Optimize your VM systems!

March 2024

How to optimize the acquisition and use of video management systems

The acquisition of video management systems (VM) for operating rooms is very often little (or not at all) optimized because it does not meet an elementary rule of logic: the adequacy between the real needs and the equipment purchased. Indeed, most often the need is evaluated in a general way and the chosen material meets this need whereas according to each specialty, and sometimes each type of intervention, the need can be extremely different.

The biomedical engineer in charge of the acquisition will tend to choose a VM system that corresponds to the average of the needs stated by future users (as the lowest common denominator) whereas it is much more sensible to take the time to identify the specific needs of each user or, at a minimum, of each operating room according to the types of interventions that will be performed there. Typically, a room where endoscopy is mostly performed will not require the same equipment as a neurosurgery, orthopedic surgery or cardio-surgery room. Hybrid or interventional rooms, responding to a completely different and very specific specifications.

Similarly, if a future user is asked how many video sources he may need to use at the same time, he (or she) will tend to keep a ‘wiggle room’ and over-size his or her needs. Thus, most systems will be configured with too many video inputs (and the cabling, converters, encoders and software licenses that go with it) so with a significantly higher price tag.

Moreover,when collecting needs, many features are often requested, some of which, later, very little or never used. It’s like “we” prefer to choose the ''all-options model'', especially when “it’s not our own money”.

So the very first video management systems that appeared on the market almost twenty years ago were certainly very efficient, very complete but also very complex, very cumbersome, very noisy, very expensive, very everything and above all very …oversized.

In hindsight, the sites that acquired these systems realized that they used barely 10% of the included features, so paid, with. Generally, the next acquisition will most often move to a much simpler system (and therefore less expensive) limited to the only features that were actually used with the previous system and it is very often at this stage that ISIS is solicited.

Another conceptual error, more recent, and especially related to the use of IP video technology is to want to share VM systems. Under the guise of an easy interconnection between the different operating rooms, the systems are connected on a single central unit and even if elementary precautions are taken to secure this central unit, however, the risk of failure always exists and “when the boiler of the condominium is down, everyone cold”.

From experience, it can be said that the interconnection between two operating rooms has almost no interest, operators do not need to view a connected video source in another room and audio/video communications between two rooms are perfectly possible by other means. On the other hand, the fact that each system is completely independent ensures the proper functioning of the entire operating theater and allows, in case, to distribute the interventions on the ''remaining'' operating rooms.

So now that we have optimized the acquisition and considering that the installation has completely met everyone’s expectations, the next step is the correct use of the systems and again, it is essential to respect some basic rules.

Staff training: if the decision-makers for the acquisition of the VM system are generally biomedical engineers and surgeons, the real “daily” users are most often the operating room nurses. It is therefore essential that every person who will have to use the system is properly trained. It is the responsibility of the operating room head-nurses to provide the necessary trainings and not only at the time of the initial installation but also throughout its use since, nowadays, the turnover of OR staff is very important.

From experience, and when possible, it seems wise to identify one or two ''references'' more familiar with the technologies implemented in VM systems and who will intervene on the front line in case of problems with the device (misuse or failure) and who will act as agents (double, if they are two) of liaison with the technical department of the company that installed the VM system.

Maintenance in operational conditions: even if this type of VM systems, mainly based on the integration of computers and electronic systems do not require special maintenance, it may make sense to periodically check their proper functioning but also check the integrity of the various connections, cables and other devices used, which suffer more from the daily use of the systems by the personnel.

Hardware and software evolutions: a VM system is an important acquisition and, whatever the amount of systems installed, always represents a considerable budget. Indeed, the goal is to keep these systems operational as long as possible but also to upgrade them to be more efficient but also as compatible as possible with technological developments (IP, optical fiber, 4K,8K, etc.), current and future.

The choice of transmission cables: for interconnections, it may make sense not to have to choose a wiring technology that will limit to a particular video technology. Recently, on a site that hesitated between the two HDMI and IP technologies, we proposed a double cabling: hybrid links (optical fiber + copper) compatible with HDMI and single optical fiber (dual LC multimode) compatible with IP. As HDMI technology has finally been adopted by the site, multimode optical fibers will not be used initially but could be if the site migrates one day on an IP technology. The financial delta for this “double cabling” is extremely reasonable or even insignificant in terms of infrastructure work.

Virtuous approach: ISIS has several historical sites of more than 10 years, some choose constant and regular software and hardware evolutions and others to evolve their system in a single step. The goal is to limit mass replacements of equipment that are costly for the health system and… for the planet.

Evolve YES – Replace NO !

This responsible approach, ISIS offers to some sites that made other choices several years ago but whose companies that provided the systems have either disappeared, or do not want (or cannot) upgrade their systems and propose to replace their equipment with new ones.

On several sites, ISIS acted as a ''Video-Management Specialist'' and, after a specific study, proposed a solution allowing to reuse a large part of the installation and the initial wiring, where possible and compatible with the new technologies used.

In conclusion: if it is very important to choose the video management system, or systems, that will be used in the operating room, it is also important to plan the best possible use and anticipate their technical evolution and, so avoid a very expensive bad experience.