Anesthesia information management systems

Published on 07/02/2015 by admin

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Anesthesia information management systems

Daniel V. Simula, MD and Jeff T. Mueller, MD

An anesthesia information management system (AIMS) is the anesthesia component of an electronic medical record (EMR). This data acquisition system collects and displays real-time perioperative data from anesthesia machines, patient monitors, and other medical devices. An advanced AIMS also provides decision support capability for clinicians and facilitates information management and quality improvement functions. Much like the flight deck management and flight control systems found in modern aircraft, an AIMS can minimize manual clinical documentation duties and facilitate increased situational awareness and attention to critical tasks.

Anesthesiologists have long been at the forefront of improving monitoring capabilities and enhancing patient safety. With advances in minicomputers in the 1970s and the advent of desktop computing in the early 1980s, anesthesiologists began to explore the viability of an automated anesthesia record. Given that a single anesthetic can create millions of bits of information and that up to 40% of an anesthesia provider’s time is spent as an information scribe, computer automation was seen as a natural way to create a higher quality record that required less manual documentation. Early designs consisted primarily of homegrown proprietary designs that did not benefit from standardization or integration with other systems. Over the past 30 years, established medical device and information technology companies have entered the AIMS market. Even today, this market is continuing to mature, and AIMS vendors currently provide products with wide variations in functionality and integration.

Architecture and configuration

Conceptually, an AIMS is simply the clinical information system that supports perioperative care. An AIMS can be a stand-alone system or can be integrated within a larger medical records system. In integrated environments, an AIMS might interface with clinical systems, such as an EMR or a CPOE (computerized physician order entry) system, or with practice management systems focused on surgical scheduling, supply management, quality improvement, or coding and billing.

A proper AIMS requires high-reliability hardware, software, and networks. Special attention to human factors engineering and user interface technologies has been shown to be extremely important for the successful design, deployment, and, perhaps most important, user acceptance of any AIMS installation. An AIMS presents all of the attendant requirements of a mission critical system. Dedicated support from the organization’s information technology department is an essential ingredient of a successful AIMS.

Prevalence and utilization

It is widely believed that AIMS utilization lags behind that of many other EMR components. A 2008 study demonstrated that only 14% of U.S. academic anesthesiology departments had fully operational systems.

Even today, the majority of AIMS implementations are stand-alone systems focused primarily on producing an automated anesthesia record. They tend to be poorly integrated with hospital EMRs, operating room management systems (e.g., surgical scheduling, patient tracking, supply management), and other operational systems (e.g., pharmacy, blood banking, physician orders, accounting, billing, quality reporting). However, evolving requirements created by pay-for-performance, quality, and safety initiatives and other administrative expectations are increasing the demand for integration and advanced AIMS. In response to these demands, a number of AIMS vendors are broadening their product offerings to include support for a wide variety of capabilities, such as preanesthesia evaluations, barcode-enabled drug and blood product administration and charting, drug-conflict checking, and user-accessible databases for outcomes research and quality reporting. Even with these attempts to offer more advanced functionality, there are significant downsides if these capabilities are poorly integrated with EMRs and hospital-wide information systems.

As with any evolving technology, early implementations deliver value primarily through singular feature–specific capabilities. Only later in the technology lifecycle does higher-order value from integration begin to overtake the more discrete functions of the system. The current literature on EMRs and medical informatics rarely mentions the use of AIMS. These omissions highlight just how different AIMS requirements are when compared with more general EMR functions and hospital information systems and how little actual integration currently exists. Given that the operating room is arguably one of the most fast-paced, resource-intensive, and high-risk environments in all of health care, it is surprising that anesthesiology is still faced with large “information gaps” and a general lack of advanced information technology.

Benefits

At first glance, the most obvious benefit of an AIMS is the elimination of manual charting on a paper anesthesia record, which not only reduces the need for mundane recordkeeping, but also provides real-time display of higher-order, clinically relevant information. Although they were viewed as significant progress at the time they were implemented, first-generation systems provided little more than the convenience of automatic charting and a legible record. As AIMS technology has progressed, additional benefits have been realized. A well-designed AIMS can add value to an anesthesia practice and the associated facility that is not attainable with paper anesthesia records. Benefits in quality improvement, safety, cost management, revenue capture, and medical liability have all been demonstrated. However, deploying any new and evolving technology introduces risks, and many of these risks and pitfalls have also been noted in the literature. Institutions without the necessary financial and technical resources or the full commitment of senior leadership should consider AIMS implementation cautiously. Making an informed decision includes consulting the literature and specialty organizations for guidelines, policies, technical recommendations, and best practices.

Although an increasing array of benefits have been attributed to AIMS technologies, the question of whether these systems broadly and consistently produce a positive financial return remains hotly debated. One significant confounding factor regarding return-on-investment discussions is determining who receives the benefit and who pays the cost. Although both anesthesia groups and facilities may realize significant benefit from an AIMS, the acquisition and support costs are frequently provided by hospitals or academic institutions. For the limited number of organizations that have deployed an AIMS, survey findings show that return-on-investment expectations have “generally been met,” with specific benefits attributed to improved clinical documentation, data collection for clinical research, enhancement of quality improvement programs, and improved regulatory compliance. Despite these benefits, the adoption of EMRs, and AIMS, has not yet occurred in many smaller health care facilities, where the majority of Americans receive their care. To provide the health care community with incentives to overcome the obstacles to EMRs, in 2009 the U.S. Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH). Through Medicare and Medicaid, the U.S. government will make available $27 billion over a 10-year period to facilitate the transformation to EMRs and, by extension, AIMS.

Summary

In their most basic stand-alone form, AIMS do little more than collect intraoperative anesthesia data and automate the recordkeeping for anesthesia care providers. More advanced AIMS include interfaces with other systems and decision support and information management functions. These advanced capabilities can directly facilitate improvements in billing, quality improvement, safety, regulatory compliance, and research. An integrated AIMS, by interfacing directly with the EMR and other hospital information systems, can facilitate improved and more efficient care far beyond the operating room. Generally, health care lags behind other industries in the utilization of integrated information technology. With fewer AIMS installations relative to other EMR components, this is particularly true for anesthesiology. However, AIMS implementation and use should increase significantly as the technology matures and its value becomes increasingly demonstrated and understood.

[/level-membership-for-anesthesiology-category][not-level-membership-for-anesthesiology-category]

Anesthesia information management systems

Daniel V. Simula, MD and Jeff T. Mueller, MD

An anesthesia information management system (AIMS) is the anesthesia component of an electronic medical record (EMR). This data acquisition system collects and displays real-time perioperative data from anesthesia machines, patient monitors, and other medical devices. An advanced AIMS also provides decision support capability for clinicians and facilitates information management and quality improvement functions. Much like the flight deck management and flight control systems found in modern aircraft, an AIMS can minimize manual clinical documentation duties and facilitate increased situational awareness and attention to critical tasks.

Anesthesiologists have long been at the forefront of improving monitoring capabilities and enhancing patient safety. With advances in minicomputers in the 1970s and the advent of desktop computing in the early 1980s, anesthesiologists began to explore the viability of an automated anesthesia record. Given that a single anesthetic can create millions of bits of information and that up to 40% of an anesthesia provider’s time is spent as an information scribe, computer automation was seen as a natural way to create a higher quality record that required less manual documentation. Early designs consisted primarily of homegrown proprietary designs that did not benefit from standardization or integration with other systems. Over the past 30 years, established medical device and information technology companies have entered the AIMS market. Even today, this market is continuing to mature, and AIMS vendors currently provide products with wide variations in functionality and integration.

Architecture and configuration

Conceptually, an AIMS is simply the clinical information system that supports perioperative care. An AIMS can be a stand-alone system or can be integrated within a larger medical records system. In integrated environments, an AIMS might interface with clinical systems, such as an EMR or a CPOE (computerized physician order entry) system, or with practice management systems focused on surgical scheduling, supply management, quality improvement, or coding and billing.

A proper AIMS requires high-reliability hardware, software, and networks. Special attention to human factors engineering and user interface technologies has been shown to be extremely important for the successful design, deployment, and, perhaps most important, user acceptance of any AIMS installation. An AIMS presents all of the attendant requirements of a mission critical system. Dedicated support from the organization’s information technology department is an essential ingredient of a successful AIMS.