The sheer volume of data streams that comprise the anesthesia patient chart make integrating anesthesia into the perioperative electronic medical record a challenging task — and one that not all anesthesia providers are convinced will improve the accuracy and efficiency of charting. Whether you're beginning to go paperless or upgrading your existing system, be sure to include your anesthesia providers in the planning process. Here are 4 questions and concerns they're likely to raise.

1. Why do we need an anesthesia EMR? The goal of the anesthesia EMR is to capture and store all physiologic data, including gas agents and ventilator settings, in digital form. In addition to automating the intraoperative anesthetic record, these systems let anesthesia providers electronically document the entire perioperative patient experience, including pre- and post-op evaluations. With government and reimbursement incentives pushing all healthcare providers to go digital, it's imperative that anesthesia records communicate and coordinate with the surgical facility's databases to provide information about a patient's demographics, laboratory studies, medical history, billing and quality measures such as the timing of antibiotic dosing.

2. How will going paperless improve patient care? Theoretically, the anesthesia EMR can increase charge capture, facilitate patient throughput and improve patient care. Surgical facilities can analyze EMR data to establish practice standards for medication safety, perioperative medical error rates, billing success and adherence to accrediting body requirements. For example, the University of California San Francisco Medical Center uses the EMR to calculate a "risk score" based on the patient's history and physician exam, which helps determine the need for pre-operative beta-blockers. Electronic systems also facilitate reporting of mandated data to regulatory bodies such as the Centers for Medicare and Medicaid Services.

3. Do EMRs really improve efficiency? Anesthesia EMRs should facilitate a smooth transition from intraoperative to PACU care, letting the anesthesia provider move on to the next patient without the undue burden of paper charting. But while EMRs are touted as time savers, your anesthesia providers may worry that digital records actually impede efficiency and distract them from direct patient care. Those who've already worked with EMRs at other facilities may have encountered systems that weren't equipped to efficiently capture multiple streams of information from various monitoring sources. The EMR software market is constantly evolving and improving to accommodate the complexity of the perioperative process. The best way to ensure the system you select actually enhances, rather than detracts from, efficiency is to seek input from your anesthesia providers and let them help trial the system before you make a purchase.

4. Will electronic records increase my liability risk? Fear of litigation is 1 reason why anesthetists have been slow to adopt EMRs. Their primary concern is that erroneous or misleading data — for example, false EKG readings taken while briefly adjusting leads for patient positioning — permanently stored in the digital record could paint an unfair picture of a case and present a potential liability in the event of a malpractice suit. Whether they're founded or not, you must find a way to allay such fears in order to comply with Washington's push for all patients to have a fully integrated electronic health record by 2014.

Research by the American Society of Anesthesiologists about the benefits of EMRs may help you make the case to your anesthesia providers. A recent analysis of ASA's Closed Claims Project database shows that, out of a total of 6,458 claims, 27 were found to be cases in which some form of EMR was used. In the organization's assessment, only 4 out of the 27 malpractice cases could be "blamed" on the electronic medical record. In a 2007 ASA survey of 55 anesthesiology departments, about a third of which had used EMRs for several years, 4 departments rated the electronic record as "essential to litigation defense," and 18 departments rated the EMR as an overall valuable tool.1