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A low cost anesthesia information management system for use in obstetrics
Abstract Number: F-15
Abstract Type: Original Research
Introduction: Anesthesia information management systems (AIMS) are believed to improve patient care, outcomes, documentation, quality management, compliance and billing. 1. However, the high cost of a comprehensive AIMS, largely attributed to the automated anesthesia (AAR) component, has limited their widespread adoption. 2. Since much of the OB anesthetic workflow does not require an AAR, we believed it possible to design and implement an OB AIMS solution lacking this component, but including elements for preanesthesia evaluation (PAE), procedural documentation, progress notes and post delivery follow-up. A database hosted on a server that the clinician would access wirelessly on a tablet device would provide an alternative to paper and pen charting and would achieve the majority of the goals of a conventional AIMS at a fraction of the cost.
Methods: The OB AIMS solution is a relational database developed using Filemaker Pro 11 Advanced and Database Pros software. A Dell PowerEdge T310 server with a Windows Server 2008 operating system used Filemaker Server 11 to host the database. iPad 2s loaded with Filemaker Go for iPad, accessing the server wirelessly, were used to document patient encounters. individual screens on the iPad 2 were constructed to allow input of demographic date, history and physical examination, procedure notes, progress notes and post delivery notes. The server was networked to a workstation to process patient billing data and to a computer in the clinical area that was used to build and maintain the database and to generate reports. HP Officejet Pro wireless printers were used to print patient records. Data backup was carried out locally and at a remote server. Secure log-on procedures, electronic signatures and privilege sets for users were established to ensure HIPAA compliance.
Results: The OB AIMS allows simultaneous access by multiple users in different locations. It generates legible and standardized documentation of obstetric anesthetic care. Individual and aggregated provider reports on completeness of documentation, clinical performance and the incidence of adverse events can be produced to track physician performance. Electronic transmission of billing information eliminates handwritten vouchers. Billing personnel can alert anesthesiologists for missing or inadequately documentation and deficiencies can be remedied wirelessly maximizing revenue capture.
Discussion: Widespread adoption of AIMS may take another decade. 3. Less sophisticated, lower cost systems may provide tangible benefits in documentation, compliance, clinical care and quality management in the interim. The iPad clinical interface is convenient and easy to use. The cost of the system can be borne by individual anesthesia groups and rapidly recouped by improvements in billing.
References: 1. Anesthesiology News. 2010;36(8):1-8. 2.Anesth Analg. 2008;107(4):1323-1329. 3. ASA Newsletter. 2011;75(6):10-13.