Some hospitals have videotaped medical procedures as part of quality improvement initiatives. While the idea of healthcare workers being videotaped may conjure thoughts of "Big Brother" and fears of invasion of privacy, Marty Makary, MD, MPH a surgeon at Johns Hopkins in Baltimore, takes a decidedly different approach to video recording in healthcare settings.
"As a surgeon, I'm simply proposing this as a way for us to have better peer review and transparency with patients for increased satisfaction and a more complete electronic health record," he says. "It's about better performance; it's not punitive or Orwellian."
Low-cost intervention
While there are a wide range of applications of video recording, including compliance monitoring, education and peer review, Dr. Makary does not advocate recording every process in a hospital. Instead, he suggests using existing video technology to record procedures for use in peer review and transparency efforts. Many surgical procedures today, including heart catheterizations, arthroscopic knee surgery, laparoscopic hysterectomy and colonoscopy, are video-based, according to Dr. Makary.
Using existing technology makes video recording virtually free to implement in hospitals, setting itself up for a potentially large return on investment. However, many hospitals have not taken advantage of this opportunity. "Most technology has the option to record, but it has been in the 'off' position," Dr. Makary says. "It's time to turn the 'record' button on and use video for quality improvement."
Examples of quality improvement
In an article in the Journal of the American Medical Association in April, Dr. Makary shared examples of studies in which healthcare providers improved processes through video recording. For example, in one study, gastroenterologists reduced variation in practice and improved quality when they were aware their procedure videos were being recorded and reviewed.
Improving peer review
Recording medical procedures can also improve the peer review process by providing an objective evidence base for external reviewers. External peer review provides accountability and transparency, which can improve quality and patient safety. For example, Dr. Makary suggests cases of unnecessary heart stents could have been prevented with a robust peer review process. "There would have been more accountability with the procedure and indications," he says.
Similarly, video recordings of procedures can be used for educational purposes. One study showed that reviewing videos of a surgical procedure with a peer taught surgeons ways to improve, according to Dr. Makary. He likens this process to a football team reviewing a video of a game to perfect techniques and learn from mistakes.
Being transparent, improving satisfaction
Just as providing videos of procedures to peer reviewers increases transparency among physicians, providing video recordings to patients increases transparency among consumers. A study found that when offered a copy of a video of their procedure, 80 percent of patients accepted and 60 percent were willing to pay for it, according to Dr. Makary. This transparency can educate patients, enhance the completeness of their electronic medical records and improve their satisfaction, he says.
One of the concerns with sharing videos of procedures with patients is the potential for them to be used in malpractice suits. However, the likelihood of patients using videos in lawsuits is low because lawsuits stem primarily from dissatisfaction; if patients are more satisfied when they receive videos of their procedures, they will be less likely to sue the physician, Dr. Makary suggests. He says a similar concern arose when copies of CT scans and MRIs first became available to patients, and there was no accompanying increase in lawsuits.
Focus on improvement
Dr. Makary emphasizes that video recording in healthcare should be about improvement. "Overall, the message is positive," he says. "It's not punitive; it's about learning and performing optimally. Historically, inexpensive quality improvement innovations that have a strong appeal to patients are good for everyone."
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"As a surgeon, I'm simply proposing this as a way for us to have better peer review and transparency with patients for increased satisfaction and a more complete electronic health record," he says. "It's about better performance; it's not punitive or Orwellian."Low-cost intervention
While there are a wide range of applications of video recording, including compliance monitoring, education and peer review, Dr. Makary does not advocate recording every process in a hospital. Instead, he suggests using existing video technology to record procedures for use in peer review and transparency efforts. Many surgical procedures today, including heart catheterizations, arthroscopic knee surgery, laparoscopic hysterectomy and colonoscopy, are video-based, according to Dr. Makary.
Using existing technology makes video recording virtually free to implement in hospitals, setting itself up for a potentially large return on investment. However, many hospitals have not taken advantage of this opportunity. "Most technology has the option to record, but it has been in the 'off' position," Dr. Makary says. "It's time to turn the 'record' button on and use video for quality improvement."
Examples of quality improvement
In an article in the Journal of the American Medical Association in April, Dr. Makary shared examples of studies in which healthcare providers improved processes through video recording. For example, in one study, gastroenterologists reduced variation in practice and improved quality when they were aware their procedure videos were being recorded and reviewed.
Improving peer review
Recording medical procedures can also improve the peer review process by providing an objective evidence base for external reviewers. External peer review provides accountability and transparency, which can improve quality and patient safety. For example, Dr. Makary suggests cases of unnecessary heart stents could have been prevented with a robust peer review process. "There would have been more accountability with the procedure and indications," he says.
Similarly, video recordings of procedures can be used for educational purposes. One study showed that reviewing videos of a surgical procedure with a peer taught surgeons ways to improve, according to Dr. Makary. He likens this process to a football team reviewing a video of a game to perfect techniques and learn from mistakes.
Being transparent, improving satisfaction
Just as providing videos of procedures to peer reviewers increases transparency among physicians, providing video recordings to patients increases transparency among consumers. A study found that when offered a copy of a video of their procedure, 80 percent of patients accepted and 60 percent were willing to pay for it, according to Dr. Makary. This transparency can educate patients, enhance the completeness of their electronic medical records and improve their satisfaction, he says.
One of the concerns with sharing videos of procedures with patients is the potential for them to be used in malpractice suits. However, the likelihood of patients using videos in lawsuits is low because lawsuits stem primarily from dissatisfaction; if patients are more satisfied when they receive videos of their procedures, they will be less likely to sue the physician, Dr. Makary suggests. He says a similar concern arose when copies of CT scans and MRIs first became available to patients, and there was no accompanying increase in lawsuits.
Focus on improvement
Dr. Makary emphasizes that video recording in healthcare should be about improvement. "Overall, the message is positive," he says. "It's not punitive; it's about learning and performing optimally. Historically, inexpensive quality improvement innovations that have a strong appeal to patients are good for everyone."
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