ProjectProposal-RobertHeld
From CS160 User Interfaces Fa06
Contents |
Anoto-Based Surgical Planning and Healthcare Management
The following proposal outlines the application of the Anoto digital pen to the maintenance of patient records, with a particular focus on the planning stages of surgical procedures. The intention is to provide physicians with a system that reduces errors and facilitates treatment development without necessitating a large shift from current practices.
Target User Group
The primary target user group for the “digital healthcare” project would be cardiovascular surgeons and neurosurgeons. The degree of planning necessary for their work involves the simultaneous management of medical images, patient history, and the surgeon’s personal knowledge and experience. The same may be said for any type of surgeon, but we would focus on the two specialties listed above because there is already a significant body of literature on 3D, computerized cardiovascular surgical planning [1-3], and we would have easy access to neuroradiologists and neurosurgeons at UCSF. During my Fall 2005 research rotation, I made contact with several professors in the UCSF radiology department, so access to doctors there should be manageable. When designing a product for surgeons and physicians, it is important to remember that they need planning aids that do not impede the methods they already use with comfort. A viable product should also provide a marked advantage over traditional tools to justify the time and money spent on adapting to it. They need something that is easy, quick, robust, and secure.
Problem Description
The problem to be solved in the digital healthcare management system lies in the gap between hand-written clinical assessments and the computerized planning systems already in place. Despite dramatic advances in computerized anatomical models based on medical images, cardiovascular surgeons still prefer to plan procedures using pen and paper [4]. For instance, finite element analysis-based planning systems have received positive responses from surgeons due to their ability to predict the flow of blood and distribution of arterial pressure postoperatively [3]. However, the systems still include 2D “sketchpads” in the computer interface to maintain that aspect of the planning process. If the sketchpads are still used in some capacity, it would be logical to preserve the pen-and-paper process and find a way to integrate it with the program. The program would then be more approachable to surgeons. Additionally, the portability and easy sharing afforded by print-outs are preferred by clinicians [5]. If they could annotate the printouts and automatically add the changes to the original patient files, it would reduce the amount of time spent on record keeping and provide a more comprehensive patient history with little effort. Projects designed for patient record-keeping using the Anoto digital pen have already begun [6], indicating that there is a clear interest in creating a hand-writing-to-digital interface in the clinic. In general, if the paper-based and computerized aspects of patient records and treatment planning can be bridged, surgeons and clinicians could ease more comfortably into the advantages offered by modern medical software packages.
Problem Context
Manipulation of patient data occurs in the operating room, reading room, clinic lobby, conference rooms, and even possibly the physician’s home. Therefore, the solution to the problem outlined above would need to be lightweight and portable at a wide variety of locations. Furthermore, the ability to carry it in a briefcase would be beneficial. The solution should also be easy to learn, as surgeons will likely be unwilling to spend much time learning a new technology that is unfamiliar and perhaps even unclear in its potential advantages. A computerized patient database would be necessary to store all pertinent data and manage the hand-written entries it receives. Additionally, any medical images would need to be stored in the same database. Computerized predictive models for potential surgeries already exist for cardiovascular [1, 3, 4], neurological [7], and liver procedures [5]. A way to automate the translation of sketches into treatment options in one of the simulators would be useful, but may take a long time to develop. Therefore, simply linking the sketches to the appropriate simulator files would be useful.
Solution Sketch
Similar to the NISChart project begun by Cohen and McGee [6], the proposed solution would rely on the Anoto digital pen. Patient data forms would be printed on Anoto paper and used by clinicians to record observations and related information. Forms would be created with exam-specific fields to facilitate data entry. Every sheet would also have a uniform patient number field to facilitate its upload to the patient database. The field would include individual boxes for each number to enhance character recognition and help ensure accurate filing.
An Anoto plug-in would also be created for surgical simulation programs. The plug-in would allow the user to print out views of the 3D anatomical patient images to Anoto paper. The surgeon would then use an Anoto digital pen to sketch out the proposed procedure in relation to the tissues and organs on the paper. Blank Anoto paper could also be used to sketch the procedure without relying on medical images. All of the Anoto paper would include the same uniform patient ID field mentioned above. After sketching the surgical plan, it would then be automatically appended to the patient’s computer file for future reference. If previously defined terms and symbols were employed in the sketches on the simulation printouts, they could be used to automatically generate a treatment model with the software. Otherwise, the doctor or a technician could later bring up the sketch on the simulator workstation and manually enter the treatment plan using the software tools.
The sample form seen below includes an angiography image taken from reference [3]. The patient ID is seen at the top of the form. The blue writing are sample comments that could made by a clinician. The comments would be uploaded automatically to the patient's database folder and attached to the corresponding image.
The Anoto pen is extremely portable, so it is unlikely that it would impede current clinical practices in patient assessment. Most importantly, the integration of the written material with the digital files would provide doctors with a single resource that could yield a comprehensive assessment of their observations and prognoses of the patient.
References
[1] S. A. Spicer and C. A. Taylor, "Simulation-based medical planning for cardiovascular disease: visualization system foundations," Comput Aided Surg, vol. 5, pp. 82-9, 2000.
[2] B. N. Steele, M. T. Draney, J. P. Ku, and C. A. Taylor, "Internet-based system for simulation-based medical planning for cardiovascular disease," IEEE Trans Inf Technol Biomed, vol. 7, pp. 123-9, 2003.
[3] C. A. Taylor, M. T. Draney, J. P. Ku, D. Parker, B. N. Steele, K. Wang, and C. K. Zarins, "Predictive medicine: computational techniques in therapeutic decision-making," Comput Aided Surg, vol. 4, pp. 231-47, 1999.
[4] C. Taylor, "Computer Modeling and 3D Visualization for Treatment Planning," U. U. B. G. G. i. Bioengineering, Ed. Berkeley, CA, 2005.
[5] E. K. Fishman, B. S. Kuszyk, D. G. Heath, L. Gao, and B. Cabral, "Surgical Planning for Liver Resection," Computer, vol. 29, pp. 64-72, 1996.
[6] Cohen, P. R. and McGee, D. R. 2004. Tangible multimodal interfaces for safety-critical applications. Commun. ACM 47, 1 (Jan. 2004), 41-46.
[7] R. Kikinis, P. L. Gleason, T. M. Moriarty, M. R. Moore, E. Alexander, 3rd, P. E. Stieg, M. Matsumae, W. E. Lorensen, H. E. Cline, P. M. Black, and F. A. Jolesz, "Computer-assisted interactive three-dimensional planning for neurosurgical procedures," Neurosurgery, vol. 38, pp. 640-9; discussion 649-51, 1996.
