Anesthesia Information Management Systems (AIMS)

Anesthesia Information Management Systems (AIMS) can be independent applications or modules in an integrated electronic health record (EHR). The anesthesia record was first conceived over 100 years ago by Dr. Harvey Cushing and Dr. Codman [1] while in medical school, and consisted of serial measurements of vital signs and a list of medications administered during the course of the anesthetic.

At present day, the anesthesia record is a comprehensive document that describes the course of an operation in the form of a timeline, including physiologic measurements (blood pressure, heart rate, respiratory rate, cardiac rhythm, ventilation parameters, medication record, intravenous fluids and transfusions, urine output, estimated blood loss, and additional techniques such as airway management as well as invasive monitoring equipment).

There has been a proliferation of automated processes to capture most of the physiologic parameters, as well as ventilator settings and anesthetic delivery via gas analyzers. The utilization of automated recording applications is supported by patient safety experts, such as the Anesthesia Patient Safety Foundation[2]. However, despite these benefits and endorsements, adoption of AIMS platforms is still not universal across the United States.

Many providers continue to utilize paper records as a means to record the delivery of an anesthetic.

In general, there are a number of challenges that pertain to the implementation of an AIMS platform that may thwart organizations from implementing the system.

Anesthesiologists must be able to provide anesthesia in a number of locations, many of which extend beyond the boundaries of the operating room. Anesthesiologists may practice at various hospitals, caring for patients in different operating room complexes. Patients requiring anesthesia may present in a number of settings, including diagnostic radiology suites (MRI, interventional radiology procedures, PET/CT imaging), radiation oncology centers, gastroenterology or endoscopy suites, ambulatory surgery centers, intensive care unit, recovery room, emergency room, or other clinical care areas where procedures may be performed). Furthermore, anesthesiologists may be involved in transporting a patient between multiple venues.

Furthermore, anesthesiologists record vital signs very frequently. In traditional paper records, vital signs are recorded in 3-5 minute intervals. However, AIMS platforms have the capacity of exceeding these constraints. However, there is still some variability across vendors in terms of the frequency of recording vital signs and physiologic data.

Key functions that pertain to AIMS and can integrate with meaningful use requirement include: - Integration with hospital EHR for medication reconciliation - Developing allergy list - Drug-drug interaction checking - Syndromic surveillance and reporting

- The Anesthesia Quality Institute (www.aqihq.org) is currently a leading entity in reporting of anesthesia-related events at a national level. The organization maintains a registry that can assist anesthesiologists to improve patient safety by understanding developing trends that may otherwise not be seen at a local or even regional level.

Muravchick et al., report on certain functional requirements that are specific to the operating room, which should be taken into consideration when designing and deploying an AIMS [1]: - Workstation function during transient hospital power failure. - Workstation behavior after accidental power-down. Does it automatically return to a log in screen? - Is network access required to initiate/complete a case? - Is it possible to start a case in an emergency, prior to identifying a patient and entering all demographic information in the system? - Is the data stored in a server or a local workstation? - Does hardrive failure on the server cause data corruption? - Does the AIMS consistently record physiologic variables during the course of a case? - Does the AIMS interact with surgical and perioperative scheduling applications? - How does the AIMS function during daylight savings transitions? How does the database account for redundant vital signs during daylight transition during a case?

References: 1. Muravchick S, Caldwell JE, Epstein RH, Galati M, Levy WJ, OʼReilly M, et al. Anesthesia Information Management System Implementation: A Practical Guide. Anesthesia & Analgesia. 2008 Nov;107(5):1598–608.

Anesthesia Patient Safety Foundation [3]

Anesthesia Quality Institute [4]

Wake Up Safe [5]

Submitted by Jorge Galvez