Anesthesia information management systems, or AIMS, can be a service line solution for operating rooms that can help in a facility's move toward paperless systems. James Koch, MD, an anesthesiologist at Inova Fairfax (Va.) Hospital and creator of the Frontiers AIMS solution, discusses four key points healthcare providers should consider when evaluating AIMS systems and what these systems should do for anesthesia management.
What is an AIMS?
Similar to an EHR, an AIMS is intended to create a robust medical record. It can also help the anesthesia care provider monitor and track a patient's vitals during surgery along with other perioperative data. The bedside components of the system are interfaced directly with anesthesia machines and/or patient monitors.
According to Dr. Koch, the concept for AIMS evolved from large hospital groups looking to find a way to monitor and track patient outcomes. "Most of the concern arose from compliance issues," he says. "When you have 100 care providers each doing things a little differently, patient outcomes differ, such as time spent in the PACU, vomiting after recovery, etc. Prior to the implementations of AIMS, we could only reference paper records to determine trends, which made it virtually impossible to get at the data. The time costs alone for reviewing paper records were phenomenal."
The increased interest in evidence-based healthcare has also led to a greater willingness by executives, administration and staff to consider using an electronic system to record anesthesia and perioperative data. "Prior to electronic records and data mining, we've had to rely mostly on anecdotal evidence, which is not truly evidence based," says Dr. Koch. "An AIMS gives the facility access to 100 percent of what is done in the operating room, which can then be presented to clinicians. Once they believe the evidence, it opens the gates to many different kinds of improvements in care."
4 things to look for in an AIMS
1. Users must be comfortable with the system and the user interface. According to Dr. Koch, clinicians need to be comfortable with how an AIMS works and to know that it will make their jobs easier instead of adding stress and burden.
"Clinicians want a reliable system," Dr. Koch says. "Computers are reliable to a point, so you need to make sure that the data are stored in more than one location, such as on a network server as well as the computer's local hard drive."
An intuitive clinician user interface is also important to an AIMS' success at a facility. "The more facile the input can be, the lower the training threshold will be," Dr. Koch says. Keyboards and touch screens can be cumbersome at the OR bedside. Newer technology is being developed to overcome these challenges. One example is a "sidecar" unit that offers a "whacker wheel" device. According to Dr. Koch, it is designed to enable the anesthesia care provider to be as hands-free as possible in order to focus on patient care needs rather than data entry via the AIMS interface.
Training should also be the easiest and most enjoyable part of the implementation process, according to Dr. Koch. In his experience, training has included bedside one-on-one instruction while patients are being treated in addition to any required formal training class sessions.
Another consideration is that an AIMS fit into the work environment without impeding the clinician's workflow of patient care and monitoring. "There is no desk in an OR," Dr. Koch says. "Patient care is always the most important aspect of OR care, record keeping is secondary. An AIMS must not distract from the care mission and should have a minimal footprint at the anesthesia workstation."
2. Administrators should be able to use the system to solve problems. A solid AIMS should not only be easy to use by clinicians but should allow administrators to access data and create reports that support the decision-making process for operational enhancements and safety improvement at the facility.
Input is important to accomplishing this goal. Dr. Koch says facilities should decide what it is they want to accomplish with the implementation of an AIMS system. "Do you want to track and resolve operational points of pain such as OR delays due to incorrect NPO instructions? Are you looking to improve scheduling of procedures and recovery? A good AIMS will allow an administrator to select from a list of database fields to help create a report that highlights the frequency of a problem or concern," he says. "With this data, the management team can implement an improvement strategy and then use the same report monitor for the desired change in process."
A good clinician user interface will also help with compliance management, as a good AIMS will notify users if mandatory information is missing from the record of care. "Some AIMS allow system administrators to create a 'bucket list' of items that need be included in the medical record," Dr. Koch says. "An elegant AIMS will prompt clinicians and staff members to enter this priority information as part of the record keeping process."
Usually, compliance management is a very labor intensive process. Administrative time has to be expended in educating and monitoring clinician compliance with prescribed care processes and care documentation. According to Dr. Koch, an AIMS can virtually eliminate the overhead management costs of compliance management and can raise the compliance score in any area of focus. Dr. Koch notes that it is important to makes sure a system is flexible enough that it can be modified as compliance requirements are updated. "Eighty percent of compliance management is proper documentation in the medical record," he says.
3. AIMS should be useful to all aspects of a facility. Good systems will allow administrators to track data in a number of areas, which can help with both clinical issues, such as risk management, and business issues, such as coding and billing.
An AIMS should track behaviors in the operating room, such as changes in blood pressure and drugs used to reverse such reactions. This information is gathered through data output ports in the anesthesia machine that the AIMS connects to, allowing information to stream onto the record. Input data can include textual information entered manually or collected through an EHR, such as patient weight, height and allergies, as well as data within the OR such as patient positioning and drug administration.
"This can help with risk management because it adds a level of completeness to the record," Dr. Koch says. "The system updates more frequently than an anesthesia provider would record information manually. Additionally, because the system tracks users, administrators can query individual users about potentially problematic issues or trends identified in a report."
The AIMS can also assist important business aspects of a healthcare facility's operations, as it can help ensure inclusion of documentation billers and coders need. Some payors, such as Medicare or Medicaid, require extensive information, and the AIMS can help collect this data, according to Dr. Koch. If the facility relies on paper records, data is often missing or inaccurate, thus impacting reimbursement.
Other areas that a good AIMS should monitor are scheduling, turnover time and recovery time. According to Dr. Koch, some systems include quality improvement fields that require users to input reasons for a delay in the schedule.
4. Hardware and software should be easily integrated with existing systems. A good AIMS system should be relatively flexible in its startup costs. Dr. Koch notes the following pieces that may be necessary for a healthcare facility to purchase and install a system:
- Personal computers — Depending on the level of access your facility wants, this may require one for every bedside
- Server and networking
- Wireless network
- Mounting solutions for OR, PACU, etc.
- Harnesses for the interface to anesthesia machines and patient monitors.
Many AIMS are software programs that then can be installed on an existing network. Dr. Koch notes that if a healthcare facility has an existing EHR system, it may be necessary to ask that EHR software vendor to enable access to parts of the system so that the AIMS can access the data. However, this may only be necessary if the facility wants to include a patient input portal.
A good AIMS should also include in-house software drivers for its interface to medical input devices. "Drivers are available from several third-party vendors, and some AIMS solution providers use these third-party drivers. The medical device interface is a critical part of the AIMS solution. If the AIMS vendor does not control and manage the entire software suite there is a huge potential for system errors," Dr. Koch says.
Dr. Koch is a practicing anesthesiologist and a consulting physician with Merge Healthcare, manufacturer of Frontiers perioperative clinical information management solutions. Learn more about Merge Healthcare.