This is the first in a series of CSA Online First articles about anesthesia information management systems (AIMS), written by Drs. Johnathan Pregler and James Moore from the Department of Anesthesiology at UCLA. UCLA is in the process of adopting such a system, and these blog articles will provide insight into the experience from their perspectives. The editorial comments throughout the article are based upon the editor, Dr Linda Hertzberg’s perspective, as a consequence of having gone through this process first hand in her own hospital, several years ago.
Choosing an AIMS:
Many factors will determine which information system is best for any particular practice. Integration with a facility’s non-anesthesia clinical systems is a primary determinant. The ability to transfer data easily from other physicians’ records and offices, nursing notes, and test results to the anesthesia perioperative record is a tremendous advantage. This alone will significantly reduce the amount of time and effort that anesthesiologists spend on documentation. AIMS cost estimates should include subsequent maintenance expenses, for software, hardware, and information technology infrastructure. Cost is certainly important, yet for an AIMS purchased as part of an Electronic Health Record (EHR) system for an entire enterprise, both the cost as well as the selection may be limited for the institution’s anesthesia department. However, the best information system for a hospital at large, does not always come with the ideal anesthesia information system. If the anesthesia module of an integrated system does not meet the needs of the anesthesia providers, a careful assessment of the pros and cons of installing an anesthesia system from another vendor should be undertaken.
Editor’s note: We were encouraged at our hospital to install a certain system that was supported by the vendor for the surgical peri-operative documentation piece. The reality was that the supposedly compatible systems never really communicated properly with one another. Now the hospital is obligated by its corporate parent to switch to an entirely different EHR within the next year. Needless to say, it remains to be seen if the current AIMS will be able to integrate with the new EHR, since the hospital cannot afford to install the supposedly compatible AIMS currently. Based on our experience, even if a “compatible” system is installed, there is no guarantee that it will integrate properly with existing systems. Be aware of these potential issues as you go forward.
If complete freedom exists in choosing an AIMS vendor, prospective systems should be considered for the value that they provide both in and out of the operating room. A principle consideration is that the system functions well in the operating room environment. Data collection should be automated across all of the different anesthesia machine and monitoring options at the facility.
Editor’s note: Consider all the places anesthesia is administered, labor and delivery (epidurals), cath lab, GI, radiology, ICU other out of OR areas. If you truly want to go completely electronic you will need to have the system installed and readily available in all your current offsite areas with the capacity and funds to expand to new sites as needed. We have multiple out of OR areas where we don’t have the AIMS and use paper records.
The system should have provisions for data collection in the case of a temporary interruption of the network or servers.
Editor’s note: We revert to paper records when this happens. Hopefully other institutions have a better backup plan.
Documentation of the written component of the record should be by template that can be modified easily during clinical care. In general, the AIMS should make documentation of anesthesia care easier than the use of paper.
Editor’s note: There is a learning curve and it will take time to reach this point once the system is installed, however, with a good system, one should be able to document quickly and accurately. I can do a record just as quickly (and very much more legibly than my own handwriting) with our AIMS.
In addition, users at other institutions that currently employ the prospective AIMS can provide critical insights into that system’s attributes.
If the chosen automated anesthesia record (AAR) does not include a comprehensive perioperative database, one may need to be purchased, implemented, and maintained independently.
Editor’s note: The importance of this cannot be over emphasized. If all you have is an anesthesia record, without other clinical data, you will not be reaping the benefit of risk stratification, quality improvement, and outcomes data that may be gleaned from a good AIMS. It has taken us a long time to be able to use our AIMS for this purpose.
The necessary resources for a separate database project may appropriately derive from the parent institution if the lack of database is a system-wide issue. Preferably, a modern AIMS will include such a database.
This introductory article has provided readers with some considerations when selecting an AIMS, including perspectives from within the process and in hind sight. Part 2 in this “AIMS Insights” series will discuss AIMS hardware and data sharing with outcomes registries. Please provide feedback about your own experiences by leaving comments below.
AIMS Insights, Part 2
AIMS Insights, Part 3