Bridget Philip, M.D. is vice chair of the department of anesthesia at Santa Clara Valley Medical Center (SCVMC), a 574-bed, county-owned teaching hospital in San Jose, Calif., and is director of SCVMC’s perioperative clinic, and is also an adjunct clinical faculty member at Stanford University Medical School in nearby Palo Alto. Dr. Philip and Dr. Friedrich E. “Fritz” Moritz, the chair of anesthesiology at SCVMC were the two physician champions helping to lead the implementation of an anesthesiology information management system (AIMS) from the Atlanta-based Surgical Information Systems (SIS).
With 12 operating rooms within the hospital's perioperative suite and 900 surgical procedures being performed every month, the SCVMC anesthesiology department keeps its 20 anesthesiologists and four CRNAs (certified registered nurse anesthetists) busy. By going live with an anesthesiology information management system in November 2009, SCVMS joined a growing group of progressive hospitals whose leaders are investing in AIMS, in order to improve clinical documentation, patient safety, efficiency, regulatory compliance, and charge capture/billing effectiveness. What's more, the SCVMS anesthesiology department went live with its solution within 44 days after funding approval. Dr. Philip spoke recently with HCI Editor-in-Chief Mark Hagland regarding her and her organization’s experiences in this area. Below are excerpts from that interview.
What made you and your colleagues decide to go ahead and implement an anesthesia information management system?
One of the main drivers was that we already had SIS’s interoperative nursing module installed, so it was an easy step to implement SIS for the anesthesiologists, and there was a direct link to pass from one module to the next. Second, there’s the handwriting legibility issue. And clearly, nobody’s in compliance with handwriting requirements [embedded in federal and Joint Commission mandates on anesthesia documentation]. Another thing was billing efficiency, the ability to bill almost immediately. We don’t yet have the analytics solution. So far, we have nursing; we have the anesthesia module, and the PACU [post-anesthesia care unit] module for the nurses.
Overall, what has your experience been with automation?
It’s been fantastic. You really have to have a champion in the department to head everything and withstand the initial challenges; but over time, I can safely say, nobody in our department wants to do paper [documentation] again. We’ll even change operating rooms to get the system, if it’s down in one room.
One of the chief barriers to adoption, from what I understand, is at a cultural level, since virtually all anesthesiologists in practice for more than a couple of years have been practicing anesthesiology in the context of paper-based documentation, and many have been fearful of potential medical-legal and other complications.
I’m lucky that about half of my department is on the younger end of the spectrum. And of course, nobody likes change, and especially in an environment when you’re working in a very timely way. But this is just something that all of us here believed needed to happen. And we had a lot of people from SIS to support the implementation. We also made sure everybody had time to speak to the SIS crew while they were here. And we worked with mock patients on the computer. And we did this over a span of time, so that if you had a quick-turnover case, you could still do paper, but if you had a long case, you could delve into this.
And you and Dr. Moritz were right there, of course, and had learned the system.
Yes, and the majority picked it up very quickly; and we had the Stanford residents as well, and picked it up very quickly. And they were reeducated down the line, too; and that’s OK, too, everybody has their own learning style.
What would your advice to CIOs and CMIOs, regarding the potential for anesthesia information management systems in operating rooms, and as they consider first steps in moving towards their implementation?
You need for your anesthesia department to be on board. As soon as we decided to go ahead with this, we announced it at our department meeting; we announced it far ahead of time. What’s more, we kept everyone clued in ahead of time; and tried to make sure everyone had buy-in. And of course, you have to comply with CMS [Centers for Medicare and Medicaid Services] and JCAHO [Joint Commission on Accreditation of Healthcare Organizations] regulations, but then there are a lot of little details and elements that are custom to each organization as well. Where is the record going to print afterwards? Who will sign off—the attending and resident? Etc. And we structured it well so there would be enough time, and to practice on a mock patient, to do all that.
So I think this is the best thing that’s ever happened in this department, to be honest. And it’s really helped our QA/QI [quality assurance/quality improvement] process. Also, we’re a level 1 trauma center, one of two in the immediate Bay Area. And when a trauma comes up, I cannot sit there on paper and add in the elements; it’s great that it’s coming through automatically. The entire record is captured 100-percent accurately in terms of the vitals and gases; I just have to keep up later with the drugs.
Can you discuss how any concerns over medical malpractice issues dissipated with use of the system?
Yes, it’s fantastic; the accuracy of the record is 100-percent. And sure, there are going to be a few inaccurate recordings. And in a bad situation like a stat c-section or a code, which we have frequently, all the information is completely inaccurate. So initially, that was a big concern, but now the anesthesiologists realize that they can go back and fill in any missing or incorrect elements, whereas previously, I couldn’t read 70 percent of the paper records anyway; it was crazy.
How do you see the trajectory of AIMS adoption evolving forward over the next few years?
Especially now with healthcare reform, and meaningful use, people will be driven to install and implement these systems; and adoption will happen fast. And the other thing is, as I work with the anesthesia residents here, and at the VA [Veterans Administration health system] in Palo Alto as well, it’s now becoming a part of the training of the new residents. And they will drive their departments to adopt sooner rather than later. I’m so excited about all this stuff.