Chapter 22 Information technology and the anaesthetic workstation
Record keeping
Most anaesthetists in the United Kingdom still create a handwritten record, which is sometimes augmented by a printout from the monitoring systems. These are both only stored in paper format. Table 22.1 lists the advantages and disadvantages of manual records compared with computerized records. The report of the National Confidential Enquiry for Perioperative Deaths for 20001 showed that 5% of case notes were lost, and in 3% of those present the anaesthetic record was missing. There is no evidence that these figures have changed significantly since then. Nevertheless, the report concluded that ‘Improvements in Information Technology can make retrieval of patient information more, rather than less, difficult’. This must be viewed in the context of the time when records were all paper based, and the majority of information systems did not communicate with each other.
Computerized anaesthetic records
Computerized anaesthetic record systems have been available for many years, but despite their benefits and the sophistication of modern systems they have yet to gain widespread acceptance. One of the major impediments to their introduction has been the lack of a ‘business case’ to prove their financial worth. This is despite the fact that anaesthetists are involved in 60% of inpatient hospital activity, and that many studies have shown the benefits of automated records.2,3
One of the difficulties in providing a business case is that there is little, if any, evidence of cash savings from the introduction of a computerized record. However, electronic patient records have been shown to provide many ‘softer’ benefits, including improved patient safety (due to reliable and clear communication), better information about the patient and the clinical process at the point of care, and the ability to identify good and poor care by linking care to outcomes.4
The National Health Service in England is currently making a major investment in information technology for integrated medical records through NHS Connecting for Health.5 Initially anaesthetic and critical care systems were to be a key component, but delays in introducing the core systems have made it unlikely that anaesthetic systems will remain part of the programme. Now it is anticipated that the ‘Clinical Five’6 (see Box 22.1) will be delivered for most hospitals through off-the-shelf solutions, which will be linked to each other and to existing systems (including anaesthesia and critical care) by some form of integration system.
The features required of a computerized anaesthetic system are listed in Box 22.2.
