Anesthesia Information Management Systems: A New Venture

A Transformation to New Era

Dr Codman and Dr Cushing, two surgeons, pioneered the use of paper documenting a patient’s physiologic condition during anesthesia⁵ in the 1890s. The normal practice in the 1900s was to keep a paper anesthetic record. However, in the 1970s and 1980s, there was a strong trend toward electronic perioperative data acquisition, storage, retrieval, and formatting.⁶ In the 1970s, computers were used to record patients’ data, and in the 1980s, Duke Automatic Monitoring Equipment System was developed to capture patient data directly from the monitors.⁷ Subsequently, the demand for AIMS rose from 75% in 2014 to 90% in 2020.⁸

Electronic health record (EHR) systems Epic, Cerner, and others⁹ (Fig. 1) have been installed extensively in hospitals. The AIMS component enhances interoperability and access to other EHR components including laboratory findings and automated order entry, as well as secondary uses like research and quality improvement projects.

AIMS are employed not just in the perioperative phases of operating room (OR) care, but also in other settings where patients are cared for, including intensive care units, wards, labor and delivery suites, and acute pain services.¹⁰

Functioning of AIMS during Perioperative Period (Documentation in Action)

The most valuable system, AIMS, provides for the preservation and documentation of reliable data, which is the foundation for making decisions at the point of care.¹¹ AIMS collects data from devices such as patient monitors, anesthesia machines, and drug infusion records. Clinical events such as anesthesia induction, patient positioning, insertion of invasive lines such as central venous catheterization and arterial line insertion, the start of surgery, end of the surgery, administration of medications, fluids, and blood products can also be documented manually. As data is stored in the record, a clinician can access, review, and change it using the user interface. The decision to include preoperative assessment of the patient in AIMS depends on the hospital policy or the company’s guidelines. This is because the changes are not allowed in certain software programming companies once the record is complete and the system is logged out. The data entry tools range from a simple free-text field to comprehensive information, drop-down menus, the facility to save images, and other patient characteristics. The preoperative modules contained in AIMS include demographics (name, age, gender, ASA physical status). Some AIMS feature a history-taking questionnaire and recommend preoperative laboratory testing based on customizable algorithms that take into account the patient’s comorbidities and treatments.¹¹ Patient risk stratification is a key aspect of AIMS, which can be determined using saved patient data and algorithms such as the modified Lee-Goldman index.¹² This preoperative module also allows access to the hospital’s EHR system and can load relevant patient data such as allergies, medications, and procedure information during the preoperative and intraoperative periods. It may be possible to include a few AIMS modules like previous anesthesia records, any event, physical and systemic examination, and a document regarding the plan of an anesthetic after a complete and thorough assessment of the patient. AIMS reduces redundant data entry by carrying information (such as patient’s age and allergies) across the intraoperative chart.

Manual data entry of case events (e.g., case timings, drug administrations, airway management events, regional or nerve blocks) and automatic transcription of vital signs and ventilator data into the accumulating computerized record are all part of intraoperative charting. The AIMS facilitates the continuous recording of anesthesia data since it will be used in real-time during a case.

AIMS allows postoperative documentation in recovery units like PACU and ICU. This advanced technology allows to develop skills among clinicians, nurses, and other hospital staff to effectively carry out a particular task, by using just-in-time information at the point of care. Some AIMS support the clinicians by providing an algorithm that can make drug dosing calculations based on a patient’s age, weight, and renal function.

Advantages of AIMS

The advantages of AIMS in hospital systems are described in the peer-reviewed literature¹³ (Annexure 1). It has described the advantages in the category of patient safety and quality of care, documentation, operations management, cost containment and reimbursement, and clinical research which showed improved and promising results. According to an assessment of the research, AIMS can give a good net return on investment in four areas- (1) more effective staff scheduling and lower personnel costs, (2) lower anesthetic drug prices, (3) better charge/billing capture, and (4) appropriate hospital reimbursement due to improved hospital coding are among these areas. It was shown that institutes were able to control their billing rate for epidural catheters, central lines, and arterial catheters by configuring their AIMS software so that individual clinicians were prompted for documentation of invasive operations when the system identified triggering events. Due to accurate documentation, revenue cycles improved and payment for services was appropriate. The accuracy of AIMS data does not differ whether patient variables are entered through the console manually or automatically from the monitors. AIMS has a valuable contribution in medicolegal cases mainly to review clinical records in the defense process.

AIMS: Clinical Decision Support

Anesthesia information management system (AIMS) offers clinical decision support into either clinical (especially protocols and guidelines) or administrative processes. Clinical decision support systems based on AIMS improve various elements of clinical performance and patient care, especially when they are incorporated into clinical workflow and consist of evidence-based recommendations rather than assessments¹⁴ (Annexure 2).

AIMS: A Boon

The application of AIMS has facilitated research, multicentre study projects, and anesthesia practices. Various studies using AIMS have been published by the Multi-centre Perioperative Outcomes Group and the Anaesthesia Quality Institute’s National Anaesthesia Clinical Outcomes Registry.¹⁵ It is important to get clear, consistent perioperative data through valid and reliable documentation to execute high-quality outcomes in clinical as well as reporting systems.

Role in Various Sectors

The AIMS has benefits such as legibility, faster data entry, reduction in human errors, enhanced data completeness, cost savings, and easy access to previous records.

Drawbacks

Some physicians are hesitant to utilize AIMS due to a desire to save paper records, the high expense of installation and maintenance, anesthetic providers’ inattention, medicolegal issues, and reluctance to change clinical workflow patterns. However, many studies have proved AIMS to be more accurate and more reliable than paper records.¹⁷ The return on investment outweighs the cost of AIMS installation.

Criteria to Select AIMS Project Installation Company

The selection goal should specify the proposed installation’s precise requirements, as well as the geographical requirement and the clinical activities that must be supported. Once a vendor has been chosen, they should detail their systems’ ability to handle a catastrophic incident (e.g., a server failure, power loss, or network interruption) as well as their redundancy methods. The system stability, user interface, system responsiveness and security, and network connectivity should all be highlighted in the AIMS software and hardware demonstration¹⁸ (Annexure 3).

Future Prospects of AIMS

AIMS will become more widely used in India’s high-tech hospitals in the next years, with improved user interfaces, mobility, and connectivity within hospital EHRs. Because the increase in patient care is less visible, AIMS adoption is slower than other available technologies such as newer physiologic monitors or current-generation anesthetic machines. AIMS are anticipated to become a crucial modality for providing the lowest cost, highest quality care across an anesthetic department as they continue to demonstrate better care procedures, billing efficiency, and quality assurance benefits.¹⁹ The use and usefulness of AIMS modules are growing, and automatic data collecting will be available from the latest, most current technologies, such as barcode medicine labeling systems and “smart” pharmaceutical infusion pumps. Analytical approaches such as machine learning and visual analytics, which ease the computing of massive AIMS databases, are used to improve quality and performance. Machine learning algorithms applied to AIMS data record perioperative events and assign clinical relevance to physiologic data. Another propitious application of technology to AIMS data is real-time analysis of patient data which helps in clinical decision making and patient care.²⁰

Synopsis

A large number of peer-reviewed studies have demonstrated that these high-tech devices may improve operating room efficiency while also improving the quality of care provided and that this is attainable with proper planning. A large number of resources are required for a successful AIMS implementation. The time spent on training, installation, and program customization is included in these resources. A modern-era AIMS will depict improved standardization, interoperability, and integration of the system.²¹ An AIMS will aid an attentive, conscientious, meticulously vigilant anesthesiologist with the help of detailed record-keeping and good knowledge of current trends in the practice and is less likely to be judged negligent in case of his patient care.