Rapid Implementation of an Anesthesiology Information Management System
Rapid Implementation of an Anesthesiology Information Management System
Careful planning allows a public hospital in California to reap patient safety
and financial benefits from technology on the fast track.
At most hospitals, it takes a significant time to bring in new information technology systems. Indeed, the wheels move slowly as these organizations attempt to get new technology approved, purchased—and finally implemented. As such, these providers have a difficult time moving to the front of the IT adoption line, even though the patient safety and efficiency advantages would certainly be welcomed by the patient communities that they serve. Many times, public hospitals have even more barriers to overcome to gain access to leading edge technology to benefit their community.
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Figure 2. Anesthesia Information |
Leaders at Santa Clara Valley Medical Center in San Jose, Calif., however, decided to turn this seeming disadvantage into a distinct advantage as they brought in a new electronic anesthesiology information management system, an advanced technology that has become an important part of their healthcare organization’s enterprise-wide electronic health record (EHR).
Certainly, as a public hospital with limited funding for new technology, Santa Clara leaders acknowledged the importance of taking a very deliberative, measured approach to investing in information technology. After all, with a mission that includes acting as a healthcare safety net for community members with no medical coverage or ability to pay, the hospital could not afford to go down the wrong path.
A deliberative approach does not have to be synonymous with slow and stodgy, though. Case in point: After purchasing an anesthesiology information management system, the 512-bed hospital implemented the technology in just 44 days. That’s quite an accomplishment, as the solution serves the needs of 12 operating rooms and 2 labor and delivery suites, which all-together handle approximately 900 surgeries monthly.
Doing Away with the Status Quo
Like many other hospitals, Santa Clara had for many years relied on a labor-intensive and time-consuming paper-based anesthesia management, tracking, and reporting system. As time went on, though, physician, hospital, and technology leaders realized that electronic systems offered a better alternative.
The challenge was to choose the right system, as the hospital needed to be especially careful in investing public monies. At the same time, the need to quickly tap into the clinical and financial benefits clearly associated with automated anesthesiology processes loomed.
Fortunately, the concept of automation was one that already was embraced by many at the hospital. Santa Clara had purchased a single-database perioperative management system in 2001. Today, all of the hospital’s surgical suites are using that system to electronically deliver and document care. Leaders recognized that the technology had resulted in a variety of clinical and financial benefits, and they wanted to replicate similar results in the adjoining anesthesia arena.
“Our operating room director and anesthesia chairperson, Dr. Friedrich Moritz, has been here for a while and was involved with the implementation of our perioperative information system back in 2001. He knew that the system had been instrumental in helping to streamline processes and improve charge capture—so he thought we could leverage a system to get the same kind of benefits in anesthesiology,” says Michelle Sandelien, RN, CNOR, clinical coordinator for perioperative services.
Indeed, an automated system could help the hospital move beyond the challenges traditionally associated with manual anesthesia management, such as time-consuming data entry, cumbersome patient-based paper charting, difficulties with compliance and reporting, and, perhaps most importantly, the propensity to make—and then have to correct—errors. What’s more, the technology presented the opportunity to bolster revenue by submitting bills with complete information, accessing a comprehensive list of medications for billing, and eliminating the need to use a third-party billing service.
“Early on we were looking to accomplish three main goals through the implementation of an anesthesiology information management system—first, to improve the accuracy of our clinical and administrative documentation; second, to improve the efficiency of our anesthesiology processes; and finally, to eliminate clinical and administrative errors,” according to Dr. Bridget Philip, assistant chairperson of the hospital’s anesthesiology department and active supporter of the project. “The system has helped us quickly make progress in all of these key areas.”
From Slow and Steady to Fast and Furious
With such benefits hanging in the balance, getting the system up and running as quickly as possible became a pressing imperative. However, being a public hospital meant that the system could not be purchased without a thorough and time-consuming approval process. Leaders would have to define specific needs for this new system and invite request for proposals (RFPs).
To do this, the hospital established a steering committee with representatives from information technology, procurement, operating room, and anesthesia to define exactly what functions and features were needed in the anesthesia management system. The committee issued an RFP and then meticulously evaluated responses, ranking each vendor’s offerings on a numeric scale.
In the end, the hospital purchased a system from the same vendor that supplies the perioperative system. The resulting system, operating on a common database, eliminated the need for additional interfacing charges while providing a single, seamless perioperative system that was both more efficient and accurate.
The anesthesia information management system (AIMS) enables anesthesiologists to view patient events in real-time, to see what medications have been administered, when they were administered, and what effect they had on the patient’s vital signs. In addition, the system automatically captures over 120 vital signs from patient monitors. The tool also records codes, modifiers, and professional services to facilitate timely and accurate billing. Also the anesthesiology system runs on the same database as the perioperative solution, eliminating the need for interfacing and re-entering patient information for each surgery. This not only saves data entry time, but improves patient safety by eliminating errors caused by duplicate data entry.
Even though the buying process took a full year, anesthesia and perioperative leaders used this time to get a jump start on the implementation, according to Pamela Terry, IT project manager.
“We knew that we would have to carefully choreograph the implementation and training efforts and make sure that we secured the resources to make it happen,” Terry says. “So, we started the planning well in advance of the technology purchase. We started in-depth planning in August, and actually kicked off the implementation in early October. We did a lot of planning ahead of time, and that was key.”
As such, when the anesthesia management system was implemented in October of 2009, the hospital was ready to hit the ground running.
“The fact that the county wheels turn slowly and everyone had a year to get used to the idea made it possible for us to take a more aggressive stance with the implementation. All of the cultural buy-in—which in many situations can slow things down—was already done,” Terry points out.
Sticking to the Plan
To speed things along, the project manager, Pamela Terry, made sure that all of the players—from the hospital leadership to the clinicians, to other staff members—stuck to a detailed project management plan.
To start, Sandelien worked with the director of anesthesiology to make sure that the documentation “wizards” in the system met the needs of the clinician end-users and contained all of the correct terminology.
“We wanted to make sure that everyone impacted by the new system was involved in the implementation and had what they needed and wanted when they started using the system so we would not have to backtrack,” Terry says.
Santa Clara commenced the training phase of the implementation with an in-service for all anesthesiologists and CRNAs (certified registered nurse anesthetists). Clinicians then participated in one-on-one sessions, lasting from about 30 minutes to about an hour each, depending on the needs of each individual.
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Santa Clara Valley Medical Center uses perioperative and anesthesiology solutions from Surgical Information Systems, Alpharetta, Georgia. |
A group of Santa Clara “super-users” then circulated throughout the operating suites to help users with questions during the initial 2-week implementation period. In addition, vendor representatives were available in the lunch and break areas to answer users’ questions and help with any concerns.
During this implementation period, the hospital maintained a dual paper and electronic system. Clinicians had to demonstrate that they were proficient in the electronic system before they were allowed to migrate completely to the new system.
“We reviewed each user’s electronic documentation to make sure that the user was proficient with each key element of documentation before allowing them to move on to exclusive electronic documentation,” Terry says.
Enjoying the Fruits
Although the rapid implementation required staff members to roll up their sleeves and get considerable work done, the initial results are validating the effort. After getting the system up and running in just 44 days, the hospital has realized a litany of benefits.
According to Dr. Bridget Philip, an instrumental champion in the implementation of the new system, “This rapid implementation simply would not have been possible without the support of our senior management, the extensive planning efforts of our implementation team, a strong vendor partner, and the fact that we communicated early and often with all of the staff who were impacted by the new system.”
Most importantly, the system is leading to improved care at the county facility. To start, anesthesiologists and CRNAs are spending less time manually documenting care. This allows anesthesiologists, CRNAs, and anesthesia residents to provide a greater amount of direct patient care.“Previously, the clinicians would have to spend time making little marks on graphs to document all of the vital signs. Now, this is all done automatically with uploads from the vital sign monitors to the computer system,” Sandelien says. “The clinicians just have to glance at it—and then they can spend their time with hands-on patient care, instead of making little tick marks on a piece of paper.”
Improved Regulatory Compliance
The automated system also makes it possible for the hospital to ensure that specific quality measures such as those associated with the Surgical Care Improvement Project (SCIP) are being addressed.
For example, one of these measures call for all patients to receive a warming blanket prior to surgery. With the paper-based system, sometimes clinicians would provide the blanket and document that they did so in the chart; sometimes they would provide the blanket and neglect to document it in the chart; and sometimes they simply would not provide the blanket. The problem was that it was impossible to determine if the warming blanket had not been provided or if the clinician simply had neglected to document the provision.
With the electronic system, however, electronic “wizards” pop up on the screen, prompting clinicians to provide the requisite care before moving on to the next step. For instance, immediately after the patient has been admitted to the OR, the wizard will come up prompting the clinician to provide the warming blanket. The clinician cannot move on to the next step until the blanket is provided and the documentation is completed. The next wizard might then prompt the clinician to administer an antibiotic, a safety measure that is required in many surgeries. “The way the electronic system is set up, it makes it much easier to comply with all the safety requirements as clinicians are reminded to carry out certain measures in a logical fashion,” Sandelien says.
Better Billing
The system also has resulted in improved documentation, which, in turn, has resulted in streamlined and more accurate billing. With the manual process, the hospital was making about three to five billing errors every 2 weeks—and that has been reduced in half. “The electronic documentation is so much clearer than someone’s handwriting. So, it is a much faster process. The documentation is also more accurate and complete so it is much easier to come up with the correct CPT code the first time around,” says Sandelien, who is responsible for the hospital’s perioperative coding and documentation efforts.
The system also makes it easier to capture charges. For example, when working with a manual system, the hospital had previously only charged for about 30 drugs that were administered during surgeries. The electronic system holds a list of more than 200 drugs, making it possible for the hospital to electronically capture charges each time one of these drugs is administered to a patient. Though analysis is still in progress, Santa Clara estimates that this will greatly increase average drug capture, which is expected to generate many thousands of dollars annually in increased medication billings.
Such results have made all of the diligence and hard work required to implement the system worthwhile, according to Dr. Bridget Phillip. “The rapid implementation of our anesthesiology IT system required everyone in the department to undergo rapid change, which is always difficult. Today, about 1 year after the implementation, I would venture to say that no one here would ever consider going back to a paper-based system,” Dr. Phillip says.
Kermit Randa is senior vice president, Surgical Information Systems in Alpharetta, Georgia. He can be reached at randa@sisfirst.com