OR.NET: multi-perspective qualitative evaluation of an integrated operating room based on IEEE 11073 SDC

  • M. Rockstroh
  • S. Franke
  • M. Hofer
  • A. Will
  • M. Kasparick
  • B. Andersen
  • T. Neumuth
Original Article



Clinical working environments have become very complex imposing many different tasks in diagnosis, medical treatment, and care procedures. During the German flagship project OR.NET, more than 50 partners developed technologies for an open integration of medical devices and IT systems in the operating room. The aim of the present work was to evaluate a large set of the proposed concepts from the perspectives of various stakeholders.


The demonstration OR is focused on interventions from the head and neck surgery and was developed in close cooperation with surgeons and numerous colleagues of the project partners. The demonstration OR was qualitatively evaluated including technical as well as clinical aspects. In the evaluation, a questionnaire was used to obtain feedback from hospital operators. The clinical implications were covered by structured interviews with surgeons, anesthesiologists and OR staff.


In the present work, we qualitatively evaluate a subset of the proposed concepts from the perspectives of various stakeholders. The feedback of the clinicians indicates that there is a need for a flexible data and control integration. The hospital operators stress the need for tools to simplify risk management in openly integrated operating rooms.


The implementation of openly integrated operating rooms will positively affect the surgeons, the anesthesiologists, the surgical nursing staff, as well as the technical personnel and the hospital operators. The evaluation demonstrated the need for OR integration technologies and identified the missing tools to support risk management and approval as the main barriers for future installments.


Integrated operating room Intelligent OR OR.NET IEEE 11073 SDC 



The authors were funded within the OR.NET project by the German Federal Ministry of Education and Research (BMBF) with the Grant Numbers 16KT1236, 16KT1238, 16KT1239 and 16KT1242.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Ethical approval

For this type of study formal consent is not required.


  1. 1.
    Dadam P, Reichert M, Kuhn K (2000) Clinical workflows—the killer application for process-oriented information systems? In: Abramowicz W, Orlowska ME (eds) BIS 2000. Springer, London, pp 36–59CrossRefGoogle Scholar
  2. 2.
    Lemke HU, Berliner L (2011) Systems design and management of the digital operating room. Int J CARS 6:144–158. doi: 10.1007/s11548-011-0608-y CrossRefGoogle Scholar
  3. 3.
    Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, Zinner MJ, Dierks MM (2006) A prospective study of patient safety in the operating room. Surgery 139:159–173. doi: 10.1016/j.surg.2005.07.037 CrossRefPubMedGoogle Scholar
  4. 4.
    Sexton JB, Makary MA, Tersigni AR, Pryor D, Hendrich A, Thomas EJ, Holzmueller CG, Knight AP, Wu Y, Pronovost PJ (2006) Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel. Anesthesiology 105:877–884CrossRefPubMedGoogle Scholar
  5. 5.
    Hu Y-Y, Arriaga AF, Roth EM, Peyre SE, Corso KA, Swanson RS, Osteen RT, Schmitt P, Bader AM, Zinner MJ, Greenberg CC (2012) Protecting patients from an unsafe system: the etiology and recovery of intraoperative deviations in care. Ann Surg 256:203–210. doi: 10.1097/SLA.0b013e3182602564 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lemke HU, Vannier MW (2006) The operating room and the need for an IT infrastructure and standards. Int J CARS 1:117–121. doi: 10.1007/s11548-006-0051-7 CrossRefGoogle Scholar
  7. 7.
    Padoy N, Blum T, Ahmadi S-A, Feussner H, Berger M-O, Navab N (2012) Statistical modeling and recognition of surgical workflow. Med Image Anal 16:632–641. doi: 10.1016/ CrossRefPubMedGoogle Scholar
  8. 8.
    Janß A, Benzko J, Merz P, Dell’Anna J, Strake M, Radermacher K (2014) Development of medical device UI-profiles for reliable and safe human-machine-interaction in the integrated operating room of the future. In: Proceedings of the 5th international conference on applied human factors and ergonomics 2014, pp 1855–1860Google Scholar
  9. 9.
    Guédon A, Wauben L, Overvelde M, Blok J, van der Elst M, Dankelman J, van den Dobbelsteen J (2014) Safety status system for operating room devices. Technol Health Care. doi: 10.3233/THC-140854 PubMedGoogle Scholar
  10. 10.
    Kasparick M, Schlichting S, Golatowski F, Timmermann D (2015) New IEEE 11073 standards for interoperable, networked point-of-care Medical Devices. In: Proceedings of the 37th IEEE engineering in medicine and biology society (EMBC), pp 1721–1724Google Scholar
  11. 11.
    Wubben I, van Manen JG, van den Akker BJ, Vaartjes SR, van Harten WH (2010) Equipment-related incidents in the operating room: an analysis of occurrence, underlying causes and consequences for the clinical process. BMJ Qual Saf 19:e64–e64. doi: 10.1136/qshc.2009.037515 CrossRefGoogle Scholar
  12. 12.
    Cleary K, Kinsella A, Mun SK (2005) OR 2020 workshop report: operating room of the future. Int Congr Ser 1281:832–838. doi: 10.1016/j.ics.2005.03.279 CrossRefGoogle Scholar
  13. 13.
    Korb W, Bohn S, Burgert O, Dietz A, Jacobs S, Falk V, Meixensberger J, Strauss G, Trantakis C, Lemke HU (2006) Surgical PACS for the digital operating room. Systems engineering and specification of user requirements. Stud Health Technol Inform 119:267–272PubMedGoogle Scholar
  14. 14.
    Köny M, Benzko J, Czaplik M, Marschollek B, Walter M, Rossaint R, Radermacher K, Leonhardt S (2013) The smart operating room: smartOR. Distributed networks: intelligence, security, and applications. CRC Press, Boca RatonGoogle Scholar
  15. 15.
    Andersen B, Ulrich H, Kock A-K, Wrage J-H, Ingenerf J (2014) Semantic interoperability in the OR.NET project on networking of medical devices and information systems—a requirements analysis. In: 2014 IEEE-embs international conference on biomedical and health informatics (BHI), pp 428–431Google Scholar
  16. 16.
    Kasparick M, Schlichting S, Golatowski F, Timmermann D (2015) Medical DPWS: new IEEE 11073 standard for safe and interoperable medical device communication. In: Proceedings of the IEEE conference on standards for communications and networking of the (CSCN), pp 212–217Google Scholar
  17. 17.
    Koeny M, Benzko J, Czaplik M, Walter M, Radermacher K, Rossaint R, Leonhardt S (2012) Getting anesthesia online: the smartOR network. Int J Adv Internet Technol 5(3 and 4):114–125Google Scholar
  18. 18.
    Benzko J, Janss A, Dell’Anna J, Radermacher K (2014) Man-machine interfaces in the operating room. Biomed Eng/Biomed Tech 59:430–430Google Scholar
  19. 19.
    Kühn F, Leucker M (2014) OR.NET: safe interconnection of medical devices. In: Gibbons J, MacCaull W (eds) Foundations of health information engineering and systems. Springer, Berlin, pp 188–198CrossRefGoogle Scholar
  20. 20.
    Andersen B, Ulrich H, Rehmann D, Kock A-K, Wrage J-H, Ingenerf J (2015) Reporting device observations for semantic interoperability of surgical devices and clinical information systems. In: Proceedings of the 37th IEEE engineering in medicine and biology society (EMBC), pp 1725–1728Google Scholar
  21. 21.
    Pfeiffer JH, Dingler ME, Dietz C, Lueth TC (2015) Requirements and architecture design for open real-time communication in the operating room. In: Proceedings of IEEE international conference on robotics and biomimetics (ROBIO 2015), pp 458–463Google Scholar
  22. 22.
    Mildner A, Janß A, Dell’Anna-Pudlik J, Merz P, Leucker M, Radermacher K (2015) Development of device-and service-profiles for a safe and secure interconnection of medical devices in the integrated open OR. In: Seehusen F, Felderer M, Großmann J, Wendland M-F (eds) Risk assessment and risk-driven testing. Springer, Cham, pp 65–74CrossRefGoogle Scholar
  23. 23.
    Dingler M, Dietz C, Pfeiffer J, Lueddemann T, Luth T (2015) A framework for automatic testing of medical device compatibility. In: Proceedings of the 13th IEEE international conference on telecommunications (ConTEL), pp 1–8Google Scholar
  24. 24.
    Decker N, Kühn F, Thoma D (2014) Runtime verification of web services for interconnected medical devices. In: International symposium on software reliability engineering, ISSRE 2014, Naples, pp 235–244Google Scholar
  25. 25.
    Andersen B, Kasparick M, Golatowski F, Ingenerf J (2016) Extending the IEEE 11073-1010X nomenclature for the modelling of surgical devices. In: Proceedings of the 3rd international conference on biomedical and health informatics (BHI), pp 244–247Google Scholar
  26. 26.
    OASIS (2009) Devices Profile for Web Services Version 1.1Google Scholar
  27. 27.
    Schlamelcher J, Onken M, Eichelberg M, Hein A (2015) Dynamic DICOM configuration in a service-oriented medical device architecture. In: Proceedings of the 37th IEEE engineering in medicine and biology society (EMBC), pp 1717–1720Google Scholar
  28. 28.
    Plourde J, Arney D, Goldman JM (2014) OpenICE: an open, interoperable platform for medical cyber-physical systems. In: ICCPS, pp 221–221Google Scholar
  29. 29.
    ASTM International (American Society for Testing and Materials) (2013) ASTM F2761–09(2013), medical devices and medical systems—essential safety requirements for equipment comprising the patient-centric integrated clinical environment (ICE)—Part 1: general requirements and conceptual model. West ConshohockenGoogle Scholar
  30. 30.
    Iseki H, Muragaki Y, Tamura M, Suzuki T, Yoshimitsu K, Ikuta S, Okamoto J, Chernov M, Izumi K (2012) SCOT (Smart Cyber Operating Theater) project: advanced medical information analyzer for guidance of the surgical procedures. In: Proceedings of the international display workshops, pp 1880–1883Google Scholar
  31. 31.
    Pahontu R, Schneider G, Bergh B, Merzweiler A (2015) An IHE based gateway architecture to link healthcare IT with medical devices in the operating room. In: Proceedings of the 17th international conference on E-health networking, application & services (HealthCom), pp 586–589Google Scholar
  32. 32.
    Kasparick M, Schmitz M, Golatowski F, Timmermann D (2016) dynamic remote control through service orchestration of point-of-care and surgical devices based on IEEE 11073 SDC. In: IEEE-NIH 2016 special topics conference on healthcare innovations and point-of-care technologies, CancunGoogle Scholar
  33. 33.
    Rockstroh M, Franke S, Neumuth T (2013) A workflow-driven surgical information source management. In: Lemke HU (ed) The International Journal for Computer Assisted Radiology and Surgery. Springer, Heidelberg, pp 189–191Google Scholar
  34. 34.
    Franke S, Rockstroh M, Schreiber E, Neumann J, Neumuth T (2016) Context-aware medical assistance systems in integrated surgical environments. In: 28th conference of the international society for medical innovation and technology (SMIT) (in print)Google Scholar

Copyright information

© CARS 2017

Authors and Affiliations

  • M. Rockstroh
    • 1
  • S. Franke
    • 1
  • M. Hofer
    • 2
  • A. Will
    • 3
  • M. Kasparick
    • 4
  • B. Andersen
    • 5
  • T. Neumuth
    • 1
  1. 1.Faculty of Medicine, Innovation Center Computer Assisted SurgeryUniversität LeipzigLeipzigGermany
  2. 2.Department of ENT SurgeryUniversity Hospital of LeipzigLeipzigGermany
  3. 3.Center for Information TechnologySchleswig-Holstein University HospitalLuebeckGermany
  4. 4.Faculty of Computer Science and Electrical Engineering Institute of Applied Microelectronics and Computer EngineeringUniversity of RostockRostockGermany
  5. 5.Institute of Medical InformaticsUniversität zu LübeckLübeckGermany

Personalised recommendations