Reply: Hyperlinked Dynamic Standard Operating Procedures for… : Plastic and Reconstructive Surgery

We thank Dr. Patel for attempting to implement the hyperlinked standard operating procedure system we proposed in our article.1 We understand the difficulties that were encountered in the process and wish to respond.

Any new system will have barriers to implementation and ours is no exception. The success or setback of a particular technology relies on the end-user acceptance of it. There is a need to assess the user’s technology acceptance before the development or improvements for that technology. The COVID-19 pandemic has accelerated the adoption of digital technology worldwide. Internet access has improved globally and doubled in Asia since 2014; however, last-mile connectivity is still a challenge in certain locations.2

A prerequisite for our system is the availability of internet coverage, at least in the most relevant areas in the hospital. We have an internal Wi-Fi network at our institution, and hence connectivity issues were minimal. Another prerequisite is the need for staff to be well versed in the operation of a device that can access the internet. As such, the recipients in our system only need to be able to access a URL link through an internet browser. An orientation or training session can solve any unfamiliarity with the process. The issue of personnel not in possession of a compatible device is another barrier to implementation; however, with the rapid penetration of smartphones globally, we believe that the issue will diminish over time.3,4

One prime motivation for developing and implementing such a system was ensuring team safety. It was conceived with the principles of minimizing interpersonal contact and exchange of potentially contaminated material. The traditional method of using printed media does not address these issues. The designation of a staff member to visit every area of interest is a risky proposition due to the possibility of asymptomatic COVID-19 carriers. We also believe such a task would use up considerable person-hours in large centers, which would only add to the prevailing deficit in human resources required in the combating the pandemic. The display of printed material at specific locations can encourage crowding, further detracting from the goal of ensuring personnel safety. Another aspect is the inability to link with other relevant resources and documents, which can be easily achieved in a digital system.

Peering toward the future of medicine, the role of systems leveraging information and internet technologies cannot be overstated. The rapid surge in the use of digital and computer-based solutions to tackle the myriad of challenges posed by the COVID-19 pandemic is evidence for the utility and benefits that such systems bring.5 Traditional offline methods of information dissemination do have their role in situations where the prerequisite infrastructure or knowledge for an internet-based system is nonexistent or insufficient. However, we believe that they must only be employed as stop-gap measures. The immense challenges faced during this pandemic have re-emphasized that our focus must be on the development and advancement of hospital infrastructure and on rendering the workforce to be proficient in the use of digital technologies.3


The authors have no financial interests to disclose.

Shivangi Saha, M.D., M.Ch.
Department of Plastic, Reconstructive and Burns Surgery
All India Institute of Medical Sciences
New Delhi, India

Praveen Prakash, M.B.B.S.
Department of Physiology
Jawaharlal Institute of Postgraduate Medical Education and Research
Puducherry, India

Maneesh Singhal, M.D., M.Ch.
Department of Plastic, Reconstructive and Burns Surgery
All India Institute of Medical Sciences
New Delhi, India


1. Saha S, Prakash P, Singhal M. Hyperlinked dynamic standard operating procedures for ensuring team safety during the COVID-19 pandemic. Plast Reconstr Surg. 2021;147:574e–576e.

2. Thorne E. Leveraging tech in the developing world–for Covid-19 and beyond. August 5, 2020. Tony Blair Institute for Global Change. Available at: Accessed June 16, 2021.

3. Budd J, Miller BS, Manning EM, et al. Digital technologies in the public-health response to COVID-19. Nat Med. 2020;26:1183–1192.

4. Top Countries/Markets by Smartphone Penetration & Users [Internet]. Newzoo. Available at: Accessed June 25, 2021.

5. He W, Zhang ZJ, Li W. Information technology solutions, challenges, and suggestions for tackling the COVID-19 pandemic. Int J Inf Manage. 2021;57:102287.


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