Becker's Clinical Quality & Infection Control

63 QUALITY IMPROVEMENT & MEASUREMENT Will augmented reality in the OR will reduce surgical errors? 5 notes By Jessica Kim Cohen A ugmented reality, a type of tech- nology that superimposes digital images onto a user's field of view, may be able to decrease medical errors and improve hospital costs, two researchers affil- iated with the University of Maryland wrote in a Harvard Business Review article. Here are five things to know about the po- tential use of AR in medical care. 1. In the article, Sarah Murthi, MD, an asso- ciate professor of surgery at Baltimore-based University of Maryland School of Medicine's trauma center, and Amitabh Varshney, PhD, dean of the college of computer, mathematical and natural sciences at University of Maryland, College Park, noted almost every surgery in- volves a scan prior to incision to guide the pro- cedure. However, image displays are "basically the same" today as they were in the 1950s. 2. Imaging data, such as angiography and CT scans, are displayed on 2-D screens, spread across the operating room. ese displays force clinicians to look away from the patient to gather data while operating, and divert their attention to fusing information from various screens. e images are also displayed from the perspective of the imaging device, rather than the viewer, resulting in a physician having to mentally project the images onto a patient while conducting a procedure. 3. AR may be able to revolutionize image dis- play during surgery by concurrently showing imaging data and patient information from the perspective of the physician, without hav- ing to look away from the patient. e authors noted researchers at the university's Maryland Blended Reality Center Augmentarium are prototyping AR applications in medicine. For example, researchers are developing an appli- cation in which a surgeon is able to see digital images and patient data overlaid on his or her field of view using an AR headset. 4. In addition to safer procedures, the authors argued AR may also be able to reduce costs for a hospital by eliminating the need for multiple imaging screens. Today, hospitals buy separate systems for imaging displays related to ultrasound, endoscopy and bronchoscopy, and EMRs and ventila- tors also have their own screens. AR may be able to provide a shared display, reducing the need for multiple monitors. 5. e authors acknowledged AR technology has not developed enough to be deployed immediately. Developers must create hard- ware that easily fits on a physician's head and assess what types of data are displayed — and where — during surgery. As with most technological innovations, physician buy-in will also pose a challenge. "ere are a variety of technical challenges, but none of them are insurmountable," the authors wrote. "It will take gied computer scientists and visionary physicians to make augmented reality an actual reality in medi- cine. But we are excited for the future, where the use of AR in healthcare will be just as commonplace as use of a stethoscope." n WSJ report spurs House oversight of hospital accreditation processes By Emily Rappleye T he House Energy and Commerce Committee is seeking information from CMS and four accredita- tion agencies, including The Joint Commission, to ensure their accreditation processes for hospitals in the Medicare and Medicaid programs follow federal stan- dards and ensure patient safety. Representatives sent letters to The Joint Commission, the Bureau of Healthcare Facilities Accreditation, the Center for Improvement in Healthcare Quality and DNV GL Healthcare. The oversight is a direct response to a September 2017 article published by The Wall Street Journal that found The Joint Commission rarely revokes its seal of approval when hospitals are not compliant with Medicare regulations. The report found 350 Joint Commission hospitals violated Medicare requirements in 2014, and more than one-third had additional violations in 2015 and 2016. More than 30 hospitals were able to keep their accreditation. "Although CMS has worked to strengthen its oversight of [accrediting organizations], the committee is con- cerned about the adequacy of CMS' oversight as well as the rigor of the AO survey process," the letter to CMS reads. "For example, according to CMS' most recent annual report to Congress, in [fiscal year] 2015, AOs conducting hospital surveys did not report 39 percent of 'condition level' deficiencies that were subsequently reported following validation surveys conducted by State Survey Agencies no later than 60 days following the AO survey." The committee is seeking information on contracts between the AOs and CMS, complaints, correspondence about adverse events, and disparities between AO and state surveys, performance reviews and corrective actions, among other items. n "[W]e are excited for the future, where the use of AR in health- care will be just as commonplace as use of a stethoscope." -Sarah Murthi, MD, and Amitabh Varshney, PhD, researchers at the University of Marlyand

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