Review article: The evolving role of information technology in perioperative patient safety

Abstract

Purpose The adoption of new technologies in medicine is frequently met with both enthusiasm and resistance. The universal adoption of health information technology (IT) and anesthesia information management systems (AIMS) remains low despite the potential benefits. Electronic medical records, and hence AIMS, are at the intersection of patient safety. This article highlights advantages and barriers to adoption and implementation of IT in general and AIMS in particular, with a focus on clinical decision support systems (CDSS) and computerized physician order entry (CPOE) as hallmarks that may lead to improvement in patient safety and quality in the perioperative setting. Principal findings The advantages of health IT and AIMS include improved legibility of documentation; the ability to integrate new scientific evidence into practice; enhanced management and exchange of complex health information; the ability to standardize order sets, incorporate computerized physician order entry, and provide clinical decision support; and the ability to capture data for management, research, and quality monitoring and reporting. While not foolproof, AIMS have been shown to improve safety, quality, and patient outcomes. Barriers to the adoption of health IT and AIMS include costs, lack of truly interoperable AIMS components in health-system IT solutions, and lack of clinician involvement in implementation, planning, design, and installation of many IT or AIMS products. Conclusions Health IT and AIMS are at the intersection of patient safety and technology. Anesthesiologists are perfectly positioned to be the physician leaders of adoption, design, implementation, and integration, not only for AIMS but also for health-system IT solutions in general.

Asymmetry in patient-related information disrupts pre-anesthetic patient briefing

“…Anesthesia Information Management Systems (AIMS) show the potential to improve patient safety and quality in the perioperative setting. AIMS make legibility of documentation more feasible, which, in consequence, helps optimizing the exchange of complex health information [8]. In contrast, our data shows that using computer-based documentation and information systems was a significant nuisance.…”

“…With demographic changes there is a rising proportion of elderly patients suffering multiple comorbidities and polypharmacy. The fragmented nature of delivering health care, the large volume of transactions, the need to integrate scientific evidence into practice, and a rising transfer of information make electronic information management systems more appropriate to address continuous quality improvements and patient safety initiatives [8,9]. Here, IT is at the crossroads of technology and patient safety.…”

“…Criticism includes discomfort with rapid documentation and electronic data entry during short or emergency procedures and inconvenient placement of the system at the anesthesia workstation. A further barrier to adoption and implementation of IT seems to be the question about legal status with missing or outlier data [8,10]. In total, IT adoption will be decreased when interfaces between different software manufacturers or the lack of active physician involvement in planning, designing, and implementation of IT solutions still impede clinical practicability [8].…”

“…A further barrier to adoption and implementation of IT seems to be the question about legal status with missing or outlier data [8,10]. In total, IT adoption will be decreased when interfaces between different software manufacturers or the lack of active physician involvement in planning, designing, and implementation of IT solutions still impede clinical practicability [8]. At present, it remains open to question whether local solutions should be sought in optimized user training, in user-oriented software programming or in clinically appropriate hardware development.…”

Opportunities to enhance perioperative patient safety: 2013 and beyond

“…Michael Stabile and Lebron Cooper identify that uptake of health IT and AIMS remains variable despite the potential benefits, and they identify advantages and barriers to the adoption and implementation of IT in general and AIMS in particular. 3 Later articles in this theme issue address specific clinical issues that present ongoing challenges to the practicing clinician. Medication error remains a leading cause of adverse events in the perioperative setting.…”