anesthesia information management systems: workflow engineering and return on investment

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    AparCenter, 1500 E. Medical Center Drive, Ann Arbor, Michigan48109-0048; E-mail: oreilly@umich.edu

    Semerefore, the benefits of implementing an elec-nic perioperative process will depend on theectiveness and efficiency (or lack thereof) of antitutions current paper-based systems.

    * http://www.asahq.org/Newsletters/2002/6_02/subnews_602.htm. 2004 Elsevier Inc. All rights reserved.0277-0326/04/2302-0011$30.00/0doi:10.1053/j.sane.2004.01.005

    151inars in Anesthesia, Perioperative Medicine and Pain, Vol 23, No 2 (June), 2004: pp 151-157nesthesia Information Managemeand Return o

    Michael OReilly, MD, MS, Kevin K. Trem

    ollowing its annual meeting in 2001, the An-esthesia Patient Safety Foundation (APSF) is-

    d the following statement: The APSF endorsesd advocates the use of automated record-keepingthe perioperative period and the subsequent re-val and analysis of these data to improve patientety.* This proclamation notwithstanding,en the competition for scarce healthcare re-rces, keen analysis and persuasive argumentsrequired to advance a project for the acquisition

    d implementation of perioperative informationtems. Return on investment data are central forking those arguments. The purpose of this paperto make the case that an anesthesia informationtem is worth the considerable investment ine, energy, and money and to present a proma financial analysis. Where appropriate, expe-nce from the implementation of an anesthesiaormation system at the University of Michiganll be included.Determining a return on investment (ROI) for anormation technology (IT) project is notoriouslyficult.1 Traditional ROI analyses measure theects of IT on decreased operational costs andreased revenue. However, to the best of ourowledge, such an analysis has not been pub-hed for anesthesia information systems. Sincech of the benefit of IT relates to improvedductivity, a cost and revenue analysis may notect the whole picture with respect to the valueimplementing an information system.2 Intu-ely, it is apparent that paper-based systems are

    t sustainable. However, the transition to elec-nic information systems is a complex and chal-ging endeavor. Much of the work involves

    anging the way people do their jobs; that is,rk process reengineering. The required analysisll reveal benefits that may not be directly relatedthe implementation of an information system butystems: Workflow Engineeringvestment

    hD, MD, and Paul Baumgart, MBA

    The ROI model for anesthesia information sys-s is further complicated by the fact that some ofbenefits will be to the anesthesiologist ande to the institution. But perhaps the most im-

    rtant aspect of implementing an anesthesia in-mation system relates to the intangible benefits;particular, increased patient and provider satis-tion and improved patient safety and quality ofe. Although these are difficult to quantify, theybecoming increasingly important as the com-

    tition for patients and nursing staff increases.The argument for implementation of an infor-tion system can be summed up as if you cantasure it you cant manage it. Everyone knowsr paper systems are inefficient at best and dan-rous at worst. However, more specific benefitsst be described, and if possible quantified, to

    nstruct a business case to advance a project torchase and implement a perioperative informa-n management system. More importantly, it isal to determine the scope of a project and toticipate taking advantage of various opportuni-s that may not be readily apparent.Information systems improve efficiency becausey capture pertinent information at the point ofvice and leverage data already collected orailable from other information systems. That is,mplete and accurate clinical documentation,mbined with other digital data, will drive a num-r of downstream processes. For example, chargeture and quality assurance data can be gener-d as reports from the database. In addition,

    rom the University of Michigan Health System, Ann Arbor,higan, and General Electric Medical Systems Informationhnology.ddress reprint requests to Michael OReilly, MS, MD, De-tment of Anesthesiology, University of Michigan Medical

  • information is collected once and then reconfirmedby others as the data are carried forward during thecar

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    Electronic Advanced Testing DocumentationEnhances Workflow

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    152 OREILLY, TREMPER, AND BAUMGARTe process. For example, allergy information canconfirmed; it is better to say, I see you had aere reaction after taking penicillin versus Do

    u have any allergies to medications? In ourrrent paper-based system, the patient may beed this question five times between admitting

    d discharge from the hospital.

    ACTICAL EXECUTION: MOVING PATIENTSTHROUGH THE SYSTEM

    The operating room is a very important sourcerevenue for most hospitals. Increasing the effi-ncy and utilization of the operating room hasditionally been driven by the data available fromerating room scheduling systems. Anesthesiolo-ts and hospitals have vested interests in thecient execution of the OR schedule, and bothuire documentation of sentinel time stamps inperioperative process. This mutual interest in

    ciency and documentation is evidenced by thenvergence of OR scheduling systems and anes-sia documentation systems. Perioperative infor-tion systems help move patients through thetem and therefore provide some ROI by ensur-the required documentation is completed and

    sent at the point of care; i.e., in the holdingm prior to bringing the patient to the OR.

    PATIENT ADVANCED TESTING

    There are three ways an anesthesia advancedting and evaluation clinic can avoid delays andlp move patients through the perioperative pro-s efficiently: (1) by ensuring the patient is med-lly prepared or optimized for anesthesia andgery (and hence the case will not be delayed orcelled because of an unrecognized or untreatedevaluated co-morbidity); (2) collecting andnning the documents that are required for the

    tient to get into the operating room, in particular,consent and surgical history and physical; (3)

    suring the anesthesiologist who will be caringthe patient has all relevant data at the point of

    e. The direct return on investment will be re-ed to the number of cases that are delayed orcelled and for what reason at a particular insti-

    ion.The most significant impact of automating theanced testing process may relate to reducing theravation of those involved in the process. Collect-all existing relevant clinical documentation, in-

    ding labs, consultant reports, and test results at theint of care, is a labor-intensive process in the pa--based world. Prior to the implementation of anctronic system in the Patient Advanced TestingT) Clinic at the University of Michigan, three

    dical assistants were required to assemble all ofrelevant paper documents. Now, the clinic runs

    th one medical assistant and their role has changedcommunicating with other clinics and scanningcuments into the database.Since the patients may move through the systemter than the paper, it is a challenge to make theults of the evaluation available to all stakehold-(nurses, surgeons, and anesthesia care provid-

    ). Providers may be in different locations and,ally, would like to have access to the informa-n at the same time. This cannot be accomplishedth efficiency in a paper-based system. At theiversity of Michigan, prior to the implementa-n of an electronic system, one person had tolk over to the Operating Room from the PATnic every day to deliver the paper advancedting forms. These were placed in a filing cabi-t. An audit revealed that 50% of the paper copiesre never retrieved. It was progressively moreficult to find the paper copies since they tendedaccumulate. Implementation of the electronictem was a workflow enhancement for the anes-siologist as well as the clerk whose job it was tolk over with the paper copies and file them.ho likes to file?)

    When a patient is seen in advance, and it istermined they require further tests or evaluation,w do you ensure there is appropriate follow-upthese results by the ordering physician so thatevaluation is completed and reviewed prior tostart of surgery? In our electronic system, out-

    nding issues are identified and the database gen-tes an alert three days prior to the date ofgery. The alert goes to the ordering physician asll as to the anesthesiologist who will be caringthe patient. Electronic notification continues atcified intervals until the flag on the pending

    ue is cleared. This ensures the patient does not

  • show up in the holding room with unresolvedissues.

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    in real time, the cases for which they are respon-sible. In addition, complete and accurate clinicaldomo

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