De-Identification in Surgical Video: What You Need to Know

De-Identification in Surgical Video​: What You Need to Know

As recording surgical procedures quickly becomes the standard of care in the field, maintaining patient and staff privacy within recordings is an issue that all institutions should carefully consider to ensure regulatory compliance and ethical practices. 


For video footage, maintaining privacy means de-identifying those who are recorded. If you’re wondering what this involves and how to make sure your institution follows best practices, we’ve got you covered.

What is De-Identification?

The concept of data de-identification arose with the implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The Privacy Rule considers individually identifiable health information to be protected health information. This includes information such as names, birthdates, or social security numbers that are attached to health information, including electronic health information such as recorded surgical videos.


The HIPAA Privacy Rule contains a de-identification standard, which states that health information is considered de-identified if 18 types of identifiers are removed. These include items such as names, dates, medical record numbers, biometric identifiers such as finger and voice prints, and most importantly for video recordings, full-face photographs and any comparable images. 

How To De-Identify Surgical Video

Although it may sound daunting to de-identify an entire surgical video, there are important points to keep in mind that can make the process simple and automated. This was outlined in a recent JAMA Surgery article, in which the Mayo Clinic, in partnership with Theator, set the standard for use, analysis, and de-identification of intracorporeal surgical videos:

1. Obtain consent

Even though obtaining signed consent prior to a surgical procedure is second nature, in the age of recording surgical video it’s important to make sure this process is specifically covered in your surgical consent. Patients should be made aware that their procedure will be recorded, assured that their privacy is protected, and informed about how the recorded footage will be used. Although obtaining consent does not actually de-identify surgical video, it’s a critical first step to ensuring ethical and compliant practices. 

2. Remove identifying information

While it may seem like a good idea to include information such as a procedure date or patient medical record number on a recorded video, since these are considered identifiers, it’s best not to do so. This reduces the risk of a surgical video being traced to a specific patient if it is used for educational or other purposes.

3. Automate removal of out-of-body frames

Luckily, the technology already exists to automatically remove out-of-body video footage, which poses the highest risk for identification. By identifying out-of-body video with greater than 99% accuracy, Theator’s surgical platform technology significantly reduces the risk of accidentally including images of patients or staff that could result in identification of protected health information. Automation of this process is the key to success in de-identification, as manual removal of identifying footage would be prohibitively time consuming.

De-Identification in Surgical Video

Although it’s valid to be concerned about the privacy of recorded surgical video, it’s important to know that solutions already exist to overcome the challenges of maintaining patient and staff privacy. By initiating updated consent processes, removing identifiers from recorded material, and implementing a system that automatically identifies and removes out-of-body frames, institutions can meet their patient’s needs for privacy and remain compliant with regulatory standards.

Choose the Product That Captures ALL Your Surgical Video

Theator: The Product That Captures ALL Your Surgical Video

Leaders across the surgical profession are upgrading their operating rooms to incorporate innovative AI technologies that improve surgical care. If you’re among these forward-thinking leaders, you may be wondering how to choose between available technologies and which benefits one solution offers over another. 


Here’s what Theator brings to the table that you won’t find anywhere else.

Compatibility With Existing Equipment

Many surgical AI tools on the market are only compatible with their own OR hardware or software. Not only can this mean bigger upfront costs, it can also cause you to miss out on valuable surgical data if all of your hardware and software isn’t compatible with their technology.


With Theator, you never need to worry about this issue because our Surgical Intelligence Platform is compatible with any and all hardware and software you’re already using in your OR. When you partner with Theator, you won’t encounter any upfront costs or delays related to compatibility issues. 

Capture ALL Your Surgical Video

Ensuring compatibility of your surgical AI platform with your existing hardware and software is the first critical step toward capturing ALL of your surgical video going forward- not just some of it. You might be wondering why capturing all your surgical video is so important. The answer is simple: more data = more opportunity to improve quality and outcomes.


Recorded surgical video improves care from multiple angles. First, trainees (and even experienced surgeons) can review cases to continuously improve their technique and decrease errors. In addition, a greater volume of recorded surgical video means more data that can be mined to identify patterns and systems issues affecting care. 


Theator provides two key features related to surgical video recording that set us apart from the competition. Our Surgical Intelligence Platform automatically records every surgical case when it begins. No additional steps or room for human forgetfulness. 


Additionally, our AI technology provides real-time updates and feedback to improve efficiency and alert surgeons to critical intraoperative events as they occur. This means no time-consuming manual review of video footage is needed. Our AI-assisted Platform can identify practice variability, support clinical decision making, and immediately provide the information you need to improve patient outcomes.

Bring Your Operating Room Up to Speed

Partnering with Theator to upgrade your ORs using our universally compatible Surgical Intelligence Platform means capturing six times more surgical video than you would with our competitors. That’s six times the amount of information at your fingertips to increase transparency, enhance medical education, identify practice variability, and improve clinical decision making, quality, and patient outcomes. 


With so many benefits to surgeons and patients, the choice in surgical AI technology is clear. Reach out today to book a demo and learn more about what Theator can do for you.

Three Benefits of Recording Surgical Videos

Three Benefits of Recording Surgical Videos

Intraoperative video recording is quickly becoming the standard of care across surgical specialties, and with good reason. Recorded surgical videos are a valuable educational tool for trainees and experienced surgeons alike and improve the transparency and quality of care provided in the OR. Let’s take a deeper look at what this means for day-to-day surgical practice and patient outcomes. 

1. Recording Surgical Video Provides More Transparency

Improving transparency regarding surgical practices is important for both surgeons and patients. Patients experience anxiety about undergoing surgery and are interested in understanding what happens when they are under anesthesia. 


For surgeons, having recorded surgical video available for review is an invaluable tool for managing postoperative patients. One surgeon whose hospital has been automatically recording all surgical video for over a decade described a patient who had undergone emergency surgery the night before, but was worsening the next day. 

Upon review of the recorded surgical procedure, it was noted that a small bowel perforation was missed the prior night. Without the benefit of recorded surgical video, determination of the cause of the patient’s worsening would likely have taken much longer. A study of recorded bariatric surgeries found similar benefits in identifying postoperative complications by reviewing recorded surgical video. 

Notably, the surgeon mentioned above also reported there were “three or four” instances of recorded surgical video being submitted for legal cases over the decade since they began automatically recording. In each instance, the case was settled in favor of the hospital. 

2. Recorded Surgical Footage Can Be Used For Training & Education

Recorded surgical video provides the opportunity for trainees to gain exposure to exponentially more surgical procedures than they are otherwise able to by only attending procedures in person. Surgical residents with access to recorded surgical videos report accessing them to prepare for upcoming cases, improve their surgical anatomical knowledge, and review cases in which they participated to solidify their skills. 


Importantly, the use of surgical video to prepare for surgical cases has been associated with a decreased procedural error rate when performing the procedure that was studied. Taking recorded video to the next step in surgical training, cases performed by residents that are recorded can later be reviewed by multiple surgeons for feedback and evaluation.


The educational benefits of recorded surgical video don’t end with trainees. Even experienced surgeons benefit from refining and continuously improving their skills, and studies suggest that self-evaluation is not the best method of skills assessment. The objective data provided by surgical video recordings can provide the necessary data for surgeons to make actionable changes.

3. Surgical Video Provides Information Needed For Quality Improvement

The bottom line is that surgical video recordings are enormous sets of data that provide otherwise unavailable information about what occurs in the OR. For surgeons and hospitals looking to improve the quality of care they offer, recording surgical video is the first step in gathering the data needed to do this. 

Consider the current use of patient outcomes to drive quality improvement initiatives. Without intraoperative data, how can a link (or lack thereof) between what happens in the OR and patient outcomes be established? Often, it cannot. 

In this realm, there is an opportunity to pair recorded surgical video with AI technologies to gain deeper insight into practice variability and surgical outcomes than is possible with manual review alone, which is inherently limited by time and cost restraints.

AI tools paired with surgical video recording can identify steps in a surgical procedure, offer suggestions for clinical decision making, and enhance intraoperative diagnosis. The integration of such tools into everyday surgical care provides the specific feedback needed to improve patient outcomes.

Why Aren’t All Surgical Videos Recorded?

Simply put, automation is the key to success with surgical video recording. Without automation, surgeons are unlikely to remember to manually record each procedure they perform when it involves an additional step to everything else they are doing to prepare for a case. Investing in a technology that offers automatic recording is an essential step in collecting surgical data and improving outcomes. 

Failing to Record Surgical Video Leaves Valuable Data on the Table

If your institution isn’t currently recording all surgical procedures, you are lacking a large and essential data set that can be used to improve quality, transparency, education, and patient outcomes. Especially given that video is already used regularly in laparoscopic and endoscopic procedures, integrating software that automatically records video from tools already in use is a simple step that can result in a great leap forward in your institution’s technological, safety, and quality capabilities. Knowledge is power, and recorded surgical video gives your institution the power to create a culture of continuous improvement that benefits patients and surgeons. 

Considering AI in your operating room? Get our AI Technology Evaluation Checklist​:

Why Automation is the Key to Surgical Video Recording Success

The Key to Surgical Video Recording Success is Automation

Recording intraoperative surgical video and using an artificial intelligence (AI) platform to analyze recorded content is quickly becoming standard practice in operating rooms across the country. If your hospital or healthcare organization is embarking on the quality improvement journey offered by such platforms, it’s critical to understand their features to decide which one is best for your organization.


One such essential component of a high-quality surgical AI platform is the ability to automatically record surgical video instead of counting on surgeons to manually hit the record button.


You may be thinking, “Is it really that hard to remember to hit a record button?” In fact, our experience shows that it is.

Real Life Impacts of Automated Surgical Video Recording

We worked with a urologist who intended to always record his robotic-assisted radical prostatectomy (RARP) procedures. In the 10 years before adopting Theator’s Platform that automatically records all procedures, he managed to manually record 122 procedures. In just one year after implementing Theator’s technology, he recorded 163 procedures — a 1200% increase! 


What does this look like for an entire hospital? When Theator’s Platform was deployed at a hospital that performs 120 cases per week, they went from recording only 8.3% of cases to recording 100%. 

Why Does Automated Surgical Video Recording Matter?

Are you wondering why it’s so important to record every case instead of a select few? Great question! When it comes to actionable data, more is simply better for identifying patterns and trends. 


For example, consider a clinical trial for a new drug. You are far more likely to identify potential adverse effects in a trial with 2000 participants than you are in one with 20 participants. The same goes for recorded surgical data. Identifying practice patterns and variations should be based on all available data from a group or surgeon because a select sample may not accurately reflect true practice.

How Is Recorded Surgical Data Analyzed?

First and foremost, it’s important to know that Theator’s AI Platform will do the analyzing for you. This means there is no need for a busy surgeon to take time out of their day to manually review hours of video footage.

Theator’s proprietary AI technology can identify surgical steps, adverse events, variations in practice, and more – all of which can be linked to patient outcomes. This allows your institution to design plans with measurable goals to improve the quality of care. Patients, hospitals, and surgeons all stand to benefit from automated video recording and data analysis.

Tips for Integrating Surgical AI Platforms

When considering a surgical AI platform for your organization, be sure to understand the ins and outs of how data is recorded, stored, accessed, and analyzed. Some questions to ask are:

    • Is surgical video data automatically recorded?
    • Does the platform software integrate with the hardware already used in your ORs?
    • Does the platform offer storage of recorded video? Is it limited or unlimited?
    • What metrics will be analyzed in recorded video?
    • Does the platform link analyzed data to patient outcomes?

By embarking on the surgical AI journey as an educated consumer, you are more likely to find the platform that best fits your institution’s needs. 

Recording Surgical Data: What You Need to Know

What Surgeons and Administrators Need to Know About Recording Surgical Data

Recording intraoperative video is not a new concept, especially for those who perform laparoscopic or robotic procedures. However, as the practice of surgery continues to evolve by incorporating advanced technologies, such as AI, into everyday care, the role of intraoperative video recording will need to shift to better accommodate and advance the use of these tools. 


How will this change day-to-day surgical care? What are the best ways to protect privacy and security in this new digital age of healthcare? These and other common concerns are addressed in the July 2023 recommendations published by the AI Task Force of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Read on for a breakdown of what they had to say.

Why Record (More) Intraoperative Video?

The idea of recording extensive data to improve safety originated in the aviation industry. Following highly publicized plane crashes in the 1970s, recording in-flight data became standard procedure and the systems that were put in place to address identified issues resulted in the industry achieving a near-perfect safety record. 


Applying the same practices to surgical video offers the opportunity to improve patient outcomes and reduce complications in a similar manner. Importantly, recording intraoperative video is an easy process since ORs are already equipped with the necessary tools—meaning little to no valuable OR time is required to implement collection. Furthermore, currently available AI technologies are already adept at analyzing recorded video to identify surgical steps and variations, which means there is no need for surgeons to spend additional time manually reviewing recordings. 

Surgical Data: Who, What, When, Where, and Why

Before implementing large-scale surgical video recording, it’s important to understand the many aspects of using and managing this data that will come into play for an organization. The SAGES AI Task Force breaks these down as follows:

    • Data Use: This refers to the need to address all stakeholders in the use of recorded data, from surgeons to patients to administrators and beyond. What does each group need from the recorded data?
    • Data Structure: How will data be captured, stored, and formatted? This affects how accessible it is to stakeholders.
    • Data Exploration: Once data has been collected, it’s essential to define how it will be used for research purposes to improve care and promote innovation.
    • Data Governance: The ethical and legal aspects of data collection reflected in policies and procedures are key to protecting privacy and ensuring fair and just practices.

As departments, hospitals, and healthcare systems enhance their intraoperative recording capabilities and practices, all of these overlapping concepts should be proactively addressed to optimize outcomes and prevent unintended consequences. 

Data Use: Who Needs the Data and Which Cases Should Be Recorded?

In terms of what and when to record, 58% of task force members felt that surgeries should always or almost always be recorded. Of note, the group pointed out the specific need to record less frequent or more complicated procedures to maximize representation of rare events for educational and quality purposes. If storage capability is a barrier to recording all surgical video, working with a technology program that offers unlimited storage can eliminate the need to pick and choose which procedures to record and simplify the process using automatic recording of all procedures. 


Healthcare providers and patients were identified as the two most important stakeholders requiring access to recorded surgical data, and research, educational, and clinical use cases were all noted to be highly valuable roles of recorded data. Legal experts should be included in conversations and policy development regarding data use to ensure HIPAA compliance and address concerns related to discoverability of recorded data in medicolegal cases. In addition, attention to blurring out-of-body video segments can help to mitigate privacy concerns.

Data Structure: What Data Sources Are Most Valuable and How Should Data Be Stored?

In terms of which type of video to record, the task force felt that endoscopic data is a key addition to intraabdominal video to facilitate best practices. While using multiple sources to record intraoperative data increases the volume of available data, it also increases the need for data storage, so these two priorities should be carefully balanced. When planning an institutional approach to video recording, selection of technology that integrates with existing hardware can offer a logistically easier solution than starting from scratch with new equipment.

Quality and storage are main pillars of data structure that will require careful planning by organizations embarking on increasing their surgical data recording practices. Standardization is a vital element of this process to optimize accessibility and usability. In addition, video quality should be balanced with the intended data use, since higher quality data requires more storage. Choosing an unlimited storage platform can allow for consistent recording of high-quality data without the need to worry about running out of storage space.

Data Exploration: Addressing Bias and Furthering Research

It is well-documented that the healthcare system is fraught with bias, and it’s important that recorded surgical data not further contribute to this issue. To mitigate this, the task force suggests collecting additional data such as patient demographics and surgical team information to provide context to recorded data. Because recorded data are used to train AI algorithms, reducing bias in recorded data can ultimately reduce bias in these algorithms.

Planning for surgical data collection and storage should not only consider the current uses for this data, but also the potential future uses for safety and quality improvement, research, and outcomes analysis. This approach can inform forward-thinking practices for data management.

Data Governance: The Laws and Ethics of Data Collection and Storage

Transparency is key to the development of data governance policies that align with the principles of medical ethics. Patients should be informed about the use of video recording and have the opportunity to consent or decline the use of intraoperative recording. 

Related to this, access to recorded surgical data should be managed in a way that protects patient privacy and limits its use to predetermined use cases. Involvement of ethics boards and institutional review boards is encouraged to facilitate best practices in this area. 

Institute Policies Today to Be Prepared Tomorrow

The use of advanced technologies, such as AI tools, in the OR is on track to quickly become the standard of surgical care. The first step in implementing such technologies and their advantages is the collection of recorded intraoperative data. Luckily, ORs are already equipped with the tools to do this, so getting started is easy. However, the storage of large volumes of data, identification of its intended use, and privacy and security compliance are critical areas of consideration that should be planned for—purposefully and strategically that include all stakeholders—before embarking on large-scale data collection.

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