scholarly journals Manual Editing of Automatically Recorded Data in an Anesthesia Information Management System

2008 ◽  
Vol 109 (5) ◽  
pp. 811-815 ◽  
Author(s):  
David B. Wax ◽  
Yaakov Beilin ◽  
Sabera Hossain ◽  
Hung-Mo Lin ◽  
David L. Reich
Keyword(s):  
Information Management ◽  
Management System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Information Management System ◽  
Anesthesia Information Management System ◽  
Physical Status Classification ◽  
Information Management Systems ◽  
Data Points ◽  
American Society

Background Anesthesia information management systems allow automatic recording of physiologic and anesthetic data. The authors investigated the prevalence of such data modification in an academic medical center. Methods The authors queried their anesthesia information management system database of anesthetics performed in 2006 and tabulated the counts of data points for automatically recorded physiologic and anesthetic parameters as well as the subset of those data that were manually invalidated by clinicians (both with and without alternate values manually appended). Patient, practitioner, data source, and timing characteristics of recorded values were also extracted to determine their associations with editing of various parameters in the anesthesia information management system record. Results A total of 29,491 cases were analyzed, 19% of which had one or more data points manually invalidated. Among 58 attending anesthesiologists, each invalidated data in a median of 7% of their cases when working as a sole practitioner. A minority of invalidated values were manually appended with alternate values. Pulse rate, blood pressure, and pulse oximetry were the most commonly invalidated parameters. Data invalidation usually resulted in a decrease in parameter variance. Factors independently associated with invalidation included extreme physiologic values, American Society of Anesthesiologists physical status classification, emergency status, timing (phase of the procedure/anesthetic), presence of an intraarterial catheter, resident or certified registered nurse anesthetist involvement, and procedure duration. Conclusions Editing of physiologic data automatically recorded in an anesthesia information management system is a common practice and results in decreased variability of intraoperative data. Further investigation may clarify the reasons for and consequences of this behavior.

Development of a Module for Point-of-care Charge Capture and Submission Using an Anesthesia Information Management System

2006 ◽  
Vol 105 (1) ◽  
pp. 179-186 ◽  
Author(s):  
David L. Reich ◽  
Ronald A. Kahn ◽  
David Wax ◽  
Tanuj Palvia ◽  
Maria Galati ◽  
...  
Keyword(s):  
Information Management ◽  
Management System ◽  
Information Management System ◽  
Practice Management ◽  
Anesthesia Information Management System ◽  
Management Systems ◽  
Electronic Charge ◽  
Average Charge ◽  
Accounts Receivable ◽  
Information Management Systems

Background The use of electronic charge vouchers in anesthesia practice is limited, and the effects on practice management are unreported. The authors hypothesized that the new billing technology would improve the effectiveness of the billing interface and enhance financial practice management measures. Methods A custom application was created to extract billing elements from the anesthesia information management system. The application incorporates business rules to determine whether individual cases have all required elements for a complete and compliant bill. The metrics of charge lag and days in accounts receivable were assessed before and after the implementation of the electronic charge voucher system. Results The average charge lag decreased by 7.3 days after full implementation. The total days in accounts receivable, controlling for fee schedule changes and credit balances, decreased by 10.1 days after implementation, representing a one-time revenue gain equivalent to 3.0% of total annual receipts. There are additional ongoing cost savings related to reduction of personnel and expenses related to paper charge voucher handling. Conclusions Anesthesia information management systems yield financial and operational benefits by speeding up the revenue cycle and by reducing direct costs and compliance risks related to the billing and collection processes. The observed reductions in charge lag and days in accounts receivable may be of benefit in calculating the return on investment that is attributable to the adoption of anesthesia information management systems and electronic charge transmission.

scholarly journals Variability in Blood and Blood Component Utilization as Assessed by an Anesthesia Information Management System

2012 ◽  
Vol 117 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Steven M. Frank ◽  
Will J. Savage ◽  
Jim A. Rothschild ◽  
Richard J. Rivers ◽  
Paul M. Ness ◽  
...  
Keyword(s):  
Information Management ◽  
Surgical Procedure ◽  
Management System ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Information Management System ◽  
Anesthesia Information Management System ◽  
Target Range ◽  
Blood Component ◽  
Surgical Services

Background Data can be collected for various purposes with anesthesia information management systems. The authors describe methods for using data acquired from an anesthesia information management system to assess intraoperative utilization of blood and blood components. Methods Over an 18-month period, data were collected on 48,086 surgical patients at a tertiary care academic medical center. All data were acquired with an automated anesthesia recordkeeping system. Detailed reports were generated for blood and blood component utilization according to surgical service and surgical procedure, and for individual surgeons and anesthesiologists. Transfusion hemoglobin trigger and target concentrations were compared among surgical services and procedures, and between individual medical providers. Results For all patients given erythrocytes, the mean transfusion hemoglobin trigger was 8.4 ± 1.5, and the target was 10.2 ± 1.5 g/dl. Variation was significant among surgical services (trigger range: 7.5 ± 1.2-9.5 ± 1.1, P = 0.0001; target range: 9.1 ± 1.2-11.3 ± 1.4 g/dl, P = 0.002), surgeons (trigger range: 7.2 ± 0.7-9.8 ± 1.0, P = 0.001; target range: 8.8 ± 0.9-11.8 ± 1.3 g/dl, P = 0.001), and anesthesiologists (trigger range: 7.2 ± 0.8-9.6 ± 1.2, P = 0.001; target range: 9.0 ± 0.9-11.7 ± 1.3 g/dl, P = 0.0004). The use of erythrocyte salvage, fresh frozen plasma, and platelets varied threefold to fourfold among individual surgeons compared with their peers performing the same surgical procedure. Conclusions The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.

scholarly journals Intraoperative Non–Record-keeping Usage of Anesthesia Information Management System Workstations and Associated Hemodynamic Variability and Aberrancies

2012 ◽  
Vol 117 (6) ◽  
pp. 1184-1189 ◽  
Author(s):  
David B. Wax ◽  
Hung-Mo Lin ◽  
David L. Reich
Keyword(s):  
General Anesthesia ◽  
Information Management ◽  
Management System ◽  
Information Management System ◽  
Anesthesia Information Management System ◽  
Record Keeping ◽  
Anesthesia Providers ◽  
Independent Association ◽  
American Society ◽  
Time Variables

Background Anesthesia information management system workstations in the anesthesia workspace that allow usage of non-record-keeping applications could lead to distraction from patient care. We evaluated whether non-record-keeping usage of the computer workstation was associated with hemodynamic variability and aberrancies. Methods Auditing data were collected on eight anesthesia information management system workstations and linked to their corresponding electronic anesthesia records to identify which application was active at any given time during the case. For each case, the periods spent using the anesthesia information management system record-keeping module were separated from those spent using non-record-keeping applications. The variability of heart rate and blood pressure were also calculated, as were the incidence of hypotension, hypertension, and tachycardia. Analysis was performed to identify whether non-record-keeping activity was a significant predictor of these hemodynamic outcomes. Results Data were analyzed for 1,061 cases performed by 171 clinicians. Median (interquartile range) non-record-keeping activity time was 14 (1, 38) min, representing 16 (3, 33)% of a median 80 (39, 143) min of procedure time. Variables associated with greater non-record-keeping activity included attending anesthesiologists working unassisted, longer case duration, lower American Society of Anesthesiologists status, and general anesthesia. Overall, there was no independent association between non-record-keeping workstation use and hemodynamic variability or aberrancies during anesthesia either between cases or within cases. Conclusion Anesthesia providers spent sizable portions of case time performing non-record-keeping applications on anesthesia information management system workstations. This use, however, was not independently associated with greater hemodynamic variability or aberrancies in patients during maintenance of general anesthesia for predominantly general surgical and gynecologic procedures.

Detection of Intraoperative Incidents by Electronic Scanning of Computerized Anesthesia Records

1996 ◽  
Vol 85 (5) ◽  
pp. 977-987 ◽  
Author(s):  
Kevin V. Sanborn ◽  
Jose Castro ◽  
Max Kuroda ◽  
Daniel M. Thys
Keyword(s):  
Information Management ◽  
Management System ◽  
Arterial Oxygen Saturation ◽  
Strong Association ◽  
Information Management System ◽  
Anesthesia Information Management System ◽  
Arterial Oxygen ◽  
Anesthesia Record ◽  
Voluntary Reporting ◽  
Physiologic Data

Background The use of a computerized anesthesia information management system provides an opportunity to scan case records electronically for deviations from specific limits for physiologic variables. Anesthesia department policy may define such deviations as intraoperative incidents and may require anesthesiologists to report their occurrence. The actual incidence of such events is not known. Neither is the level of compliance with voluntary reporting. Methods Using automated anesthesia record-keeping with long-term storage, physiologic data were recorded every 15 s from 5,454 patients undergoing noncardiothoracic surgery. Recorded measurements of blood pressure, heart rate, arterial oxygen saturation, and temperature were electronically analyzed for deviations from defined limits. The computer system also was used by anesthesiologists to report voluntarily those deviations as intraoperative incidents. For each electronically detected incident: 1) the complete automated anesthesia record was examined by two senior anesthesiologists who, by consensus, eliminated case records with artifact or in which context suggested that the incident was not clinically relevant, and 2) the anesthesia information management system database was checked for voluntary reporting. Results In 473 automated anesthesia records, 494 incidents were found by electronic scanning of 5,454 automated anesthesia records. Sixty intraoperative incidents were eliminated, 25 due to artifact and 35 due to context. When the remaining 434 intraoperative incidents were checked for voluntary reporting, 18 (4.1%) matching voluntary reports were found. All intraoperative incidents that were reported voluntarily also were detected by electronic scanning. Based on a 10% sample, the sensitivity rate of electronic scanning was 97.2% (35/36), and the specificity rate was 98.4% (427/434). Among 413 cases with electronically detected intraoperative incidents, there were 29 deaths (7.0%), whereas there were only 79 deaths (1.6%) among 5,041 cases without incidents (chi 2 = 58.5, P < 0.001). Conclusions The use of an anesthesia information management system facilitated analysis of intraoperative physiologic data and identified certain intraoperative incidents with high sensitivity and specificity. A low level of compliance with voluntary reporting of defined intraoperative incidents was found for all anesthesiologists studied. Finally, there was a strong association between intraoperative incidents and in-hospital mortality.

IAIMS and UMLS at Columbia-Presbyterian Medical Center

1991 ◽  
Vol 11 (4_suppl) ◽  
pp. S89-S93 ◽  
Author(s):  
James J. Cimino ◽  
Soumitra Sengupta
Keyword(s):  
Information Management ◽  
Management System ◽  
Medical Center ◽  
Information Management System ◽  
Language System ◽  
Unified Medical Language System ◽  
Medical Language ◽  
Academic Information

The authors use an example to illustrate combining Integrated Academic Information Management System (IAIMS) components (applications) into an integral whole, to facilitate using the components simultaneously or in sequence. They examine a model for classifying IAIMS systems, proposing ways in which the Unified Medical Language System (UMLS) can be exploited in them.

An Anesthesia Information Management System (AIMS) as a Tool for Controlling Resource Management of Operating Rooms

2002 ◽  
Vol 41 (01) ◽  
pp. 81-85 ◽  
Author(s):  
A. Junger ◽  
L. Quinzio ◽  
A. Michel ◽  
G. Sciuk ◽  
D. Brammen ◽  
...  
Keyword(s):  
Information Management ◽  
Management System ◽  
Information Management System ◽  
Operating Rooms ◽  
Anesthesia Information Management System ◽  
Management Tool ◽  
Anesthesia Record ◽  
Time Data ◽  
Or Management ◽  
Surgical Subspecialty

Summary Objectives: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms. Methods: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations. Results: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. Conclusions: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization

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