can be initially suggested to a user of the system 10.
In this way, a conservative treatment can be pursued before a more
radical, typically more costly treatment such as follow-up surgery
is pursued. If one or more of the non-surgical treatments are
pursued and are determined to unsatisfactorily address a patient's
problem(s), then the post-op treatment planning module 240 can be
configured to suggest one or more surgical treatment options. The
post-op treatment planning module 240 can be configured to suggest
the one or more surgical treatment options upon request by a user,
e.g., when a medical practitioner requests non-conservative
treatment options for a particular patient, and/or can be
configured to suggest the one or more surgical treatment options
when a trigger event occurs, e.g., after a predetermined threshold
amount of time passes from commencement of a non-surgical treatment
for a patient after which the patient has not shown a predetermined
amount of improvement. By way of non-limiting example, the post-op
treatment planning module 240 can be configured to analyze data
gathered by the recovery module 208, discussed further below, and
determine whether the patient's mobility has improved by a certain
degree after a certain amount of time as indicated by reported pain
levels and/or analysis of captured images. Before the post-op
treatment planning module 240 suggests one or more surgical
treatment options following determination that a non-surgical
treatment is not achieving a desired outcome, the post-op treatment
planning module 240 can be configured to first suggest one or more
other non-surgical treatments.
[0309] By suggesting treatment option(s) to a user, the post-op
treatment planning module 240 can allow the user to receive and
analyze information that may be outside their area of medical
expertise, similar to that discussed above regarding the treatment
options module 212 and the post-op patient care module 242.
[0310] Recovery Module
[0311] The recovery module 208 can generally provide users of the
system 10 with an interface for managing and evaluating a patient's
recovery from surgery. More particularly, the recovery module 208
can allow a patient to monitor and manage their post-surgery
recovery, such as to record personal data (e.g. pain levels,
mobility, time to return to work, compliance with medication,
compliance with physical therapy, etc.) and compare their recovery
progress against their personal targets and/or against others
having similar demographics to the patient. The recovery module 208
can also allow medical professionals to review data gathered and
analyzed by the recovery module 208 regarding the patient's
post-surgery recovery, which can help the medical professionals
monitor the patient's progress and provide the patient with updated
and/or revised recovery planning tools and/or recovery activities
to help the patient maximize recovery potential. The recovery
module 208 can also analyze the data gathered regarding the
patient's recovery from surgery to help improve future
recommendations of the post-op module 206 regarding effective
recovery options for patients having similar demographics to the
patient.
[0312] In one embodiment, the recovery module 208 can be
implemented using one or more web pages which are configured to
receive user input and present information to a user. In an
exemplary embodiment, both patients and medical practitioners can
access at least a portion of the recovery module 208.
[0313] The recovery module 208 can include a patient monitoring
module 244 and a efficacy analysis module 246. Each of the modules
244, 246 is discussed further below in turn.
[0314] As mentioned above, the recovery module 208 can be
configured to read information from and write information to the
recovery database 308. The recovery database 308 can include a
patient targets database 330 and a surgery targets database 332.
Various ones of the post-op module's component modules 244, 246 can
be configured to access one or more of the patient targets database
330, the surgery targets database 332, and/or various other
databases, e.g., the diagnosis and treatment database 300, the
pre-op database 302, the operation database 304, and the post-op
database 306. The patient targets database 330 and the surgery
targets database 332 are discussed further below in connection with
the recovery module's component modules 244, 246.
[0315] Patient Monitoring Module
[0316] The patient monitoring module 244 can provide users of the
system 10 with an interface for monitoring and managing their
post-surgery recovery. Similar to the treatment compliance module
216, the patient monitoring module 244 can provide users of the
system 10 with an interface for tracking patient compliance with a
post-op treatment plan. The post-op treatment plan can be one of
the suggested treatment options suggested by the post-op treatment
plan module 240, can be one of the suggested treatment options
suggested by the post-op treatment plan module 240 as modified by a
medical practitioner, or can be a treatment plan entered into the
system 10 by a medical practitioner without assistance of the
post-op treatment plan module 240. The post-op treatment plan can
be stored in the treatment plan database 328. The patient
monitoring module 244 can thus allow monitoring and management of a
patient's post-op treatment, which can help the patient's doctor
evaluate the patient's progress and/or can help determine whether
and when modifications to the post-op treatment plan may be
necessary, either adjustment of the post-op treatment plan (e.g.,
changing dietary requirements, changing a frequency of doctor
check-ups, etc.) or replacement of the post-op treatment plan
(e.g., a non-surgical treatment) with another treatment plan (e.g.,
a surgical treatment).
[0317] Patients and users other than patients can submit data to
the patient monitoring module 244 for storage in the treatment plan
database 328. Data can therefore be received by the patient
monitoring module 244 whether the patient is in or not in a medical
setting and can be received throughout the patient's post-op
treatment and not just when the patient visits or consults a
medical practitioner. More accurate and more timely data regarding
post-op treatment plan compliance can therefore be gathered and
analyzed. Users can submit data to the patient monitoring module
244 similar to that discussed above regarding submission of data to
the diagnosis module 210 and to the treatment compliance module
216.
[0318] Data can be provided to the patient monitoring module 244
actively by the patient and/or other users entering the data
manually, or data can be provided passively, e.g., through the use
of sensors or devices autonomously collecting data defined as a
part of the post-op treatment plan. Examples of devices and sensors
used to collect the passive data include smartphone or tablet
integrated devices (e.g., cameras, gyroscopes, accelerometers,
global positioning systems, etc.), skin patches (such as patches
available from MC10 Inc., etc.), smart clothing with integrated
sensors, and implants with integrated sensors (e.g., integrated
sensors available from CardioMEMS, Inc.). Examples of the passive
data include range of motion, movement tracking, posture, pain
levels, bone fusion measures, medication consumption, heart rate,
pulse, sleep patterns, etc.
[0319] The application and location of material applied or
delivered to the patient can be tracked by the patient monitoring
module 244. For example, the intraoperative location of an implant,
e.g., a spinal interbody fusion implant, can be recorded and
compared to data recorded post-operatively or at follow-up visit(s)
to determine if the implant is trending to be move or migrating to
an undesirable position. Prior to catastrophic outcomes, the
patient's rehabilitation regime can be re-directed and/or a
revision surgery can be performed. Additionally, an implant can be
configured to be adjusted from outside the patient without
re-operation through, e.g., radi signals and the use of rare earth
magnets built into the implant, which can allow implant height or
lordosis to be adjusted in order to compensate for movement of the
implant or subsidence. The expansion of the implant can help to
restore lordosis, balance, or decompression, for example.
[0320] Also similar to that discussed above regarding the treatment
compliance module 216, the patient monitoring module 244 can be
configured to analyze received compliance data to determine a
compliance level and/or a success rate of the treatment overall
and/or per symptom, can be configured to compare received post-op
treatment compliance data for a patient with historic compliance
data for other patients who underwent similar post-op treatment to
help determine the effectiveness of the treatment for the patient,
and can be configured to receive data submitted by patients and
users other than patients for storage in the treatment plan
database 328. Users can submit data to the patient monitoring
module 244 similar to that discussed above regarding submission of
data to the diagnosis module 210 and the treatment compliance
module 216. The analysis and/or comparison performed by the patient
monitoring module 244 can consider data regarding the patient's
specific post-op recovery targets as stored in the patient targets
database 330, and/or can consider data regarding post-op recovery
targets for typical patients having received a same type of surgery
as the patient as stored in the surgery targets database 332.
[0321] The patient monitoring module 244 can be configured to
provide a user with information regarding a patient's post-op
treatment plan, such as by displaying post-op treatment plan
information on a device in communication with the system 10.
Non-limiting examples of post-op treatment plan information that
can be displayed on the device include reminders for upcoming
post-op appointments (e.g., physical therapy appointments),
reminders of days/times to take medication, percentage of overall
compliance with the post-op treatment plan, reminders to upload
data (e.g., video of exercise, blood pressure and/or other vital
sign reading, etc.), current list of symptoms and/or pain levels,
etc.
[0322] FIG. 28 illustrates an embodiment of post-op treatment plan
display to a user 150 on a display device 152 in communication with
the system 10. Although the display device 152 is a touch screen
tablet in the illustrated embodiment, the system 10 can communicate
with other devices, as discussed above. Similarly, although the
post-op treatment plan displayed on the display device 152 in the
illustrated embodiment includes a calendar indicating days to take
medication and a graph indicating overall compliance with the
post-op treatment plan, any combination of different types of
information can be shown on a display device in communication with
the system 10. The displayed information can be customized by a
user so that the user can receive the most relevant information for
their particular post-op treatment plan. Providing feedback on a
post-op treatment plan to a patient undertaking the plan can help
encourage the patient's compliance with the plan because progress
can be continually, visibly observed, and because healing and
resumption of normal activity can be shown as an obtainable
goal.
[0323] Efficacy Analysis Module
[0324] The efficacy analysis module 246 can provide users of the
system 10 with an interface for reviewing data gathered and
analyzed by the recovery module 208 regarding the patient's
post-surgery recovery. Similar to that discussed above regarding
the treatment compliance module 216, the patient monitoring module
244 can be configured to continually analyze received data to help
determine the efficacy of a particular patient's post-op treatment
plan in achieving the desired functional outcome, and/or to help
monitor the patient's general health. This monitoring can be
performed actively or passively methods, similar to that discussed
above. The patient monitoring module 244 can thus determine that a
particular patient's post-op treatment plan should be modified
based on comparison of the effectiveness of the treatment plan in
helping the patient reach their interim or final recovery targets
set by their surgeon and/or when compared to the aggregate of other
patients' data having similarities in multiple factors as
determined by the system 10 for a high correlation factor, such as
procedure type, patient age, bone density, spinal levels treated,
etc. The patient monitoring module 244 can learn from other
patients' experiences that the present patient's post-op treatment
could benefit from a modification, e.g., perform a specific
exercise once every other day instead of once daily, cease
performance of a particular exercise, decrease salt intake, wear a
knee brace 24/7 instead of only while sleeping, add or change
medication type and dosage, etc. Thus, the predicted outcome of
rehabilitation and treatment can be predicted for the patient if
they continue therapies that historical patients have followed.
This can increase patient compliance to rehabilitation therapies if
the patient can compare their performance to others that have had
the same procedure and similar rehabilitation therapy. The patient
monitoring module 244 can be configured to suggest the modification
of the patient's treatment post-op plan to the patient's care
provider, e.g., by providing an alert to the care provider
indicating that modification of the patient's post-op treatment
plan is recommended. The care provider can review the modification
and determine whether to modify the patient's treatment plan.
Alternatively, the patient monitoring module 244 can be configured
to automatically modify the patient's post-op treatment plan and
inform the patient via an alert as to the modified post-op
treatment plan. Usually, however, a care provider would review a
modification to check its appropriateness for the particular
patient before the patient monitoring module 244 automatically
modifies the patient's post-op treatment plan and informs the
patient of the change. Data regarding efficacy of the patient's
post-op treatment plan can be stored in the patient targets
database 330. The care provider can compare treatment groups and
redirect rehabilitation plans to those that have been determined to
be most effective.
[0325] The efficacy analysis module 246 can be configured to
capture the data collected in the operation module 204, the
diagnosis and treatment module 200, and the operation module 204 in
order to generate a comprehensive data set for each patient. The
efficacy analysis module 246 can be configured to aggregate these
data sets with other patient data sets. The data collected can be
of high enough value such that when the data is combined using a
sufficient quantity of patients, the result is a study that could
be published in a peer-reviewed medical journal for the purpose of
sharing the outcomes of a certain procedure or treatment type with
a selected patient group. The efficacy analysis module 246 can be
configured to analyze the collected data to determine variables
that may enhance or reduce patient compliance, with insights used
to modify patient compliance with one or more compliance enhancers
such as reward programs and patient support communities.
[0326] System Use
[0327] As mentioned above, the systems and methods of using the
systems described herein can be used through a medical treatment
continuum of patient care. In an exemplary embodiment, the system
can be provided throughout an entirety of the treatment continuum
of patient care, thereby maximizing opportunities for data
collected during various portions of the continuum to be used in
informing determinations made in any one or more other portions of
the continuum. The system can, however, be provided for only a
partial portion of the continuum. The system can be flexibly
implemented using any one or more modules thereof in any
combination. The system can thus be configured to accommodate
different monetary cost constraints, different availabilities of
computer infrastructure, and different end user needs. For example,
only a diagnosis and treatment module of the system can be provided
to facilitate diagnosing patients and determining treatments for
the patients based on the diagnoses. For another example, only
pre-op and post-op modules of the system can be provided to
facilitate the planning and performance of surgical procedures.
[0328] FIGS. 34A-42B illustrate exemplary embodiments of using the
system 10 in various portions of the medical treatment continuum.
Although the methods are illustrated with respect to the system 10
of FIG. 2, any of the systems disclosed herein can be similarly
used. Also, although various ones of the methods are illustrated
with respect to a spinal surgical procedure, the systems disclosed
herein can be used with respect to any type of surgical procedure,
as discussed above.
[0329] FIGS. 34A-34B illustrate an exemplary embodiment of a use of
the diagnosis and treatment module 200, and in particular the
diagnosis module 210. FIG. 35 illustrates another exemplary
embodiment of a use of the diagnosis and treatment module 200, and
in particular the treatment options module 212. FIG. 36 illustrates
another exemplary embodiment of a use of the diagnosis and
treatment module 200, and in particular the treatment compliance
module 216. FIG. 37 illustrates another exemplary embodiment of a
use of the diagnosis and treatment module 200, and in particular
the treatment compliance module 216. FIG. 38 illustrates an
exemplary embodiment of a use of the pre-op module 202, and in
particular the surgical procedure planning module 218. FIGS.
39A-39C illustrate another exemplary embodiment of a use of the
pre-op module 202, and in particular the surgical procedure
planning module 218. FIG. 40 illustrates another exemplary
embodiment of a use of the pre-op module 202, and in particular the
scheduling module 222 and the patient preparation module 224. FIGS.
41A-41C illustrate an exemplary embodiment of a use of the
operation module 204, and in particular the procedure analysis
module 230. FIGS. 42A-42B illustrate another exemplary embodiment
of a use of the operation module 204, and in particular the
equipment tracking module 232 and the personnel tracking module
236.
CONCLUSION
[0330] One skilled in the art will appreciate further features and
advantages of the invention based on the above-described
embodiments. Accordingly, the invention is not to be limited by
what has been particularly shown and described, except as indicated
by the appended claims. All publications and references cited
herein are expressly incorporated herein by reference in their
entirety.
* * * * *