This is my professional profile with descriptions and links to my work and publications.
My primary focus is on the operating room and care of surgical patients. From a clinical standpoint, I am a head and neck cancer and reconstructive surgeon at Vanderbilt University Medical Center in the Department of Otolaryngology - Head and Neck Surgery. In addition to cancer, I also treat benign tumors of the parotid, thyroid, and neck, and have expertise in paragangliomas, parapharyngeal space tumors, Zenkers diverticulum, pharyngoceles, sialendoscopy, and minimally-invasive approaches to stones (calculi) of the parotid and submandibular glands.
I am also a researcher and academic, studying “surgical transparency” – how to enhance the transfer of information into and out of the operating room for the benefit of patients, hospital staff, and the healthcare system. This avenue of inquiry takes many forms:
Transparency is necessary to engender trust in any industry, and by forcing failures and bad practices to be publicly evident it stimulates better oversight and quality improvement. For clinical and cultural reasons, the operating room has been sequestered from public view since decline of surgical theatres in the 1960's.
A new era of surgical transparency is emerging, largely fueled by the advent of video recording for quality improvement. Despite the clear potential benefits to understanding and improving the operating room, we must carefully consider the potential effects that ubiquitous recording can have on team behavior and on patient privacy. I spoke on this recently at the 2018 MacLean Conference, and a link to the video will be posted here when available. I continue to research this topic as part of the International Center for Surgical Safety and will be speaking on patient perceptions of surgical recordings at their annual conference in January 2019.
My most recent publications also include research on overlapping surgery - a practice where one surgeon overlaps some part of two procedures. In these cases, assistants or trainees handle more routine aspects of the surgery. While this is safe and appropriate when handled correctly, it is critical that patients are informed of who will be doing which parts of their surgery while they are under anesthesia. and that trainee participation is closely managed. This topic has highlighted a significant disconnect between patient expectations and the reality of the operating room, and we continue to study patient perceptions to understand the effect that surgical transparency will have on the surgeon-patient relationship.
A visual abstract of my surgical transparency research narrative appears below.
Human-centered design is sorely needed in health care. This includes tangible, patient-level enhancements such as the devices we developed with patients during the first DesignWithPatients event, LaryHacks. This also includes systemic interventions to improve the way information is used by health care providers and patients.
I am presently heading up a redesign of the surgical informed consent process in collaboration with Cat Moon and the Program on Law and Innovation at Vanderbilt Law School; our first stakeholder event was held November 2018 in partnership with Nashville Design Week. We envision an informed consent document and process that bolsters surgeon-patient communication and serves as a record of shared decision making, while diminishing administrative burden. More to come as prototypes are developed.
I also have a longstanding interest in redesign of the OR and the way the surgical built environment can affect efficiency and team performance. This requires our continuing to open the doors of the operating room to experts from other fields. Here is a guide my team and I wrote on field research in the OR for those outside the medical field.
My blog post on the surgical "master-plan", and thoughts towards improving team coordination in the OR was an early inspiration for founding ExplORer Surgical. The key is ensuring that every team member has coordinated information specific to their role and specific to the moment in the case. It is also important to consider how technology can best be implemented in surgical environments, and I shared some lessons on adapting technology to the operating room at AMIA 2018 Clinical Informatics Conference.
I currently serve on the Clinical Transformation Advisory Committee of the Center for Medical Interoperability. We recently held an event in conjunction with the 2018 inaugural Nashville Design Week on how information technology and the surgical built environment interact.
In addition to displaying information, it is critical to consider how to capture information in the operating room. A few years ago, my lab conducted on using the Microsoft Kinect to assess ergonomics in the operating room. We found that he Kinect is a useful tool for anonymous recording of surgical activity. My present passion project is developing a wearable camera for the operating room, nicknamed "Cleopatra", that overcomes the challenges of boom- and head-mounted cameras (obstruction and instability). I obtained a grant to focus on this work as the 2020 Vanderbilt Institute for Surgery and Engineering Physician in Residence.
I frequently give talks at meetings and workshops of professional societies, business groups, and public and private organizations. While every talk is original and tailored to the specific audience, the following topics are the most frequently requested. Please contact me at my academic office if you are interested in my speaking services.
I trained at the University of Chicago in medicine, otolaryngology, clinical ethics, and data science. My advanced training in head and neck surgery was at Vanderbilt, and I’ve now been in practice since 2011. During that time, I’ve also served as faculty of the MacLean Center for Clinical Medical Ethics, the Center for Biomedical Ethics and Society, and the Institute for Surgery and Engineering, as well as serving as a preceptor for classes in the Booth School of Business and the Institute of Design. I ran the Operative Performance Research Institute at University of Chicago until I was recruited to Vanderbilt in 2015, where I now run the Surgical Analytics Lab. Additionally at Vanderbilt, I serve as Director of the Vanderbilt Program on Surgical Ethics, and in 2019 was granted a secondary appointment in the Department of Radiology and Radiological Sciences.
External to Vanderbilt, I am an Affiliate Scientist of the International Center for Surgical Safety where I study the ethics of "Black Box" Operating Room recording. I also serve on the Clinical Transformation Advisory Committee of the Center for Medical Interoperability, a cooperative research and development lab that advocates for healthcare data liquidity. Additionally, I am a founding member of the Consortium for Surgical Ethics, a non-profit committed to promoting ethics discourse and scholarship amongst surgeons. I am a Fellow of the American College of Surgeons and the Triological Society.
From an invention and entrepreneurship perspective, I founded ExplORer Surgical in 2015; this company focuses on surgical data and performance and is based on an app I developed while at the University of Chicago that enables surgical teams to more efficiently manage their tools and tasks. I served as Chief Medical Officer of ExplORer Surgical until our series A investment round in 2017, and I remain a clinical advisor. My most recent lab-based invention is a wearable surgical camera that is in pilot trials and is patent-pending.
In 2017, I founded DesignWithPatients, a multidisciplinary program that partners patients with experts in design, engineering, medicine, business, and other talents from Vanderbilt and across Nashville. Our first event was "LaryHacks" a competition to develop quality-of-life enhancements in partnership with Laryngectomy patients.
My research and writing has been featured in the Boston Globe and the New York Times. I speak regularly on topics of transparency, surgical ethics, data science, head and neck surgery, and operating room efficiency, cost-reduction, and design. I have received funding from the National Science Foundation, the American Cancer Society, the Gold Humanism in Medicine Honor Society, the National Institutes of Health, the Howard Hughes Medical Institute, and the Greenwall Foundation. My complete list of peer-reviewed medical publications is available via PubMed.
The views and opinions expressed here are not necessarily those of Vanderbilt University Medical Center, ExplORer Surgical, my other affiliates and/or sponsors, and these views and opinions may not be used for advertising or product endorsement purposes.
1215 21st Avenue South, Nashville, Tennessee 37212, United States
Copyright © 2018 Alexander Langerman - Views My Own; All Rights Reserved.