Based on current research and development activities, a timeline with five stages of maturity levels for the development of the Digital Operating Room (DOR) during the first quarter of the twenty-first century will be outlined. In particular, there are several areas of technology development for the DOR such as (1) Devices, including signal detection and recording, robotics, navigation systems and simulation technologies, which allow more precision in the delivery of personalized interventional therapy; (2) Information and Communication Technology (ICT) Infrastructure and Standards, including Digital Imaging and Communications in Medicine (DICOM), Integrating the Healthcare Enterprise (IHE), the electronic medical record (EMR), and Therapy Imaging and Model Management System (TIMMS) infrastructure for the storage, integration, processing and transmission of patient specific data in and outside the operating room; and (3) Functionalities, including patient specific modeling for selected interventional processes, optimization of surgical workflow as well as TIMMS engines and repositories for improving the overall quality of surgical interventions. Patient specific modeling, work flow management and standards are key aspects for the development of DOR technologies. They will be the prerequisite for intelligent infrastructures and processes in the digital operating room of the future. Architectural aspects of an intelligent infrastructure, specifically a Therapy Imaging and Model Management System (TIMMS) and the Patient-Specific Model (PSM) as well as Standards and integration mechanisms are therefore briefly discussed in this paper.