Skip to main content
SpringerLink
Log in

A multimedia electronic patient record (ePR) system for image-assisted minimally invasive spinal surgery

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

This paper presents the concept of bridging the gap between diagnostic images and image-assisted surgical treatment through the development of a one-stop multimedia electronic patient record (ePR) system that manages and distributes the real-time multimodality imaging and informatics data that assists the surgeon during all clinical phases of the operation from planning Intra-Op to post-care follow-up. We present the concept of this multimedia ePR for surgery by first focusing on image-assisted minimally invasive spinal surgery as a clinical application.

Methods

Three clinical phases of minimally invasive spinal surgery workflow in Pre-Op, Intra-Op, and Post-Op are discussed. The ePR architecture was developed based on the three-phased workflow, which includes the Pre-Op, Intra-Op, and Post-Op modules and four components comprising of the input integration unit, fault-tolerant gateway server, fault-tolerant ePR server, and the visualization and display. A prototype was built and deployed to a minimally invasive spinal surgery clinical site with user training and support for daily use.

Summary

A step-by-step approach was introduced to develop a multimedia ePR system for imaging-assisted minimally invasive spinal surgery that includes images, clinical forms, waveforms, and textual data for planning the surgery, two real-time imaging techniques (digital fluoroscopic, DF) and endoscope video images (Endo), and more than half a dozen live vital signs of the patient during surgery. Clinical implementation experiences and challenges were also discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

API:

Application program interface

BIS:

Bispectral index system

CO2 :

Carbon dioxide

CR:

Computed radiography

CSI:

California Spine Institute

CSS:

Cascading style sheet

CT:

Computed tomography

DICOM:

Digital imaging and communications in medicine

EMG:

Electromyography

ePR:

Electronic patient record

GIF:

Graphics interchange format

GUI:

Graphical user interface

HIPAA:

Health Insurance Portability and Accountability Act

HIS:

Hospital information system

HTML:

Hyper text markup language

HTTP:

Hyper text transfer protocol

HTTPS:

Hyper text transfer protocol secured

ICT:

Information and communication technology

IA-MISS:

Image-assisted minimally invasive spinal surgery

IPILab:

Image Processing and Informatics Laboratory

IRB:

Institutional Review Board

IT:

Information technology

IU:

Integration unit

IVF:

Intravenous fluid

JPEG:

Joint Photographic Expert Group

LCD:

Liquid crystal display

MB:

Megabytes

mmHg:

Millimeters of mercury

MRI:

Magnetic resonance imaging

OR:

Operating room

PACS:

Picture archiving and communication system

PHP:

PHP: hypertext preprocessor

PNG:

Portable network graphics

RAM:

Random access memory

RIS:

Radiology information system

RS232:

Recommended Standard 232

SC:

Secondary capture

SDK:

Software development kit

TB:

Terabytes

USC:

University of Southern California

VAS:

Visual analog scale

VGA:

Video graphics array

References

  1. Vallfors B (1985) Acute, subacute and chronic low back pain: clinical symptoms, absenteeism and working environment. Scan J Rehab Med Suppl 11: 1–98

    CAS  Google Scholar 

  2. Chiu J, Savitz MH (2005) Use of laser in minimally invasive spinal surgery and pain management. In: Kambin P (eds) Arthroscopic and endoscopic spinal surgery—text and atlas, 2nd edn. Humana Press, New Jersey, pp 259–269

    Google Scholar 

  3. Chiu J (2004) Anterior endoscopic cervical microdiscectomy. In: Kim D, Fessler R, Regan J (eds) Endoscopic spine surgery and instrumentation, vol 5. Thieme Medical Publisher, New York, pp 48–58

    Google Scholar 

  4. Chiu J (2004) Endoscopic lumbar foraminoplasty. In: Kim D, Fessler R, Regan J (eds) Endoscopic spine surgery and instrumentation, Chap 19. Thieme Medical Publisher, New York, pp 212–229

    Google Scholar 

  5. Chiu J, Clifford T, Greenspan M (2000) Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty. Mt Sinai J Med 67: 278–282

    CAS  PubMed  Google Scholar 

  6. Haller JW, Ryken TC, Vanier MW (2001) Image-guided surgery of the spine. J Min Invasive Spinal Tech 1(1): 87–92

    Google Scholar 

  7. Jaikumar S, Kim D, Kam A (2002) History of minimally invasive spine surgery. Neurosurg Supp 2002 5(2): 1–14

    Google Scholar 

  8. Huang HK (2004) PACS and imaging informatics: principles and applications. Wiley, Hoboken, p 704

    Book  Google Scholar 

  9. Huang HK (2001) PACS, informatics, and the neurosurgery command module. J Mini Invasive Spinal Tech 1: 62–67

    Google Scholar 

  10. MySQL AB, Sun Solaris Microsystems Inc. http://dev.mysql.org

  11. Apache web server, Apache software foundation http://httpd.apache.org

  12. Liu BJ, Huang HK, Cao F, Zhou MZ, Zhang J, Mogel G (2004) A complete continuous-availability (CA) PACS archive server solution. Radiographics 24(4): 1203–1209

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. IPILab, Department of Radiology, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite DEI 2100, Los Angeles, CA, 90033, USA

    Jorge Documet, Anh Le, Brent Liu & H. K. Huang

  2. California Spine Institute Medical Center Inc, 1001 Newbury Road, Thousand Oaks, CA, 91320, USA

    John Chiu

Authors
  1. Jorge Documet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anh Le
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brent Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. K. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorge Documet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Documet, J., Le, A., Liu, B. et al. A multimedia electronic patient record (ePR) system for image-assisted minimally invasive spinal surgery. Int J CARS 5, 195–209 (2010). https://doi.org/10.1007/s11548-009-0387-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-009-0387-x

Keywords

Search

Navigation