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Anesthesiology Documentation for the 21st Century

May 14, 2013
by John DeGaspari
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Electronic data entry takes various forms in the OR

Documentation in the operating room (OR) is a challenging task, and especially so for anesthesiologists. Records are dense, and when they are recorded on paper in shorthand during surgical procedures—a common practice even today—extraction of data from manually entered records can be very challenging and burdensome.

That was the reason that Sheridan Healthcare, a Sunrise, Fla.-based provider organization that offers contracted anesthesia, emergency medicine, neonatology and radiology services to hospitals, looked for an alternative method to enter data, according to Roger Brown, M.D., an anesthesiologist and national medical director, clinical informatics at the organization. About three years ago, Sheridan began exploring ways to document in real time and upload the information to the hospital’s existing electronic health record (EHR) and share it with other caregivers.

Sheridan found a solution (supplied by Nashville, Tenn.-based Shareable Ink, Corp.) that filled its requirements, Brown says. The cloud-based solution provides what the vendor refers to as “data liquidity,” i.e., it takes the input from physicians and converts it into a codified structure that can be used in various downstream purposes, including electronic medical records, analytics, or billing. The solution uses digital pen-on-paper input technology, and has recently added the iPad as well.

Sheridan went live with the solution at its first site about two-and-a-half years ago, and it is being used in about 20 sites today. “It’s providing us with a method of data captures that previous was very difficult to access,” he says. He notes that Sheridan has been providing anesthesia services since 1953, and it has only been in the last few years that it has been able to use electronic records to capture data. For most of that time it has relied on paper records, with the quality and completeness of the information ranging from fair to poor, he says.

Brown says the criteria used in selecting a solution were that it easily captures and uploads data and not negatively impact the ability of providers to deliver clinical care. He says the technology was relatively simple to implement. Anesthesiologists record their own notes, entering most of the information in the OR during surgery using the digital pen, and some of the information in the recovery room, where it is uploaded. It takes only a minute to synchronize the pen and upload the information, he says. Data includes a great deal of 500 to 600 data points of demographic and clinical information, including meaningful use data.

Building on its experience with the digital pen, Sheridan plans to implement the tablet as an input device, according to Brown. “There are advantages and disadvantages to [digital] pen on paper, and one of the disadvantages is that it doesn’t provide real time information, like a tablet would,” he says. “That’s the next step, which would be great.”

One advantage of the digital pen and paper is that it can be used in the various environments where anesthesiologists work, both in the OR as well as outside it, such as labor and delivery environments, Brown says.

Brown notes that the OR has historically been one of the last bastions of resistance to EHR implementation, mainly because surgery is a complex undertaking. He says that some hospital clients of Sheridan rely on the Sharable Ink solution rather than go through the expense of implementing a full-fledged EHR in their OR, because it meets their needs for data capture and it saves them a major EHR installation cost. The difference is especially critical with smaller hospitals with limited IT budgets, he says.

Brown notes that the OR is a fast-paced environment. “Anything that slows the casework down or limits the turnover or delays the OR day at all really can throw a wrench into the operations,” he says. Because the Shareable Ink solution tends not to slow down the workflow, it is generally smiled upon by surgeons, he says.

Brown says he would be interested in incorporating clinical decision support as part of the data capture process (something that Sharable Ink president and CEO Steve Hau says the company is exploring), noting that anesthesia in particular has developed a significant number of checklists that will continue to multiply as the discipline matures. “Decision support in anesthesia has been stretched for a long time, and any technology we can use to augment that is welcome,” he says. “A Holy Grail for us is real-time decision support at the point of care. Emergencies in anesthesiology are measured in seconds and minutes, so I absolutely expect that decision support will be a very important part of an electronic system that is going to be brought into an OR.”