The Basics of Anesthesia Information Management Systems

Abstract

HOW TO CHOOSE AN ANESTHESIA INFORMATION MANAGEMENT SYSTEMThere are many commercial products that are marketed as anesthesia information management systems (AIMS) in the United States (US) and worldwide. The overwhelming majority of anesthesiology departments who use AIMS choose commercial products, although a small number have chosen custom programming solutions. Despite incentives to adopt electronic health records and their various benefits, there was low penetration into the US market in a recent survey (o 10% of academic anesthesia practices in 2007). Adoption by smaller anesthesia practices is likely much lower. When surveyed as to why an AIMS had not been adopted, commonly cited reasons were cost, perceived medicolegal risk, and inertia. 1 Considering the low current use and the changing US healthcare environment, it is likely that many anesthesiology departments will be implementing AIMS in the near future.A detailed summary of the process of choosing and implementing an AIMS was the subject of a recent multicenter publication by Muravchick et al. 2 With some alteration, the process is described in Supplemental Digital Content 1, http://links.lww.com/ASA/A30. HOW TO USE AN AIMS Educating and Converting Skeptical Clinicians to Dedicated UsersPeople are often resistant to change, and an AIMS represents a substantial change compared with a manual anesthetic record. This is why one of the most important components of a successful AIMS is a local champion who is both motivated and empowered to overcome the many organizational and technical barriers to AIMS implementation. Such effort is rewarded, however, as clinicians eventually acknowledge that an AIMS improves the quality of their practice and rarely ask to switch back to manual/handwritten anesthesia records. 2 The medicolegal fears about AIMS arise from concern that data that would have been omitted from a handwritten record are automatically recorded in an AIMS one, even if it is factitious/artifactual or transient. A survey addressing this issue, however, showed that AIMS records either had a beneficial effect, or no effect, on outcomes of malpractice cases. No cases were hindered by the AIMS record and the majority of respondents would recommend an AIMS as part of a risk management strategy. 3 However, at least one case has been reported where a monitoring gap in an AIMS record caused by a technical failure, combined with additional data, showed that an attestation about the presence of an attending anesthesiologist at the time of extubation was entered before that event. This information was used to discredit the anesthesiologist and led to a settlement. The group's AIMS software was later modified to show an alert when the data stream from patient monitors is unexpectedly missing, and they also created a reporting system that discouraged premature attestations. 4 Improving Clinical DocumentationSeveral investigators have assessed the impact of an AIMS on the quality of clinical documentation. One study comparing AIMS-produced records to completely man...