Last Man Standing?

Electronic medical record (EMR) implementations are becoming more commonplace as hospitals and health systems race to meet governmental deadlines for achieving meaningful use. Yet implementation of an EMR in anesthesia services (referred to as an Anesthesia Information Management System or AIMS) remains low, and it’s not unusual that this practice area is one of the last departments to transition from paper to the electronic world.

Implementing an AIMS solution must be on the organization’s IT roadmap, since it enhances care coordination and contributes a financial benefit to both the institution and the group practice. Integrating documentation and workflow for anesthesia services improves efficiency and data accuracy with upstream and downstream systems such as the perioperative OR information system (ORIS) and inpatient and ambulatory EMRs. Just as important is the expectation that anesthesia data will be available in standardized and discrete formats, which will be mandatory as meaningful use Stages 2 and 3 requirements are operationalized.

Given the importance of automation of this area, anesthesia services’ stakeholders should play an important role in the AIMS system selection and implementation processes. Without their involvement, you may be faced with inefficiencies and challenges for providing high quality care. Of course, involving them in the process does not come without a challenge. Anesthesia services have many competing priorities, such as employment/contracting arrangements, scheduling commitments at multiple sites, and concerns and resistance over how an EMR may change their daily practice.

Here are 10 tips for engaging your anesthesia clinicians:

1. Convey clearly the need for change and why remaining at “status quo” will not meet the quality and financial strategic goals of the institution. Choose effective leaders at the executive and operational level. Don’t be afraid to coach them if necessary;
2. Demonstrate an understanding of the financial implications of participation on both sides—the financial burden assumed by the parent hospital and the resource burden contribution by the anesthesia teams to participate in selection, planning, design, and implementation processes;
3. Make the EMR the path of least resistance;
4. Use decision support tools to improve compliance with quality and reporting metrics, standardizing care processes whenever possible;
5. Create a highly interoperable system that includes integration of biomedical device data;
6. Ensure participation by considering all competing priorities when timing project activities;
7. Set expectations early and create a governance structure that is empowered to drive the necessary change;
8. Make training and system use mandatory once implemented;
9. Include subject matter experts from both clinical and Health Information Management (HIM) when creating your legal health record policies; and
10. Focus on system reliability. The operating room is a critical care area, and the team often has limited resources to provide assistance when any system fails. Consider service level agreements with the department to provide 24-hour coverage via online, on call support for the application and interfaces. 

Anesthesia implementation as part of a total EMR will be challenging but is essential to providing accurate real-time data to increase efficiency and care delivery, throughout the perioperative process and when applicable, the inpatient stay. By following these tips, you’ll be well prepared to implement an EMR in a department that is typically the last area remaining on the EMR roadmap. Ultimately, your anesthesia clinicians will be better engaged to support the implementation process and realize the many benefits of a well-constructed and implemented anesthesia information management system.

Terri Gocsik, nurse anesthetist, CPHIMS, is a manager at Aspen Advisors, LLC, Pittsburgh, Pa.