In endeavoring to advance the use of anesthesia information systems, the APSF sponsored a conference on October 11, 2002. Michael O’Reilly, MD, MS, from the University of Michigan, organized a group of speakers to address various practical matters and challenges associated with the purchase and implementation of an anesthesia information system.
Dr. Robert Stoelting opened the conference by emphasizing the belief of the APSF that the widespread deployment of anesthesia information will likely be the next major advance in patient safety. In 2001, the Anesthesia Patient Safety Foundation passed the following resolution: “The APSF endorses and advocates the use of automated record keeping in the perioperative period and the subsequent retrieval and analysis of the data to improve patient safety.”
The first speaker, Keith Long, MD, a private practitioner from Winchester Hospital, Winchester, MA, described how they have used data generated by their anesthesia information system to better manage their operating rooms. In particular, they used time stamps that defined the length of procedures, procedures per day, and turnover times, resulting in more cases being done in a given amount of time, and enhanced surgeon, anesthesiologist, and administrator satisfaction.
Dr. Iain Sanderson from Duke University provided an update on the Data Dictionary Task Force (DDTF). The DDTF was formed in April of 2002 with support from various vendors of Anesthesia Information Systems. Since anesthesia information systems must be configured with the terms that describe anesthesia practice, a data dictionary will help anesthesia care providers and vendors of information systems configure their systems in a way that will facilitate outcomes and process improvements research.
The DDTF has made significant progress in the last year and has developed a tool to map terms from various anesthesia information systems so that the meaning of various terms can be understood and compared. This tool is called DATAMS (Distributed Anesthesia Terms and Mapping System). Continuing work of the DDTF will determine the usefulness and overlap with currently available data dictionaries. For example, the SNOMED CT data dictionary has a number of anesthesia terms but the majority of anesthesia terms are not included in the SNOMED CT database. Since SNOMED CT endeavors to be comprehensive, the DDTF is discussing collaboration and cooperative with the SNOMED organization (See DDTF Report, Page 63.)
There were two presentations that described the value of the clinical data derived from an AIS. David Reich, MD, Mt. Sinai Hospital, NY, NY began by reviewing the studies that highlighted the inaccuracy of written paper records. Dr. Reich showed data demonstrating the connection between interoperative events and outcomes.
Steve Lussos, MD, a private practitioner from Fairfax Hospital, Fairfax, VA, described how they are using their anesthesia information as a quality assurance tool. For example, they review all cases where an ASA I or II patient received epinephrine. Dr. Lussos also described detailed cases where the use of the AIS provided insight into the sequence of events and outcomes. Lussos presented a very interesting case of a patient who had a pheochromocytoma.
Neil Feinglass, MD, from the Mayo Clinic Jacksonville, described some of the advantages and disadvantages of implementing an anesthesia information system that is tightly linked to an enterprise-wide clinical information system.
In the last presentation, Dr. Jeff Feldman addressed the issue of liability and whether or not clinicians were likely to be successfully sued if they used an Anesthesia Information System.
The overwhelming consensus of the group was that an electronic anesthesia record would help more than harm. However, it was pointed out that the group in the room was the choir and others, not present, might not agree.
Dr. O’Reilly is Clinical Associate Professor of Anesthesiology at the University of Michigan Medical School, Ann Arbor, MI.