Anesthesiology Information Systems: Advancing Fast

April 10, 2013
In October, the Atlanta-based Surgical Information Systems (SIS) released the results of a survey of healthcare leaders—executives, managers, and clinicians—involved in anesthesia care.

In October, the Atlanta-based Surgical Information Systems (SIS) released the results of a survey of healthcare leaders—executives, managers, and clinicians—involved in anesthesia care. The survey of 212 leaders in the anesthesia area found an increased demand for anesthesia information management systems (AIMS), with 57 percent of survey respondents indicating that information systems in this area are a high priority for their organizations, and 63 percent reporting that meaningful use requirements are driving forward their interest in AIMS. In addition, 43 percent of survey respondents reported that they are either already using an anesthesia information system, or are planning to implement one within the next year, while another 28 percent will be evaluating systems in the next year.

Marc Paradis, M.D., a practicing anesthesiologist who practices in two hospitals in Connecticut, reports that one of the two hospitals—the University of Connecticut Health Center (UCHC) in Farmington–has been using an anesthesia information system (from SIS) since 2006, while the other, Hartford Hospital, is moving forward with a plan to implement an AIMS, possibly by next year. Paradis, who is an assistant clinical professor of anesthesiology at UCHC and is a senior staff anesthesiologist in the department of anesthesiology at Hartford Hospital, is also a partner in the anesthesiologist group Hartford Anesthesiology Associates. He spoke recently with HCI Editor-in-Chief Mark Hagland regarding the results of the SIS survey, and the implications of those results for the industry. Below are excerpts from that interview.

The top-line results from the SIS survey—that 57 percent of respondents say that anesthesia information systems (AIMS) are a high priority for their organizations, and 63 say that meaningful use requirements are advancing their interest in AIMS, are quite interesting. What is your reaction to those results?

Those numbers are very impressive. I think, basically that what’s happened is that the snowball is starting to roll down the mountain. Anesthesiologists have been thinking about anesthesiology information systems for a long time; they’ve been watching the market; and at this point, there’s a lot of selection available. And the anesthesiology information systems are more sophisticated now, and they’re offering some of the functionality that anesthesiologists had been waiting for.

What’s more, when you add in the fact that most anesthesiologists qualify for meaningful use, and the fact that the money is there—but that the penalties also come later on—that influences people. The question now is whether the hospital and anesthesia group are aligned on this. The large majority of anesthesiologists have been doing this with the hospital footing the bill. But you are seeing some anesthesia system providers out there starting to cater more to the anesthesia groups specifically.

Does it make a difference to the architecture of the system?

Well, the thing is, regardless of whether it’s paid for and owned by the hospital or anesthesia group, you’ll still need the same level of integration. And the hospital could say, well, if you won’t share the data, you won’t be able to interface with the lab system, etc.

I can see vendors approaching anesthesia groups independently, though, if they see an entrée.

Yes, and the question for the AIMS companies is, whom do you approach? And there’s really no clear-cut answer. In some situations, the anesthesia group is highly motivated and they have a good relationship with the hospital, and happen to be near the top of the IT priority list, and that would work very well. In other cases, the anesthesia group might be resisting change. So in that situation, you might go to the chair of the anesthesia department in the hospital, or the IT department. And there, it would depend on what type of hospital it is—academic or community, etc.

In the survey, 43 percent of respondents reported that they’re already using or soon will be using an AIMS. What’s your sense of the pace of the uptick in adoption?

I think it will be what it has been in the past year, which is a very fast uptick. And unless something negative comes out of government regulation, or the meaningful use criteria are changed to exclude anesthesiologists from meaningful use, I would see a very high level of adoption within the next few years. And you’ve got PQRI [the Medicare program’s Physician Quality Reporting Initiative], you’ve got JCAHO [the Joint Commission on the Accreditation of Healthcare Organizations], the state departments of health requiring data, and I wouldn’t be at all surprised if pretty soon you had the private insurers clamoring for data in this area as well. And I think that anesthesiology groups that are doing it manually at this point realize that it’s quite onerous and time-consuming, and that it’s extremely difficult to do a 100-percent audit of a paper-based system.

The old concerns of anesthesiologists are falling away now, as these systems are implemented and being used, aren’t they? Earlier, for example, many anesthesiologists feared that implementing an AIMS would expose them to additional medical-legal risk.

Yes. I’ve had discussions with legal counsel, and at the very least, it’s 50/50, and it could either help you or hurt you, but overall, the perceptions are changing, and anesthesiologists are realizing that, increasingly, not having implemented anesthesiology information systems could pose more of a problem than having implemented them.

And the anesthesiologists’ earlier fears are falling away, and they’re finding that they don’t have to worry about lack of control over data, right?

Yes, I would agree with that, that their concerns are fading away. And now, the systems are offering the features and functionality that anesthesiologists were looking for. They’re now approaching the level that the anesthesiologists, who are fairly tech-savvy, have been looking for, for some time. The other thing to look at is that you look at the adoption of hospital systems, and the majority of systems have been adopted by non-physician providers. A lot of physicians have had problems with CPOE [computerized physician order entry] systems in their experience, and a lot of physicians have been a little leery of information systems in general.

Meanwhile, your experience with AIMS has been very good, right?

Yes, by and large. I mean, everything we do has a few warts on it. But the equally important factor is that with the system we have, the vendor has been willing to work with us to make improvements.

What advice would you give you CIOs and CMIOs, with regard to all these issues?

Well, they definitely need to reach out to their anesthesiologists as they start to contemplate either an anesthesia system or an enterprise-wide system that includes anesthesia, and to encourage their anesthesiologists to participate in all of the discussions that would involve the selection of an anesthesia information system, because you really have to have user acceptance and buy-in. And you need a physician champion; if you don’t have a clinical champion, then the implementation of any physician-based system is going to be difficult, and there have been instances of failure; obviously, that’s the last thing you’d want to do.

So I would share the following with CIOs and CMIOs: understand that the anesthesia information system is an extremely important part of an anesthesiologist’s practice. And they may find that if they are contemplating an enterprise-wide system, hopefully, it has a good anesthesiology component to it, because if not, there is the potential for the anesthesiologists to be unhappy with it, and to maybe want to move to a best-of-breed system, because we work so closely with the system.

Yes, because once you use it, it becomes so core to your work process, right?

Yes, that’s right. And remember, in order to access us, you have to come into the operating room, which has been a rather closed part of the hospital. And in at least some of the hospitals I’ve worked in, the IT people haven’t always ventured into the operating room, or even been welcomed. So the call for greater interaction and collegiality needs to go out on both sides.

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