Pulse
Director’s Cuts
Live from the OR, it’s surgery on the Web.
It begins as any surgery would: Daniel Hoeffel, M.D., an orthopedic surgeon with Summit Orthopedics in St. Paul, scrubs, checks to see that his patient is properly anesthetized, preps the surgical area, and makes an incision to begin a computer-assisted knee replacement. But this is not an ordinary day in the operating room. In just minutes, Hoeffel will be on camera, describing his every move while a fellow orthopedic surgeon and a marketing manager make comments and field questions that audience members will submit in real-time via e-mail.
As Hoeffel begins, viewers watch as if they’re standing alongside the surgical team. Occasionally, the camera zooms in on the area where the surgeon is working or on Hoeffel, the only person in the room who is miked, as he pauses to answer questions.
Welcome to the world of live surgical Webcasting. Hoeffel, who performed the Webcast procedure last May at HealthEast’s Woodwinds Health Campus in Woodbury, likens surgical Webcasting to a baseball game. “You have someone knowledgeable ‘sitting in the booth,’ so to speak, giving meaningful color commentary that enlightens the audience, and then you, of course, have the surgical team, the people on the field,” he explains.
A Captive Audience
Webcast surgeries are being hailed as a highly appealing alternative to traditional patient education and marketing approaches. OR-Live.com, which is being used by HealthEast, SMDC Health System in Duluth, and St. Cloud Hospital in St. Cloud, is one of the largest producers of live and on-demand surgical Webcasts in the United States having done about 700 live broadcasts since 1999. And although slp3D Inc., the company that owns OR-Live, still recruits hospitals to participate in surgical Webcasts, it also gets plenty of unsolicited requests from health systems across the country.
The reason? There’s an audience for them. “Since the advent of reality television, people are constantly attuned to accurately understanding what they will go through if they end up undergoing a certain surgery, and seeing how a particular physician would be doing their same surgery can really put their mind at ease,” says Kristi Schmidt, marketing manager for SMDC Health System, which is planning four Webcasts for the 2006-07 fiscal year. “The audience of a Webcast is about as targeted an audience as you can get.”
According to OR-Live.com, 55 percent of viewers are consumers and 45 percent are health care providers, most of whom (90 percent) are referring physicians seeking to get information about a particular surgeon’s approach to a procedure.
A Webcast costs about $40,000 to produce. But the estimated return on investment is striking: Depending on the type of procedure, a hosting hospital can expect to book “two to 12 procedures within 90 days” after the live Webcast, says Ross Joel, executive vice president of marketing for slp3D.
For Better and Worse
Although Webcast producers supply lights, cameras, audio and video equipment, satellite hookup, and camera and production staff for the live shoot, the hospital staff usually begins preparing for the event two to three months in advance. During this time, they select the surgeon and patient, book the operating room, create graphic elements to display during the less exciting parts of the surgery, schedule preshoots for promotional and other purposes, prepare the commentary, and, in some cases, do a dry run. All that prep work can give a hosting health care system pause, as can the prospect of doing a live Webcast.
“It’s not like it’s a videotaped production where you can edit out all of the glitches and make this nice, polished product for everyone to see,” says Joseph P. Nessler, M.D., of St. Cloud Orthopedic Associates, who has performed three hip replacement surgery Webcasts for St. Cloud Hospital since 2004. “That said, when patients do see a seamless, near-perfect Web-cast, they can be assured that it’s due to the fact that everything went fantastic during surgery—because there are no second takes.”
The main purpose of Webcasts may be patient education and consumer marketing. But hosting institutions also have the option of offering CME credit to physicians who view the live surgeries. And Webcasts can be an educational experience for the physicians who lead them.
During a Webcast of a percutaneous nephrolithotomy (kidney stone surgery using ultrasonic or laser lithotripsy), urologic surgeon Andrew Portis, M.D., a partner with Metro Urology and medical director of HealthEast’s Kidney Stone Institute, fielded an observer’s question about the amount of X-ray radiation used during the procedure. “He asked, ‘Can’t you do the same thing without doing all that X-raying?’ and we sort of looked at each other and said, ‘Well, yeah, I guess we could,’” recalls Portis, who performed the surgery during a live Webcast from St. Joseph’s Hospital in St. Paul in October 2005. Since then, Portis and his colleagues reduced the power of the X-ray during a part of the surgery that did not require a high-fidelity image, cutting the dose of radiation by about 30 percent.
Physicians who want to do a live Webcast need to have a real interest in communicating the nuances of their expertise, Portis says. And they better be unflappable. “Some of the effective aspects that come through from the Webcast are the elements of real time, of seeing things as they actually happen, and from that perspective, we are always getting thrown curveballs that require improvisation,” he says. “But on the flip side, I think that gives some humanity to what the surgeons and staff are up to, and that gives the patient a much better sense of what goes on in the OR.”—Jeanne Mettner