Integrating Image-Based Artificial Intelligence in the Operating Room: Enhancing Safety and Efficiency While Navigating Ethical Considerations
DOI:
https://doi.org/10.30953/thmt.v10.578Keywords:
Artificial intelligence, image-based artificial intelligence, implementation, operating roomAbstract
Background: Image-based artificial intelligence (IBAI) platforms offer the potential to improve operating room (OR) safety and efficiency through real-time monitoring of clinical workflows. However, implementing these platforms poses complex challenges related to data privacy, ethical oversight, legal compliance, and the need for robust governance structures.
Objective: This study aimed to describe the implementation of IBAI across a multihospital health system in the United States, the legal and ethical challenges encountered, and the strategies used to support safe and compliant integration.
Methods: An IBAI platform was deployed across more than 50 ORs across the health system. The platform uses artificial intelligence-driven audio-video analysis to support performance metrics such as first case on-time starts and turnover time. A governance framework addressing recording access, retention, and consent was developed. Key stakeholders, including department chairs, quality officers, and OR committees, were granted review authority under a structured policy.
Results: Initial skepticism among surgical staff centered on data security, liability risk, and consent. Policy refinement, transparent communication, and updated consent language led to increased support of platform use. Video retention was set at a maximum of 30 days (audio at 7 days), with access limited to designated leaders. These parameters are provisional and may be modified in response to evolving legal and ethical guidelines. Early qualitative feedback suggests improved confidence in the system, with further quantitative evaluations underway.
Conclusions: This use case highlights the importance of ethical policy development, stakeholder engagement, and transparent communication to successfully implement IBAI in surgical settings. Ongoing refinements are being made based on stakeholder feedback as the health system evaluates expansion to other clinical applications.
Downloads
References
Bellini V, Russo M, Domenichetti T, Panizzi M, Allai S, Bignami EG. Artificial intelligence in operating room management. J Med Syst. 2024;48(1):19. https://doi.org/10.1007/s10916-024-02038-2
Peregrin T. Black box technology shines light on improving OR safety, efficiency. Am Coll Surg Bull. 2023;108(7). Available from: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/july-2023-volume-108-issue-7/black-box-technology-shines-light-on-improving-or-safety-efficiency/
Chen Y, Esmaeilzadeh P. Generative AI in medical practice: in-depth exploration of privacy and security challenges. J Med Internet Res. 2024;26:e53008. https://doi.org/10.2196/53008
Gordon L, Reed C, Sorensen JL, Schulthess P, Strandbygaard J, McLoone M, et al. Perceptions of safety culture and recording in the operating room: understanding barriers to video data capture. Surg Endosc. 2022;36(6):3789–97. https://doi.org/10.1007/s00464-021-08695-5
Osztrogonacz P, Chinnadurai P, Lumsden AB. Emerging applications for computer vision and artificial intelligence in management of the cardiovascular patient. Methodist Debakey Cardiovasc J. 2023;19(4):17–23. https://doi.org/10.14797/mdcvj.1263
Smith TG, Norasi H, Herbst KM, Kendrick ML, Curry TB, Grantcharov TP, et al. Creating a practical transformational change management model for novel artificial intelligence-enabled technology implementation in the operating room. Mayo Clin Proc Innov Qual Outcomes. 2022;6(6):584–96. https://doi.org/10.1016/j.mayocpiqo.2022.09.004
Wang C, Zhang J, Lassi N, Zhang X. Privacy protection in using artificial intelligence for healthcare: Chinese regulation in comparative perspective. Healthcare (Basel). 2022;10(10). https://doi.org/10.3390/healthcare10101878
van Dalen A, Legemaate J, Schlack WS, Legemate DA, Schijven MP. Legal perspectives on black box recording devices in the operating environment. Br J Surg. 2019;106(11):1433–41. https://doi.org/10.1002/bjs.11198
Ontario Hospital Association. [Internet]. [cited 2025 Apr 21]. Available from: https://www.oha.com/news/a-%E2%80%98black-box%E2%80%99-to-assess-and-train-expert-surgical-teams
Carroll BJ, Birth M, Phillips EH. Common bile duct injuries during laparoscopic cholecystectomy that result in litigation. Surg Endosc. 1998;12(4):310–13; discussion 4. https://doi.org/10.1007/s004649900660
Siwicki B. AI computer vision enables big OR efficiency gains for Houston Methodist Hospital: Healthcare IT News [Internet]. 2025 [cited 2025 Apr 21]. Available from: https://www.healthcareitnews.com/news/ai-computer-vision-enables-big-or-efficiency-gains-houston-methodist-hospital
Quach WT, Vittetoe KL, Langerman A. Ethical and legal considerations for recording in the operating room: a systematic review. J Surg Res. 2023;288:118–33. https://doi.org/10.1016/j.jss.2023.02.017
U.S. Food and Drug Administration. Transparency for machine learning-enabled medical devices: guiding principles. United States Food & Drug Administration, Health Canada, and Medicines & Healthcare Products Regulatory Agency; 2024. Available from: https://www.fda.gov/medical-devices/software-medical-device-samd/transparency-machine-learning-enabled-medical-devices-guiding-principles
AI knowledge repository: NHS England- NHS Digital [Internet]. [cited 2025 Apr 21; updated 2 May 2025]. Available from: https://digital.nhs.uk/services/ai-knowledge-repository
Yiu A, Lam K, Simister C, Clarke J, Kinross J. Adoption of routine surgical video recording: a nationwide freedom of information act request across England and Wales. EClinicalMedicine. 2024;70:102545. https://doi.org/10.1016/j.eclinm.2024.102545
Healthcare AI commitments: coalition for health AI [Internet]. [cited 2025 Apr 21]. Available from: https://www.healthcareaicommitments.com/
Lindegger DJ, Wawrzynski J, Saleh GM. Evolution and applications of artificial intelligence to cataract surgery. Ophthalmol Sci. 2022;2(3):100164. https://doi.org/10.1016/j.xops.2022.100164
Feubner H, Ostler D, Kohn N, Vogel T, Willhelm D, Koller S, et al. Comprehensive system integration and networking in the operating room. Surgeon. 2016;87:1002–7. https://doi.org/10.1007/s00104-016-0324-9
Arora A, Lawton T. Artificial intelligence in the NHS: moving from ideation to implementation. Fut Healthc J. 2024;11(3):100183. https://doi.org/10.1016/j.fhj.2024.100183
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ngoc-Anh A. Nguyen, MD, Brendan Holderread, MD, Divya Reddy, JD, Roberta Schwartz, PHD
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Telehealth and Medicine Today (THMT).
THMT is published under a Creative Commons Attribution-NonCommercial 4.0 International License.
