Anesthesia information management systems are the anesthesia component of electronic medical records. They record everything from vital signs to drug dosages to procedural comments — basically, all the elements of the handwritten anesthesia record, but with enhanced capabilities such as automated documentation and charge capture, patient tracking and data analysis.

Up until a few years ago, most AIMS were standalone systems specific to anesthesia data acquisition. With the nationwide trend toward enterprise electronic medical records, however, IT vendors are creating anesthesia modules that integrate into larger perioperative EMR systems. Unfortunately, a lot of these general focus products aren't necessarily well-tested or designed to meet the needs of anesthesia recordkeeping.

Surgical facilities now have the choice between purchasing separate AIMS, which may be superior in functionality for anesthesia providers, or an integrated, facility-wide system that may be less suited to the specific needs of anesthesia, but is more convenient for the purposes of facility-wide standardization. Either way, AIMS have advanced markedly in recent years and there are several mature, best-in-class programs from which to choose.

Why invest in AIMS?
Research has shown that this technology has several benefits both for anesthesia providers and for the surgical facility as a whole.

• Better documentation of clinical care. AIMS have been shown to require less practitioner time, record more vital signs and clinical notes and eliminate the problem of illegible entries, compared with handwritten records. Another study comparing AIMS and handwritten records found that missing or erroneous data occurred more frequently in the latter, especially during the first 15 minutes and last 10 minutes of a case, when the greater attention to patient care that's typically required detracts from attention to documentation.
• Improvements in quality of care. Several studies have shown that simple reminders from an electronic anesthesia record significantly improved compliance with prophylactic antibiotic administration timing. In another study, an AIMS-based algorithm that alerted the clinician if a patient had multiple risk factors for PONV nearly doubled the use of antiemetic prophylaxis for these high-risk patients. AIMS can also integrate barcode systems to prevent medication errors, improve communication during patient handoffs and guide your staff's response during clinical emergencies.
• Cost containment and security. AIMS have been shown to generate cost savings by assisting with the implementation of anesthetic drug usage practice guidelines and the identification of practitioners who may be diverting controlled substances by monitoring dispensing behaviors and medication reconciliation.
• Efficiency and throughput. Data collected by AIMS are essential to a fully functional perioperative patient tracking system that can be used to promote and maintain efficient patient flow from pre-op through discharge.
• Tracking and reporting quality measures. Electronic systems provide a much more reasonable and logical way of creating reports on quality measures, such as hypothermia prevention and antibiotic delivery, that are necessary for the reporting requirements of hospitals, surgical facilities and anesthesia practices.

How do you choose a system?
When it's your surgical facility, not your anesthesia provider, purchasing the equipment (and in most cases it will be), your priorities will be understandably different. You're going to want a system that fits your facility's needs, and typically that means an integrated solution, not a separate AIMS that doesn't link up with your perioperative EMR. Integrating the perioperative and anesthesia records will help your facility analyze efficiency patterns and areas of improvement, such as optimizing case scheduling.

Beyond this completeness factor, focus on the attributes of an electronic system that will most benefit your facility, such as the ability to track patients, generate reports on supply usage and other useful data, analyze patterns and identify areas in need of improvement, report quality measures and other functions that contribute to efficiency and outcomes. The anesthesia billing component, on the other hand, may not be as useful because your facility is unlikely to bill for anesthesia services — usually the providers will do that.

Although it's the surgical facility that typically wields the purchasing power when it comes to EMRs and AIMS, it's important to involve at least the leaders of your anesthesia practice when choosing a system. Find a physician or CRNA champion who is both motivated and empowered to overcome the many organizational and technical barriers to AIMS adoption to help you select, customize and implement your new system. But be aware that finding this champion among your anesthesia providers, and getting the rest of the team on board with your digital transition, may be a bit of a challenge.

Can you expect pushback? Count on it. The move to EMRs is a cultural change, one that's supported more by practice leaders and administrators than it is by the average practicing anesthesiologist. Most physicians that move to electronic records aren't fond of them at first, and there is definitely a generational component to this. However, research has shown that clinicians eventually acknowledge that AIMS improve the quality of their practice and rarely ask to switch back to manual, handwritten anesthesia records once the transition is complete.

One of the biggest hurdles you'll encounter is the belief among many anesthesia providers that the detailed data captured automatically by AIMS could be used against them unfairly in legal proceedings. These fears are largely unfounded, as a survey addressing this issue demonstrated that AIMS's records either had a beneficial effect, or no effect, on outcomes of malpractice cases. No cases were hindered by the AIMS's record, and the majority of respondents would recommend AIMS as part of a risk management strategy.

Not if, but when
The early adopter period of electronic anesthesia recordkeeping is over; we're now moving into a period where surgical facilities are going to be switching from paper records to EMRs at a much faster rate. The options for functional anesthesia EMR products have expanded and improved. Support your anesthesia providers in the transition by purchasing a system that enhances clinical and economic efficiency, and by taking the time to train clinicians on how to use the system to its full potential.