Adoption of Anesthesia Information Management Systems by Academic Departments in the United States

Halbeis, Christoph B. Egger; Epstein, Richard H.; Macario, Alex; Pearl, Ronald G.; Grunwald, Zvi

doi:10.1213/ane.0b013e31818322d2

Cited by 77 publications

(41 citation statements)

References 7 publications

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“…[7][8][9][10] Anesthesia information management system (AIMS) technology was once the domain of an enthusiastic minority, but use is increasing. 11,12 Published data have reduced concerns about the potential of AIMS to reduce vigilance and increase medico-legal exposure 5,13,14 (although there were more lapses in response to a vigilance task in a recent randomized controlled trial [RCT] in our own institution). 6 Sophisticated AIMS have integrated initiatives to increase adherence to guidelines, reduce errors in drug administration, and facilitate quality assurance.…”

Section: Résumémentioning

confidence: 99%

A randomized comparison between records made with an anesthesia information management system and by hand, and evaluation of the Hawthorne effect

Edwards

Hagen

Hannam

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Anesthesia information management system (AIMS) technology is designed to facilitate high-quality anesthetic recordkeeping. We examined the hypothesis that no difference exists between AIMS and handwritten anesthetic records in regard to the completeness of important information contained as text data. We also investigated the effect of observational research on the completeness of anesthesiologists' recordkeeping. Methods As part of a larger randomized controlled trial, participants were randomized to produce 400 anesthetic records, either handwritten (n = 200) or using an AIMS (n = 200). Records were assessed against a 32-item checklist modified from a clinical guideline. Intravenous agent and bolus recordings were quantified, and data were compared between handwritten and AIMS records. Records produced with intensive research observation during the initial phase of the study (n = 200) were compared with records produced with reduced intensity observation during the final phase of the study (n = 200). Results The AIMS records were more complete than the handwritten records (mean difference 7.1%; 95% confidence interval [CI] 5.6 to 8.6%; P \ 0.0001), with higher completion rates for six individual items on the checklist (P \ 0.0001). Drug annotation data were equal between arms. The records completed early in the study, during a period of more intense observation, were more thorough than subsequent records (87.3% vs 81.6%, respectively; mean difference 5.7%; 95% CI 4.2 to 7.3%; P \ 0.0001). Conclusions The AIMS records were more complete than the handwritten records for 32 predefined items. The potential of observational research to influence professional behaviour in an anesthetic context was confirmed. This trial was registered at the Australian New Zealand Clinical Trials Registry No 12608000068369.

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Section: Résumémentioning

confidence: 99%

A randomized comparison between records made with an anesthesia information management system and by hand, and evaluation of the Hawthorne effect

Edwards

Hagen

Hannam

et al. 2013

Can J Anesth/J Can Anesth

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“…Nonetheless, evidence also suggests that implementation of AIMS is on the cusp of an upward surge [6] and it may be that the handwritten anesthetic record, having served our specialty for over 100 years, is soon to be of historical interest only.…”

Section: History and Terminologymentioning

confidence: 99%

“…Evidence suggests that the AIMS' greatest strength (powerful capabilities) is also its main drawback (complexity) which has hindered its widespread adoption [6] despite vigorous endorsement by the Anesthesia Patient Safety Foundation [7]. Nonetheless, evidence also suggests that implementation of AIMS is on the cusp of an upward surge [6] and it may be that the handwritten anesthetic record, having served our specialty for over 100 years, is soon to be of historical interest only.…”

Section: History and Terminologymentioning

confidence: 99%

“…An early study found that artifacts were readily identified and screened out in the electronic record [11] and subsequent experience has borne out that artifacts are indeed, a non-issue medico-legally [10]. Nonetheless, as recently as 2008 [6], a survey of academic anesthesiology centers showed that concern for increased medico-legal exposure was one of the most frequently-cited reasons among those who had not adopted an AIMS. An anecdotal report of missing data on an electronic record [12] accounted for one instance of medico-legal liability, although undoubtedly, many unpublished cases of incomplete handwritten records have impeded efforts towards a successful defense.…”

Section: Medico-legal Documentmentioning

confidence: 99%

“…The electronic anesthetic record, in its current manifestation, is just one part of a more complex "anesthesia information management system" (AIMS) where the anesthetic record component interfaces with numerous other hospital data bases, such as medical records, preoperative assessments, laboratory results and surgical scheduling. The AIMS can also be expanded to create research, quality assurance and professional services (billing) databases [5].Evidence suggests that the AIMS' greatest strength (powerful capabilities) is also its main drawback (complexity) which has hindered its widespread adoption [6] despite vigorous endorsement by the Anesthesia Patient Safety Foundation [7]. Nonetheless, evidence also suggests that implementation of AIMS is on the cusp of an upward surge [6] and it may be that the handwritten anesthetic record, having served our specialty for over 100 years, is soon to be of historical interest only.…”

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confidence: 99%

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The Anesthetic Record: How Content and Design Influence Function In Anesthetic Practice and Beyond

Raymer¹

2011

J Anesth Clin Res

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IntroductionThe original anesthetic record was developed during the early days of the practice of Anesthesia to record pulse, as part of an effort to improve outcomes which at the time were poor. Though many aspects of our modern anesthesia practice would be unrecognizable to the pioneers of our specialty, the current handwritten anesthesia record looks remarkably similar to the original charts produced over a century ago [1]. Despite the superficial similarities, today's anesthetic record serves myriad functions beyond its central role as a medical record of anesthetic care. It is a key interdisciplinary communication tool, a source of information for research and quality assurance projects and a legal document that can be used in a wide range of medico-legal proceedings. The evolution of the record from handwritten to electronic form has advanced these roles, while at the same time bringing forth new challenges.The anesthetic record should promote the user's ability to achieve specific goals. Although it is an essential tool used by the Anesthesiologist on a daily basis, there is relatively little literature to guide its design and use. This article will describe the history of the anesthetic record and outline its use in our practice today. The content requirements, driven by legislative, medico-legal, professional and clinical factors, will be summarized. Finally, the impact of formatting choices, including handwritten and electronic media, is discussed. History and TerminologyThe first anesthetic records were devised in 1894 by two medical students, Harvey Cushing and Amory Codman. Often charged with delivering anesthetics for their surgical supervisor, Dr. F.B. Harrington, their descriptions of the use of those first charts offers a glimpse into the harrowing early days of the practice of Anesthesiology [1]. Cushing credits the charts with formalizing what had been, to that point "the very casual administration of a dangerous drug" [1]. His writings reveal how the recording of vital signs (pulse, respiratory rate, and later, blood pressure) along with the amount of ether administered was key in developing the understanding of cause and effect that modern-day anesthesiologists take for granted. The formative role that the anesthetic record played in both patient safety and the development of the specialty itself was noted by several observers, including Harold Griffith [2].The amount of information collected continued to increase and with the dawn of the digital age, the first electronic anesthetic records were introduced in the 1980's [3,4]. The electronic record allows automated capture of a large volume of physiologic and mechanical data. It also allows manual inputting of information by the clinician (by keyboard, mouse, touch-screen or microphone) and together, the automated and inputted data are organized to become the electronic anesthetic record which can be both stored in a database as well as printed out in paper form to be put on a physical chart. The electronic anesthetic record, in its current ...

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Patient Safety and Quality: Management for the Radiation Oncologist

Alite¹

2017

Clinical Radiation Oncology

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Adoption of Anesthesia Information Management Systems by Academic Departments in the United States

Cited by 77 publications

References 7 publications

A randomized comparison between records made with an anesthesia information management system and by hand, and evaluation of the Hawthorne effect

A randomized comparison between records made with an anesthesia information management system and by hand, and evaluation of the Hawthorne effect

The Anesthetic Record: How Content and Design Influence Function In Anesthetic Practice and Beyond

Patient Safety and Quality: Management for the Radiation Oncologist

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