More hospitals scoping out integrated endoscopy suites
by Julie E. Williamson

Smith & Nephew Digital OR

With the ever-present focus on the bottom line, virtually every medical specialty is searching for ways to improve efficiencies, increase procedure volume, maintain a competitive edge, and above all, improve patient outcomes.

In the field of endoscopy, that push has never been more apparent. More than ever, institutions are dedicating unprecedented resources to develop state-of-the-art, integrated endoscopy suites. And high-level, complex surgical endoscopy suites aren’t the only areas getting a facelift. Even the standard gastrointestinal procedure rooms and therapeutic endoscopy suites are beginning to earn their place in the integration spotlight, sources told Healthcare Purchasing News.

"Like all areas of healthcare, there’s a growing emphasis being placed on efficiency," said Glenn Prechac, marketing manager for OR1, integration business development, Karl Storz Endoscopy, Culver City, CA. "Endoscopic procedures have become increasingly common, so it makes sense for healthcare facilities to turn their attention to solutions that allow them to maximize their efficiencies and streamline operations."

According to data from Toronto-based Millennium Research Group, endoscopic procedures account for more than 25 percent of all surgeries now performed in developed countries; gastrointestinal endoscopy has quickly become one of the largest endoscopy segments in the U.S., earning a value of $820 million in 2003. Much of that growth has been attributed to increased awareness and screening for colorectal cancer and other GI-related conditions.

Other endoscopy specialties are also picking up steam in the U.S., including the ear, nose and throat and bronchoscopy markets, which according to MRG, generated more than $300 million in revenue in 2004. The value of the U.S. image-guided surgery market topped $110 million in 2003 and will continue to be driven by improved functionality, decreasing prices and the introduction of new applications, the research firm noted.

Naturally, manufacturers of endoscopy products are also experiencing an upswing in business. In 2003, the U.S. market for GI endoscopy devices alone garnered nearly $820 million. These devices included flexible videoscopes, biopsy forceps, biliary stone removal devices, endoscopic retrograde cholangiopancretography devices, dilation balloons, hemostasis devices, enteral feeding devices, stents, low profile devices, virtual colonoscopy devices, capsule endoscopes, polypectomy snares, anti-reflux devices and retrieval devices.

Industry sources generally agreed that business will continue to flourish, particularly for manufacturers that offer a range of endoscopy products and solutions that can integrate with new and existing technologies, and help facilities leverage their existing infrastructures.

"Today, customers are wanting more from manufacturers. It isn’t just about a certain product. Much like what has been going on in the OR, [endoscopy] customers are interested in total customizable solutions that can allow for future upgrades and make the most of their investments," said Marc Filerman, director of marketing for Digital OR, Smith & Nephew Endoscopy, Andover, MA.

Not-so-standard GI rooms
Given the high procedure volume in diagnostic GI labs, it’s little wonder healthcare organizations are interested in procuring more sophisticated solutions. Although integration is being done on a lesser scale in standard GI environments because less equipment is involved – which, in most cases, means booms and touch-panel displays, for example, are not a common fixture — manufacturers are noticing a trend toward incorporating flat-panel monitors that can be ceiling mounted, as opposed to relying on traditional bulky monitors that sit on carts.

Olympus has seen steady growth in business in regard to integration in GI, with more centers looking to move the equipment off the floor as a way to become more efficient.

Ergonomics also play into that decision. Not only does a mounted monitor make viewing more comfortable for the physician, running the wires up the wall to the ceiling can be a safer option for staff, particularly in an endoscopy suite where lighting is limited. "Having the ability to save space is important, but there’s a real benefit from an occupational health standpoint that shouldn’t be overlooked," explained Prechac.

There’s also a growing trend to route video from standard procedure rooms into other areas of the facility, such as the nurses’ station or conference room. Video routing allows for offsite consultation and can increase efficiency by allowing nurses to know when to prepare for the next case.

While such routing technology is considered high-tech, facilities may be pleasantly surprised by its relatively inexpensive price tag. According to Marc Shapiro, Olympus’ software and integration systems director, cost per room runs approximately $25,000, which includes the flat panel mount, an observation camera and the video feed.

Vendors said there’s a tendency for organizations to buy into the belief that integration typically translates into a high dollar, state-of-the-art suite. In reality, however, integration can mean simply adding newer monitors and DVD recording.

"Today, budgets are tight, so having all the technologies may not be possible or even necessary, especially for standard procedure rooms," Shapiro added. "In endoscopy, it is okay to live without some of the technology."

Bigger buy-in from advanced endoscopy
While standard diagnostic GI procedure rooms are generally more conservative in regard to integration, the same can’t be said for suites built for more complex therapeutic endoscopy procedures, such as endoscopic ultrasound and endoscopic retrograde cholangiopancreatography.

Often, the push for more advanced integration and connectivity capabilities in complex endoscopy suites comes from academic institutions that rely on state-of-the-art equipment to record procedures, perform medical record documentation and link the procedure room to other settings for the purpose of educational instruction.

"With complex endoscopy, integration can include any of the things seen in integrated operating rooms, such as a centralized touch screen, control of video routing, lights, stereo systems, audio and video conferencing, telestration, as well as different types of video inputs, such as PACS. Sometimes the equipment is on booms, but not always," noted Shapiro, adding that Olympus’ ALPHA OR and its Integrated EndoLAB share many of the same building blocks.

While some healthcare institutions may question the financial return of such an investment, Shapiro assured that enhanced efficiency is just one notable benefit.

"There are both qualitative and quantitative areas of return on investment associated with developing an integrated EndoLAB. Going this route allows you to generate more procedures by increasing efficiencies and it also helps with staff retention and recruitment," he noted. "There is a real opportunity from the PR and marketing angles to increase procedure volume by being more competitive."

Even smaller, non-academic teaching hospitals are beginning to embrace the concept of endoscopy integration and connectivity, a fact that is at least partly being driven by the lower price of technology. According to some estimates, the price of such technology has dropped by nearly half from several years ago.

Prechac calls the more widespread adoption of integration and connectivity technology — which encompasses audio/visual capabilities and medical device control — the second generation of integration. "There is a strong desire to remain competitive, he explained. "What was once only really seen in academic centers is now spilling over into smaller community facilities as well."

Endoscopic ORs go high-tech
Where GI and therapeutic endoscopy procedure rooms have only recently popped up on the integration radar screen, most agree that it’s been the surgical endoscopy suites that have helped pave the way.

More than ever, healthcare facilities are upgrading their surgical equipment – in some cases, integrating the latest video equipment with ceiling mounted suspension systems, and combining voice activation, high definition capture and display devices, among other technologies, to fully enhance the capabilities of the OR. Facilities are also embracing technology that makes it possible for surgeons to remain connected in real time to other areas both inside and outside the hospital, document and record surgical procedures and tie directly into a patient’s medical records to allow a complete, vertically integrated view of the patient at any time. By linking up to the facility’s existing PACS infrastructure, a surgeon can easily view digital images, review the patient’s medical history and essentially get a head to stern view of the patient before the procedure even begins.

Not surprisingly, the industry is seeing a shift from analog to digital signals to accommodate the need for high-definition image viewing. Shapiro said another prominent technological shift taking place is the move away from CRT monitors, which used to be the gold standard. He predicts that in the near future, only LCD monitors will be available.

In regard to the types of customers gravitating toward integrated surgical suites, Filerman said he has witnessed a distinct bifurcation. One half of the integrated customer base, he said, consists of dedicated specialty surgery centers that are very procedure-specific and only perform orthopedic procedures or arthroscopy of the knees or shoulders, for example. The remaining half is those facilities looking to design an integrated OR that can handle a myriad of surgical procedures – not just those limited to endoscopy. The reason behind the latter, he explained, is to create a multi-purpose, high efficiency surgical suite that can be well-suited and adapted to virtually any procedure.

Noting that many customers have become confused by terms in the marketplace, such as "integration" and "connectivity," which are often being used interchangeably, Filerman offered some clarification.

"In my view, connectivity refers to real-time, high-quality audio and video connections that link the operating room to different point inside and outside the OR," he explained, adding that Smith & Nephew’s Digital OR serves as the foundation for such connectivity and the backbone onto which future technology can be routed. "Integration is more computer-based and refers more to information technology and the ability to access a patient’s medical records. Still, integration and connectivity really work together."

The digital networking capabilities of the Digital OR enable surgeons to access any patient information needed at the touch of a button, which reduces time spent retrieving that information from outside the OR.

MAE Physicians Surgery Center in Jackson, MS, recently equipped two operating suites with A/V connections that provide worldwide teleconferencing and educational capabilities. The center’s upgraded surgical equipment and its hospital information systems/PACS infrastructure were tied together using Smith & Nephew’s Digital OR.

"The A/V capabilities in our new operating rooms allow for room-to-room communication for better OR efficiencies. The technologies will also enhance the teaching capabilities of our Fellowship program, allowing us to route live arthroscopic procedures directly to our new offsite wet lab," noted Walter Shelton, M.D., of Mississippi Sports Medicine. He added that if a specialist’s opinion is needed, the center can also use the A/V technology to make a real-time connection with a physician outside the operating room for telemedicine or teaching purposes.

One size does not fit all
Endoscopy facilities intrigued by the concept of integrated technology, but concerned that they can’t afford the associated expense, may be pleased to learn that integration and connectivity does not automatically translate into a budgetary deficit.

In fact, leading vendors of endoscopy products and solutions, including Karl Storz Endoscopy, Stryker Endoscopy, Olympus America and Smith & Nephew, are offering "soup to nuts" integration planning services to help facilities determine which technology and solutions best suits their needs, both from a financial and operational standpoint. Smith & Nephew Endoscopy’s Digital OR customers, for example, have access to design consulting services that enable them to customize their facilities and build the foundation for both current and future technologies.

"It’s important to offer products and solutions that are customizable, modular and upgradeable to help customers make the most of their investments," Filerman said, noting that Smith & Nephew’s project development managers work carefully with each customer to design suites that can accommodate future upgrades, rather than imposing an all-or-nothing approach. "If you help a customer plan ahead, adding on later won’t be as expensive."

Karl Storz Endoscopy offers consultative services that bring all key players to the table, from the architect and equipment planning and design personnel to manufacturers of booms and lights, among others. The goal, according to Prechac, is to take the guesswork out of the process and to spend as much time as possible educating customers about their options so they feel at ease with their decision.

Olympus has built upon its planning and design consultation services with the addition of the Olympus EndoPlanner – a software tool that enables Olympus’ nurse consultants to help physicians and hospitals with the development and planning of ASCs.

Oberle explained that a great deal is involved in the planning process, including ownership options, identification of various business models, facility design and layout efficiencies, building costs, financing, certification, accreditation, staffing and operational preparedness, equipment planning and determining the best way to care for equipment. Parking accommodations for patients must also be considered.

"It’s much more than just bringing in equipment and opening the doors. Olympus Strategic Resource Solutions, which is the consulting arm of Olympus, is about taking the vast knowledge capital and experience Olympus has and walking physicians through the process of developing a business plan and helping them determine which plan is best suited for [their] goals and objectives. He added that when developing the plan and determining the cost of the project, Olympus literally calculates down to the thumbtack.

"We want to factor in everything and anything that can help ensure a successful business venture and leave very little to chance. We don’t sell coffee pots, but we do account for those items and hundreds more in the strategic business planning process."

Today, vendors are also more willing to provide solutions that can integrate with other manufacturers’ products — from cameras and monitors to booms and lights — rather than offering only a proprietary solution.