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Towards Automated Surgical Documentation using automatically generated checklists from BPMN models
(2021)
The documentation of surgeries is usually created from memory only after the operation, which is an additional effort for the surgeon and afflicted with the possibility of imprecisely, shortend reports. The display of process steps in the form of checklists and the automatic creation of surgical documentation from the completed process steps could serve as a reminder, standardize the surgical procedure and save time for the surgeon. Based on two works from Reutlingen University, which implemented the creation of dynamic checklists from Business Process Modelling Notation (BPMN) models and the storage of times at which a process step was completed, a prototype was developed for an android tablet, to expand the dynamic checklists by functions such as uploading photos and files, manual user entries, the interception of foreseeable deviations from the normal course of operations and the automatic creation of OR documentation.
Einleitung: Nach jedem chirurgischen Eingriff ist die Erstellung eines individuellen OP-Berichtes Aufgabe des Operateurs. Dies geschieht häufig mit zeitlicher Verzögerung und aus der Erinnerung heraus, was zu einer fehlerhaften Dokumentation führen kann. Die semiautomatische Erfassung, systematische Speicherung und Textverarbeitung aller intraoperativen Daten würde nicht nur eine Zeitersparnis für den Operateur ermöglichen, sondern auch die Grundlage für Qualitätssicherung und zukünftige Datenanalysen schaffen.
Methode: In Zusammenarbeit mit der Medizininformatik der Hochschule Reutlingen wurde ein Prototyp eines halbautomatischen Checklisten-Tools am Beispiel der Cochlea Implantation entwickelt. Grundlage hierfür stellt ein BPMN-Modell (Business Process Model and Notation) dar, das anhand einer Workflowanalyse des chirurgischen Prozesses erstellt wurde. Basierend auf diesem werden automatisch generierte, dynamische Checklisten über eine Benutzeroberfläche auf einem Android-Tablet dargestellt. Die Anwendbarkeit im operativen Setting, die Steuerung über verschiedene Eingabegeräte und Überprüfung der inhaltlichen Prozessschritte wurden an einem Phantommodell getestet.
Ergebnisse: Der Prototyp ermöglicht eine intuitive Bedienung und sterile Interaktion und eignet sich damit gut für den intraoperativen Einsatz. Die Checkliste realisiert die individuelle Erfassung und Speicherung von klinischen Daten und OP-Schritten. Zusätzlich kann ein automatisierter OP-Bericht erstellt und gespeichert werden. Die dynamische Generierung der Checkliste über ein BPMN-Modell ermöglicht dabei die einfache Übertragung auf andere Anwendungsfälle.
Zusammenfassung: Die Verwendung einer dynamischen Checkliste vereinfacht die Erfassung, Speicherung und Verarbeitung von chirurgischen Daten.
Purpose
For the modeling, execution, and control of complex, non-standardized intraoperative processes, a modeling language is needed that reflects the variability of interventions. As the established Business Process Model and Notation (BPMN) reaches its limits in terms of flexibility, the Case Management Model and Notation (CMMN) was considered as it addresses weakly structured processes.
Methods
To analyze the suitability of the modeling languages, BPMN and CMMN models of a Robot-Assisted Minimally Invasive Esophagectomy and Cochlea Implantation were derived and integrated into a situation recognition workflow. Test cases were used to contrast the differences and compare the advantages and disadvantages of the models concerning modeling, execution, and control. Furthermore, the impact on transferability was investigated.
Results
Compared to BPMN, CMMN allows flexibility for modeling intraoperative processes while remaining understandable. Although more effort and process knowledge are needed for execution and control within a situation recognition system, CMMN enables better transferability of the models and therefore the system. Concluding, CMMN should be chosen as a supplement to BPMN for flexible process parts that can only be covered insufficiently by BPMN, or otherwise as a replacement for the entire process.
Conclusion
CMMN offers the flexibility for variable, weakly structured process parts, and is thus suitable for surgical interventions. A combination of both notations could allow optimal use of their advantages and support the transferability of the situation recognition system.
The operating room demands well-functioning workflows and optimized communication. Based on the formalization of specific surgical interventions via BPMN, intraoperative checklists can automatically be generated to support the surgical team by the provision of relevant clinical information and situation-dependent assistive functions. While focusing on the surgeon, other actors have not yet been considered. The aim of this work is therefore the extension of the intraoperative checklist to enable role-specific support and improved communication between the actors. The BPMN approach is adapted to depict role-specific surgical steps and clinical information to realize the collaborative, multi-role usage of the checklist. The proof of concept demonstrates the automatic generation of intraoperative checklists which provide relevant information depending on the role. An initial evaluation of the checklist based on the cochlea implantation use case shows promising results.
Introduction: After every surgical procedure, the surgeon is responsible for preparing an individual surgical report. This is often done with a time delay and relies on the correct memory of the surgeon, which can lead to inaccurat documentation. Semiautomatic recording, systematic storage and text processing of all intraoperative data would be time saving for the surgeon and form the foundation for quality management and subsequent data analysis.
Method: In collaboration with the school of informatics at Reutlingen University, the prototype of a semi-automatic checklist tool was developed using the example of cochlear implantation. The basis for this is a BPMN model (Business Process Model and Notation) of the procedure, which was created using a workflow analysis of the surgical process of cochlear implantation. Based on this, automatically generated, dynamic checklists are displayed via a user interface on an Android tablet. The intraoperative interaction, handeling of different input devices and the verification of medical correctness were tested on a phantom model.
Results: The user interface allows a simple intuitive handling by the surgeon or assistant, which can be well implemented in the intraoperative setting. The checklist allows individual recording and storage of both clinical data and surgical steps. In addition, an automated surgical report can be generated, customized and saved. The dynamic generation of the checklist via a BPMN model allows the easy transfer of the tool to other use cases.
Summary: The utilization of a dynamic checklist tool simplifies the collection, storage, and analysis of surgical data. Its potential for broader applications in clinical practice awaits further exploration via clinical studies are planned
Introduction: Even if there is a standard procedure of CI surgery, especially in pediatric surgery surgical steps often differ individually due to anatomical variations, malformations or unforseen events. This is why every surgical report should be created individually, which takes time and relies on the correct memory of the surgeon. A standardized recording of intraoperative data and subsequent storage as well as text processing would therefore be desirable and provides the basis for subsequent data processing, e.g. in the context of research or quality assurance.
Method: In cooperation with Reutlingen University, we conducted a workflow analysis of the prototype of a semi-automatic checklist tool. Based on automatically generated checklists generated from BPMN models a prototype user interface was developed for an android tablet. Functions such as uploading photos and files, manual user entries, the interception of foreseeable deviations from the normal course of operations and the automatic creation of OP documentation could be implemented. The system was tested in a remote usability test on a petrous bone model.
Result: The user interface allows a simple intuitive handling, which can be well implemented in the intraoperative setting. Clinical data as well as surgical steps could be individually recorded and saved via DICOM. An automatic surgery report could be created and saved.
Summary: The use of a dynamic checklist tool facilitates the capture, storage and processing of surgical data. Further applications in clinical practice are pending.
