Some hospitals are using new black box technology to record their operations and improve efficiency, productivity, and patient safety in the OR. However, some providers have also expressed concerns that the technology could be used for punitive purposes or as evidence in malpractice suits, Barbara Sadick writes for the Wall Street Journal.

What is the OR Black Box?

On airplanes, black boxes record detailed information about flights. Now, a technology with the same name is being used in some hospitals to record information in the OR during surgeries.

The OR Black Box system, which was developed by  Surgical Safety Technologies (SST), consists of sensors and software that record video, audio, patient vital signs, and data from surgical devices. It provides multiple perspectives on an operation rather than just relying on team members' memories. The system analyzes data and creates graphs, comments, timelines, videos, and audio claps for hospital personnel.

Hospitals can use this data to view OR performance over time or analyze certain operations more closely. So far, OR Black Boxes are "being used primarily to analyze operating-room practices in hopes of reducing medical errors, improving patient safety and making operating rooms more efficient," Sadick writes. They can also help hospitals figure out what happens if an operation goes wrong.

Currently, the technology is being use in ORs at 24 hospitals in the United States, Canada, and Western Europe.

How hospitals are benefiting from the system

At  Duke University Hospital, two ORs are equipped with black boxes, and providers are using the system to study and improve on patient positioning during surgeries. Doing so will help reduce the risk of skin-tissue and nerve injuries.

The hospital is also using the technology to improve communication among nurses during surgeries to help ensure key tasks, including confirming whether surgical instruments and devices are available to use, are completed quickly and effectively.

"The OR is a very complex domain, and we're continually striving to create a standardized environment to reduce inconsistencies by enhancing communication, efficiency, quality and safety," said Rebecca McKenzie, assistant VP perioperative services at Duke. "Black-box technology allows us to supplement or replace traditional tools like relying on memory and retroactive analysis to give us more targeted insight into quality of care."

After using black boxes, Duke administrators learned that they needed a better system to send and track specimens. Since then, the protocol for specimens, such as tissue meant for a pathology lab, has been revised with clearer instructions for each step to make sure it is handled properly and reaches the correct lab.

Teams at Duke have also been using black boxes to improve OR efficiency and productivity by shortening the time needed to prepare the OR for another procedure. McKenzie also noted that the technology may be used as a teaching tool to enhance nurses' training in the OR.

Some hospital personnel have raised concerns about the black boxes

However, even with the potential benefits of black boxes, some OR personnel have expressed concerns about how the data recorded through the system would be used.

When the  University of Texas Southwestern Medical Center  first introduced the OR Black Box technology in 2020, some members of the OR teams were worried that the data collected would be used for "punitive purposes," Sadick writes.

However, William Daniel, UT Southwestern's chief quality officer, said that after the members were reassured about "how data would be collected and used, it quickly became an accepted part of the hospital's culture."

"The ability to watch ourselves is extremely powerful in education and our training as teams," he added.

According to Teodor Grancharov, a professor of surgery at Stanford Medicine and a cofounder of SST, the OR Black Box was designed to improve systems, not assign blame. In fact, the technology's algorithms "blur faces and cartoonify bodies" so that neither medical personnel nor patients can be identified.

"Aggregate data is deidentified and anonymized so we can learn from it now and in the future, and audiovisual data is deleted after 30 days to protect the privacy and confidentiality of patients and healthcare providers," Grantcharov said.

Another potential concern is whether information collected from black boxes could be used as evidence in a malpractice lawsuit. Richard Epstein, a law professor at New York University, said black box data could be requested in legal disputes but since the technology is still new, "nobody knows what will happen."

"Legal protections are not clear-cut and are uncertain until tested by litigation and/or legislation," Epstein said, noting that "ultimately it won't be up to any institution to determine or limit the purposes for which the information is used."

Addressing this concern, Amar Chaudhry, SST's chief technology officer, said the OR Black Box system was designed to eliminate the risk of its data being used for anything other than quality improvement. Because it is set up to anonymize all data, it is highly unlikely that any information from the system could be used in medical malpractice cases.

Separately, David Felman, CMO at  Healthcare Risk Advisors, a company that works with hospitals to reduce malpractice risk, said he believes that since OR Black Box anonymizes data, it is unlikely to be used in malpractice ligation. "I believe it will make surgery safer and thus reduce liability and malpractice claims," he said. (Sadick, Wall Street Journal, 3/19)