If you're not creating an electronic record of your anesthesia data, you're hardly alone. While the experts we talked to say connecting your anesthesia monitors to your electronic medical records is a matter of when, not if, they also say we're years away from widespread use.
"EMR connectivity is becoming an identified need, but can be complicated, depending on the compatibility of the software used in individual facilities," says Julian Goldman, MD, an anesthesiologist in the departments of anesthesia and critical care and biomedical engineering at Massachusetts General Hospital in Boston and a founding member of the Society for Technology in Anesthesia.
Expect conversion to speed up when payer contracts are more closely tied to pay-for-performance initiatives and increased reimbursements depend on proof of quality surgical outcomes. Still, we thought it would be useful to give you a sense of the benefits of doing so now rather than later. As William Bray, CRNA, a nurse anesthetist at the Southeast Alabama Medical Center in Dothan, Ala., says, "Incorporating electronic medical records is where the entire industry is going. You can get dragged there, or you can get there on your own."
The benefits of electronic anesthesia records are hard to overlook. You can
- reduce medical errors,
- avoid duplicate entries in a patient's record,
- maintain more accurate clinical information, and
- transmit data between physician's offices, surgical facilities and insurers instantly.
In a nutshell, here's how it works. Patients are hooked up to the monitor, anesthesia is dialed up and vital signs are recorded electronically in a database. The monitor records the time the drug was given and the exact dose and strength of the drug. Instead of trying to remember dose information while transcribing data into the intra-op report, anesthesia providers are free to focus on patient care.
"The accuracy is incredible," says Mr. Bray. "You can't cheat or fudge the data. What happens in the OR is recorded, down to the second." Instead of observing a patient's behavior, administering a drug and taking note of the change to the patient's vital signs, electronic recordkeeping allows for a review of cases and a direct understanding of how medications affect a physiological change.
Most monitor vendors sell systems for use with proprietary connectivity software, says Dr. Goldman, who is developing standards-based network integration of medical devices to improve patient safety and efficiency. "People are recognizing the importance of broader data systems," he says, but warns about the absence of interoperativity, meaning you can't simply swap one brand of monitor with another or upgrade your clinical equipment and expect it to communicate with the software in your facility.
Be diligent in addressing the monitor's connectivity when shopping around, says Keith J. Ruskin, MD, assistant professor of anesthesiology at the Yale University School of Medicine in New Haven, Conn. "If you're buying these systems, talk to the manufacturers of the monitor and the electronic recordkeeper and ask each how both are connected," he advises, adding that simply asking is sometimes not enough.
Device manufacturers and software vendors might tell you their monitors and EMR systems can work together, even if a separate module is needed to make them compatible. Demand to see a working example of the setup and be sure to ask how much the module will cost, if it's needed at all. "Find out if the device will talk to the billing system. If it cannot, obtain a quote for the required module and get that amount written into the sales agreement," says Dr. Ruskin.
Plan now, pay later
In the outpatient environment, administrators need to first look at the cost benefit of the technology. The time and money you expend to add electronic medical record capabilities to your anesthesia monitors should be the deciding factor in making the investment. Do you need an electronic record of surgical data to justify more favorable payer contracts? Or do you have such a large center that being able to operate efficiently justifies the cost?
If you can dedicate enough staff time to both learning the system and entering current data from paper files, go ahead and invest in the technology, says Donald Martin, MD, professor of anesthesiology at Penn State University College of Medicine in Hershey, Pa. But if your technology budgets are slim and an upgrade of your anesthesia monitors is still years away, Dr. Martin suggests you transition by implementing clinical processes that translate well to EMRs.
"We've made our paper records mimic what would work electronically," says Dr. Martin. Instead of open-ended questions, his pre-op, intra-op and post-op forms contain checkbox menus and fill-in-the blank questions. That creates an organized anesthesia record, says Dr. Martin, and one that will translate easily to electronic records when staff are faced with the inevitable and arduous task of transferring patient records into computerized databases.
Seeing is believing
Designs of various monitors that work with EMRs make assumptions about your workflow based on ways to manage the anesthetic. Will you need to change how your staff works in order to incorporate a monitor into your ORs? "The process for logging a patient into the system may work in the boardroom, but will it work in the OR?" asks Dr. Ruskin, who warns against deciding on a purchase after seeing a single monitor attached to a laptop by a vendor peddling his product.
"The only way to see how a monitor works and records data is to talk to people who actually use it in a clinical setting," says Dr. Ruskin. He visited other facilities when the Yale School of Medicine decided to switch to EMRs and sought answers to the questions that matter to anesthesia providers: What do the on-screen menus look like and what do they control? How easy is it to toggle between commands? What are the default settings and how easily are they programmed?
Dr. Ruskin also delved deeper, asking practitioners for the number of keystrokes needed to call up a patient's record, the location of the electronic database and the system's built-in protections in case the central server crashes. He wanted to know the monitor's default choices for entering patient information and anesthetic dose amounts, and how the monitor performed after being splashed with cleaning solution, dropped on the floor or banged around the OR during room turnovers.
The information culled from the site visits was invaluable and was reviewed during weekly staff meetings before the EMRs' rollout. "We spent a lot of time with the people who use the systems and asked, 'Do you love it?'" says Dr. Ruskin.
As much as you may like to think otherwise, neither patients nor surgeons drive the need for new technology. It's the government and commercial payers who force the hands of facility administrators, and they soon will request a convenient means of reporting surgical data as a justification for higher reimbursements. As EMR technology improves and insurers pay a premium for having quality outcome data available, the demand for anesthesia monitors with EMR capabilities will increase.