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The Anesthesia Information Management System in Obstetric Anesthesia: Experiences and Challenges in an Academic Institution
Abstract Number: T 38
Abstract Type: Original Research
Anesthesia information management systems (AIMS) are specialized electronic health record systems that allow for the automated collection and storage of patient data during the perioperative period. During September 2011, the EPIC Hyperspace© (Version Summer 2009) AIMS was implemented at our institution for use in both general and obstetric surgical cases. While this system was well received for intraoperative documentation during general surgical cases, its use in obstetric anesthesia was met with unique challenges.
To help identify the issues specific to obstetric anesthesia practice, we administered an electronic survey to the 145 anesthesia faculty, residents, and certified registered nurse anesthetists at 6 months and 18 months after AIMS implementation with a response rate of 61% and 43%, respectively. A system upgrade addressing the issues identified during our initial survey was installed 9 months after the AIMS was implemented.
At six months, 67% of responders felt the AIMS was helpful in looking up information from prior anesthetic records which rose to 76% at 18 months. Thirty percent of the responders initially felt time efficiency was a challenge when starting an emergency cesarean delivery which decreased to 10% at 18 months. Half of the responders reported persistent network connectivity interruptions and technical difficulties at six months which decreased to 32% at 18 months. At six months, 50% of responders felt that the AIMS allowed them to focus more intraoperative time on the patient which increased to 69% at 18 months. Fifty-eight percent of responders originally indicated that the use of the AIMS allowed for more accurate recording of their patient’s physiologic responses to anesthetic agents which increased to 74% at 18 months. At six months, 60% of responders felt the system was inadequate to transition from labor epidural analgesia to cesarean anesthesia which decreased to 55% at 18 months.
Future desired features indicated by responders include the ability to automatically document patient controlled epidural analgesia demand doses (43% at 6 months / 41% at 18 months), better flagging of major adverse anesthesia events such as difficult airway (75% at 6 months / 80% at 18 months), and easier copying of information from prior preanesthesia evaluations (59% at 6 months / 38% at 18 months). At six months of use, 49% of responders felt that the AIMS was equally suited for both general and obstetric anesthesia which increased to 81% at 18 months.
Users of the EPIC Hyperspace© AIMS at our institution had a continuous improvement in their experience over the course of 18 months. The challenges that existed during the system’s initial launch have been largely resolved by software upgrades tailored to address the issues identified during our initial survey. Survey feedback will continue to be incorporated into future software upgrades to address current issues with the AIMS and to allow for more efficient data management.