In theory, creating an electronic anesthesia record and importing it into a patient's electronic medical record should be easy. You just connect the vital signs monitor to the network running the EMR software and the anesthesia information will flow directly into the patient's record and billing software, right? Unfortunately, linking monitors to EMR systems is usually not a plug-and-play operation. There might be a serial plug in the back of your monitor, but unless you recently purchased an enterprise system with an anesthesia module that captures all clinical and patient information, your monitoring devices and EMR system are going to have trouble talking to each other.

So how do you get the information that the anesthesia provider sees on the vital signs monitors into the EMR system? In most cases, you'll need the proper cables, a box called a device integrator and the proper device drivers.

• Cables and plugs. Most vital signs monitors have an RS-232 serial port, which uses a plug similar to those that attach printers to home computers. Some newer monitors have USB plugs as well.
• Speaking the same language. You can't just run a cable from your monitor into an EMR system, because they might not speak the same language. Messages coming out of most monitors are in an analog format and need to be converted to a digital format. EMR systems usually communicate between different systems in a proprietary language, or via Health Level Seven messaging format, which is the lingua franca of hospital information system standards. Now used worldwide, HL7 facilitates the flow of information between electronic clinical documents, patient tracking systems and billing and scheduling software. Not all information-collecting devices generate data that you can send to other devices using HL7, so you'll need a translator.
• Device integrators. These are sort of like the cable box on top of your TV. The anesthesia machine, pulse oximeter, cardiac monitors and other devices can be plugged directly into the device integrator, which can send data to an anesthesia information management system (AIMS), to the EMR system directly if it includes an anesthesia module or to a telemetry station.
• Device drivers. Again, just like at home, when you plug a printer into your PC, it usually doesn't work right away. You need an intermediary piece of software, a printer driver, to let the PC and the printer communicate. The same goes for medical devices. The device integrator needs drivers for each device to which it's connected. Who supplies the drivers and who pays for them depends on the situation. Your EMR software may include specific drivers with the add-on specialty modules that you purchase. Or you may need to purchase the driver from a device manufacturer or a third-party software firm.

Is it worth it?
Creating a system that connects the parts of the anesthesia process isn't cheap. Plan on spending $20,000 or more per operating room. This makes investing in your anesthesia program a difficult decision, since it isn't generally considered a direct revenue-generating specialty. However, the efficiencies, reductions in errors, improved charge capture and compliances with the Joint Commission, Surgical Care Improvement Project and other national quality measures make including anesthesia in your EMR strategy a worthwhile investment.