Peace of mind
Whereas this previously took place routinely during an outpatient visit, E-POS allows patients to prepare at home. In addition to completing a digital questionnaire, various instructional videos are provided explaining preparation for surgery, anesthesia options, and potential side effects of the chosen anesthesia. Based on international guidelines, the patient's surgical data, and the answers to the questionnaire, an advisory document is generated using AI. This document indicates whether the patient is eligible for direct digital approval or if a telephone consultation with the physician is required. "As a result, surgeries with a low-risk profile can be placed directly on the operating list following a digital preoperative assessment. Only in the case of higher-risk surgeries—meaning when there are underlying health concerns or a more complex procedure—are patients still invited for a check-up at the outpatient clinic. This allows us to screen efficiently and enables specialists to focus their attention on the patients who truly need it. And because this group has also received the necessary information in advance via video animations, we notice at the clinic that conversations between patients and specialists are much more substantive." Initially, there were certainly questions surrounding the implementation of E-POS. For instance, there was much ambiguity regarding the workflow and usability for patients and healthcare professionals. A task force mapped out all bottlenecks and resolved them in a short time. "As with any new application, there was room for improvement. Furthermore, questions were raised about the demographic that might be less digitally literate due to age. This proved unfounded; individuals either managed well on their own or had someone in their network to assist them. Overall, patients feel sufficiently informed prior to surgery thanks to the video animations. A positive side effect is that people can now absorb the information at home, whenever and with whomever they choose. Consequently, they process the information better and retain more of it than during an outpatient consultation. It creates peace of mind for individuals, which is definitely a positive aspect of the screening software."

Safety
The big question is whether E-POS, in terms of preoperative screening, offers the same level of safety as the previous situation where every patient scheduled for surgery was routinely seen at the clinic. "What we notice is that the underlying algorithm in the system is conservative, erring on the side of caution," states Van Roy. "It offers another advantage: in the old situation, prior to every preoperative consultation, the specialist had to make an assessment under time pressure. Now, the specialist has access to a clear advisory report based on which he or she determines whether and what additional preoperative examination is needed. Digital triage not only provides deeper insight into the patient's health status but may even be more consistent."

Smartwatches
Dijklander is playing a pioneering role. "We got on board early, while the system was still in development. Others initially took a wait-and-see approach. It is good to see that E-POS is being rolled out further and embraced by an increasing number of hospitals." Van Roy envisions many more possibilities for the application of artificial intelligence. "For instance, I can imagine digital monitoring continuing even after surgeries. The trend is to keep people in the hospital for as little time as possible, and digital support can facilitate this. Following certain procedures, a patient can go home immediately if you monitor their recovery process—using digital questionnaires and smartwatches, for example—and ask questions about temperature and bowel function. This allows us to monitor whether postoperative complications are developing, enabling early detection if things start to go wrong. Patients can then recover safely at home." "Developments are moving incredibly fast. Most smartwatches, for instance, can already record heart rate and blood pressure. Therefore, I expect that within five to ten years we will be able to handle the entire preoperative examination remotely, while patients are at home, provided this information can be exchanged securely. Smartwatch measurements are constantly improving. Especially now that we have to do the work with fewer people, this is a way to still provide the care you want to deliver," believes Van Roy. "The electronic highway is going to play an increasingly important role."

Risk group
As more hospitals transition to E-POS, more and more data becomes available for analysis. "I can imagine that this provides greater insight, for example into which group of patients would benefit from a preemptive ECG. In the past, this was standard for anyone over sixty; now, every hospital has its own policy. By analyzing the data, we can determine much more distinctively, targetedly, and accurately which patient group truly constitutes the risk group and still requires additional preoperative examination. And this naturally applies to any other group as well." "Digital applications that enable the exchange of medical data will increase," predicts Van Roy. But what happens to your health data, and how is this information protected against misuse? "Technological progress leads to ethical and legal discussions. In practice, regulations often lag behind technological developments. Dijklander Hospital is obligated to apply current patient privacy legislation and monitor compliance. E-POS features two-factor authentication (an extra layer of security). Only after the patient approves personal identification, the provided medical information, and consent can the digital file be sent to the anesthesiologist. Analyses required for scientific research extracted from the E-POS database will always be conducted anonymously, meaning they are non-traceable."