Implementation of an Anesthesia Information Management System (AIMS)

Abstract

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care-related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges.

Keywords: Anesthesia; electronic medical record; informatics.

Figure 1

Manually charted anesthesia record.

Figure 2

Graph/grid anesthesia information management system electronic anesthesia record.

Figure 3

Narrative commentary report from anesthesia information management system electronic anesthesia record.

Figure 4

Anesthesia information management system modules within DocuSys. Components below the horizontal line were part of the initial implementation. Items above the line were not initially implemented because they were in the final stages of product integration by the vendor.

Figure 5

Diagram of Ochsner local area network. PACU, postanesthesia care unit; OR, operating room.

Figure 6

Integration of patient and equipment data sources by the anesthesia information management system using DataCaptor as the translation software.

Figure 7

Typical anesthesia workstation including (1) DocuSys computer, (2) DocuSys touch-screen liquid crystal display monitor and keyboard, (3) Bluetooth barcode scanner, (4) physiologic monitor display, (5) anesthesia machine display, (6) movable boom containing outlets for anesthesia gases and network connection, and (7) the Pyxis machine.

Figure 8

Multiple cables at the back of the DocuSys computer.

Figure 9

Anesthesia information management system (AIMS) implementation workflow strategy.

Figure 10

Anesthesia record as displayed on liquid crystal display monitor. Note scroll bars and expanded content on the commentary at 08:46 as cursor hovers over it.

Figure 11

Content of buttons on (a) surgery intraoperative tab, (b) surgery postoperative tab, (c) administrative tab, and (d) miscellaneous tab (used to access Ochsner Health System intranet and internet).

Figure 12

DocuNote screen with drop-down box showing selection choices for mask ventilation.

Figure 13

Wireless Bluetooth barcode scanner and barcode anesthesia drug quickpick list.

Figure 14

Performance measure showing the use of end tidal carbon dioxide (ETCO₂) to monitor airway ventilation after induction of anesthesia.