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Making Anesthesia Information Systems Work

January 7, 2011
by Mark Hagland
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Interview: Jeffrey Plagenhoef, M.D., President, Anesthesia Consultants Medical Group

Jeffrey Plagenhoef, M.D., is president of Anesthesia Consultants Medical Group, the anesthesiology group affiliated with Southeast Alabama Medical Center, a 400-bed tertiary care center in Dothan, Ala. He has been a practicing anesthesiologist for two decades. Plagenhoef has been the designated physician champion for the anesthesia information system implementation at Alabama Medical Center. He is the immediate past chair of the American Society of Anesthesiologists’ Committee on the Anesthesia Care Team, and is chairman of the board of directors of the Anesthesia Quality Institute (both the ASA and AQI are based in Park Ridge, Ill.) He spoke recently with HCI Editor-in-Chief Mark Hagland regarding his perspectives on anesthesia information systems.

Healthcare Informatics: What are the critical success factors in anesthesia management systems, from the anesthesiologist point of view?

Jeffrey Plagenhoef, M.D.: The critical success factors have changed over the past five years. But the CIO must understand that he or she has to have a physician champion; there are places where the CIO has tried to drive this, and it doesn’t work very well. The people in IS/IT don’t know what makes a good AIMS [anesthesia information management system]. So my first directive would be to find a clinical champion and ask him. But basically, they need a system that’s embraced by the anesthesia community. And the IS people are sometimes guilty of forcing a system upon the anesthesiologists, because it will be a fully integrated system. And the reason that some areas of the hospital have been later adopters of electronic health records has had to do with specific needs in the cath lab or NICU [neonatal intensive care unit], or anesthesia department. We need a system that does not cause any delay in workflow; and it has to fit into the unique workflow at every site. And you can’t force a unique workflow just because it fits into some vendor’s system. So from my perspective, best-of-breed trumps integrated systems that are integrated just to be integrated.

Jeffrey Plagenhoef, M.D.

And some systems capture the digital data from the monitors and put that data into the electronic medical record, and the top seven or eight vendors all have that integration with the physiological systems. But the best systems have clinical decision support. You should have an electronic pre-anesthesia evaluation that’s well thought out and doable in terms of efficient care delivery, and so you have to have an evaluation that can’t take forever to accomplish the interview and enter the data. And that pre-anesthesia evaluation needs to be fully integrated with the interoperative record. Another example is a drug safety system; the [Indianapolis-based] Anesthesia Patient Safety Foundation has taken a strong stance that it is now time that we as a specialty address safety or lack thereof within the systems we use to administer IV medications. Some systems have a drug safety component, and others don’t have them. And that was a driving element for us here, in terms of the solution we chose. We knew we could get the electronic data entry of the physiologic system, but we wanted and needed the drug safety component. But the drug safety component doesn’t work if you don’t have an integrated pre-anesthesia evaluation. Because a good drug safety system will also tell you if the patient is allergic, if the drug is contra-indicated based on a drug the patient already takes, or is contra-indicated based on the pre-anesthesia evaluation program.

And if there’s a bad outcome, you need to know what drug was given for sure according to a barcode, to know for sure that the right dose was documented, and that the timing of the drug administration was accurate. And that’s not always the case. And barcoding in the operating room is different from barcoding on the nursing floor. Other elements include clinical decision support for compliance with all the quality and safety initiatives, all the care paths we’re supposed to be effectively implementing, for instance DVT prophylaxis reminders; some systems have blood sugar/diabetes management prompts in them, to make sure a patient on an insulin drip is getting regular monitoring of their insulin so they don’t get hypoglycemia while they’re under sedation.

HCI: Which system did you end up choosing?