How artificial intelligence and augmented reality are changing medical proctoring during COVID-19

ExplORer Surgical recently added augmented reality (AR) technology that acts as a virtual laser pointer for medical device specialists to provide on-screen guidance for surgeons. (ExplORer Surgical)

Medical device specialists often monitor the work of surgeons to provide case support during procedures in the operating room. However, during the COVID-19 pandemic, medical proctoring has gone remote.

“COVID has dramatically accelerated the need to have a remote tool, when you either don't have access to the hospital, or when there are travel restrictions that make it really difficult,” said Jennifer Fried, CEO and co-founder of ExplORer Surgical, a company that provides a software platform for case support during surgery. ExplORer offers the training platform in three formats: in-person, remote or hybrid.

Launched out of the University of Chicago Department of Surgery in 2013, ExplORer recently added augmented reality technology that acts as a virtual laser pointer for medical device specialists to provide on-screen guidance for surgeons similarly to how sports announcers use a Telestrator to mark up plays.

Introduced in November, ExplORer’s two-way audio/video system is compliant with the Health Insurance Portability and Accountability Act. The AR technology lets medical device reps zoom in or out and use a laser pointer to highlight items on the screen for the doctor. Scrub nurses that prepare the surgical instruments use the customized content in the platform to guide them through the workflow.

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Before COVID-19, physicians would fly around the world to proctor cases. In fact, six to eight surgeons would be in the room to do a procedure. With the pandemic, proctors are logging into the OR remotely, according to Fried.

Medical proctors can draw on a fluoroscopy image, share their screen and warn doctors what to look for during a procedure such as implanting a device in the body.

“The ability to do that in a live, real-time way that's also compliant is really a game changer in this environment,” Fried told Fierce Healthcare.

Fried noted that an ExplORer customer recently began a large U.S. clinical trial with surgeons in Europe while their clinical specialists were in Australia. The remote proctoring software has helped facilitate this collaboration.

Remote proctoring will likely continue after the pandemic because of its cost savings and efficiency for medical professionals, according to Fried.

“What we're seeing with COVID is, I think, people are getting more and more comfortable with remote support, as it has become a necessity,” Fried said. “I think that trend is going to be here to stay.”

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The AR features will be particularly valuable for medical proctors to help physicians through complex invasive procedures, noted Art Collins, former chairman and CEO of Medtronic and a senior medical adviser to ExplORer Surgical.

This expert training is critical when surgeons need to switch an implant operation from a large incision and open approach to minimally invasive or a catheter, Fried noted.

Adding AI to remote proctoring

Remote proctoring solutions like those that ExplORer offers will incorporate artificial intelligence features such as computer vision to collect data on procedures and feed it automatically into a surgeon’s workflow.

“AI and machine learning will become more impactful as the data set of video feeds increase, as a larger data set empowers better insights,” Collins told Fierce Healthcare. “As the use of video becomes standard practice in the OR and procedure suites, AI technologies will increasingly be able to interpret video feeds.”

In addition, medical proctors will use image-object recognition and machine learning to analyze what is happening in the OR, Fried said. The AI technology could suggest best practices based on knowing that a surgeon took an instrument off the table, as one example.

“You could say this step is taking a lot longer and know that because this instrument hasn't been put back onto the table,” she explained.

ExplORer has built early iterations of this machine learning technology and plans to launch a commercial case in 2021, Fried said.