Houston Methodist ties camera AI in 15 cardiothoracic surgery rooms to about 25 more cases a month, and says it can't prove the cameras caused it
Houston Methodist researchers published a study in the Journal of Imaging on June 27th, 2026. It covers an image based AI system from Apella that the hospital put into a 15 room cardiothoracic suite at Walter Tower in December 2022. Four wall mounted cameras in each room feed a model that timestamps workflow events such as patient entry, draping and turnover. The system also texts surgeons as a case moves. The study compares the suite with a synthetic control built from 10 donor sites. It estimates about 25 more cases a month, a 7 percent rise, with an interval of 8.3 to 41.0. A placebo test returned p = 0.182 and fell short of conventional significance. The authors call the rise associated with the deployment rather than caused by it. The rollout came bundled with workflow reviews and the study can't separate the two. The hospital holds a minority equity interest in Apella. An Apella employee ran the original analyses and a hospital analyst replicated them.
How to take part
The study is published open access and can be read in full with its methods, its limits and its conflict of interest statement. A hospital's choice of operating room software is not a public proceeding. Patients are told of the cameras by signs in the rooms.
Where
1 county. In Houston-Pasadena-The Woodlands.
Timeline
- filed
Published in the Journal of Imaging
- Today
How this decision moved
One dated line per check, oldest first. A line that says nothing changed means somebody looked and it had not.
- 2026-10-20
Admitted on the published study and the hospital's own account of it. Neither says how widely the cameras have spread since the study period, which ended in September 2023.
The evidence
Every fact above rests on one of these. The words are the source's own.
2026 Jun 27;12(7):283. doi: 10.3390/jimaging12070283Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
in a 15-room cardiothoracic suite at Houston Methodist Hospital (HMH)Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Each operating room was outfitted with four high-resolution wall-mounted camerasJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
The IBAI software was deployed at Walter Tower (WT) in December 2022.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Over a 16-month period spanning 6 months pre-deployment and 10 months post-deployment, the system monitored 5417 surgical casesJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
showed a statistically significant increase of approximately 25 cases per month (95% CI 8.3 to 41.0; p < 0.01; Bonferroni-adjusted p < 0.05), corresponding to a 7% increase in monthly case volume relative to baselineJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
roughly 7% against a baseline of approximately 339 cases per monthJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Walter Tower had the second-largest ratio of post-deployment to pre-deployment prediction error among the 11 units (Walter Tower and 10 donor sites; empirical p = 0.182)Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
the permutation result is directionally consistent with the difference-in-differences estimate but does not reach conventional statistical significanceJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
we interpret the case-volume effect as associated with, rather than caused by, IBAI deploymentJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
The current effect estimate therefore reflects the combined contribution of the technology platform and the change-management program, and cannot separately attribute the observed gains to one or the other component.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
In a sensitivity analysis using total operative minutes per month as a case-mix-insensitive outcome, the difference-in-differences estimate was not statistically significantJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Houston Methodist Hospital holds a minority equity interest in Apella Technology.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Nate Hilger, acknowledged above for conducting the original synthetic control and difference-in-differences analyses, is employed by Apella Technology.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
These analyses were subsequently replicated independently by a Houston Methodist analyst using the same aggregated dataset.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Apella Technology did not fund the study and had no role in the study design, the interpretation of results, the decision to publish, or the preparation of the manuscript, beyond the analytical contribution described aboveJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Video footage is retained for a maximum of 30 days and audio for a maximum of 7 daysJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Access to intraoperative recordings, defined as the period from incision to skin closure, is restricted to three designated rolesJournal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
The surgeon is informed whenever an intraoperative recording is reviewed.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
The system was trained on a global dataset comprising 137,517 surgical cases performed across 315 operating rooms by 1853 surgeons.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Locations and actions were confirmed by a human-led quality control team.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
The new system uses wall-mounted cameras in each OR to automatically identify and timestamp these moments.Houston Methodist, Image-Based AI Improves OR Efficiency at Houston Methodist Primary source, the company · houstonmethodist.org
It also sends text alerts to surgeons when a patient arrives, when the patient is draped and when the case ends.Houston Methodist, Image-Based AI Improves OR Efficiency at Houston Methodist Primary source, the company · houstonmethodist.org
Operative minutes did not decrease, indicating surgeons were not operating faster. However, turnover times decreased, enabling more cases to be completed within the same OR hours.Houston Methodist, Image-Based AI Improves OR Efficiency at Houston Methodist Primary source, the company · houstonmethodist.org
Staff expressed concerns about surveillance, data security and privacy, prompting extensive discussions with legal, ethics and operations teams.Houston Methodist, Image-Based AI Improves OR Efficiency at Houston Methodist Primary source, the company · houstonmethodist.org
For patients, clear signage is posted in ORs and consent is incorporated into universal consent for care.Houston Methodist, Image-Based AI Improves OR Efficiency at Houston Methodist Primary source, the company · houstonmethodist.org
the 10-month post-deployment period (December 2022 through September 2023)Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Houston Methodist has a commercial relationship with Apella Technology (San Francisco, CA, USA), the vendor of the image-based AI system evaluated in this study, comprising the purchase of operating room camera hardware.Journal of Imaging, Implementation of Image-Based Artificial Intelligence Is Associated with Increased Case Volume in a High-Acuity, 15-Room Cardiothoracic Operating Suite at a Tertiary Academic Hospital Primary source, official · pmc.ncbi.nlm.nih.gov
Questions about this decision
Answered from the record itself. Every answer is assembled from stored fields, so an answer the record has no basis for is left out rather than guessed.
What is this decision?
Houston Methodist researchers published a study in the Journal of Imaging on June 27th, 2026. It covers an image based AI system from Apella that the hospital put into a 15 room cardiothoracic suite at Walter Tower in December 2022. Four wall mounted cameras in each room feed a model that timestamps workflow events such as patient entry, draping and turnover. The system also texts surgeons as a case moves. The study compares the suite with a synthetic control built from 10 donor sites. It estimates about 25 more cases a month, a 7 percent rise, with an interval of 8.3 to 41.0. A placebo test returned p = 0.182 and fell short of conventional significance. The authors call the rise associated with the deployment rather than caused by it. The rollout came bundled with workflow reviews and the study can't separate the two. The hospital holds a minority equity interest in Apella. An Apella employee ran the original analyses and a hospital analyst replicated them.
Who decides it?
Houston Methodist Hospital decides. The record names the deciding body for every entry it carries.
Can the public take part?
The study is published open access and can be read in full with its methods, its limits and its conflict of interest statement. A hospital's choice of operating room software is not a public proceeding. Patients are told of the cameras by signs in the rooms. No dated public window is on the record. The deciding body is named and reachable.
Where in Texas does it apply?
It covers Harris County in the Houston-Pasadena-The Woodlands, TX area.
Has it been decided?
It has been decided. The dates on the item page carry when.
What happens next?
No future date is on the record. The last dated step on it was filed on June 27th.
When did it start?
The earliest date on its record is June 27th, 2026.
What kind of decision is it?
It is filed under health and education.
What sources back it?
Two sources back it. Two of them are primary.
Is it on the ERCOT grid?
Yes. It sits inside the ERCOT interconnection.
When was it last checked?
Every fact on it was last verified against its source on October 20th, 2026.
Cite this
Texas AI Docket, Houston Methodist ties camera AI in 15 cardiothoracic surgery rooms to about 25 more cases a month, and says it can't prove the cameras caused it. Tracked since June 27th, 2026. Last verified October 20th, 2026. https://texasaidocket.com/item/tx-2026-0222/. Reuse permitted under CC BY 4.0 with attribution. The same entry is in the docket JSON as item tx-2026-0222.
Beat
Filed under Health and education, with every other decision on that beat.