Florida Anesthesia Computer and Engineering Team
©
University of Florida, 1996
In the field of Anesthesiology, our information needs can be broken down by time frame into
* preoperative
* intraoperative
* post-operative
We will discuss these separately.
While as early as 1983, a paper-forms-entry based computerized preoperative and intraoperative recordkeeping system for anesthesiologists had been created, there has been no successful computerized preoperative and general "history and physical" computer system until the Hewlett-Packard funded development of PREOP at the University of Florida. We have developed a simple, successful, graphically-interfaced, physician-entry anesthesia preoperative medical records system, which is in current daily use by our Preoperative Evaluation Clinic at the University of Florida. Our system is the only known installed anesthesia evaluation system primarily utilizing direct health care provider entry of data, and one of only a few such systems for any medical specialty. Our desktop-based, limited system has been a large practical success, with 90% of outpatient preoperative evaluations at the University of Florida now entered directly into the computer by the physician evaluator. Over 30,000 outpatients have had their records computerized directly on our system. The system has now been additionally tested at M.D. Andersen hospital with success, and will be commercially available in the near future.
This system has shown very significant financial advantages, because it produces legible problem lists of patients which allow increased number of diagnoses to be verified by the coders who determine the Diagnosis Related Grouping of Medicare patients. One study done at the University of Florida demonstrated a potential for >$100,000 in increased revenue to the hospital from the use of this system in an outpatient setting, and another study suggested >$1,000,000 if the system were available on a portable basis for inpatients.
Preoperative evaluation is impossible without adequate access to the information known about the patient to other specialties. Several other universities have blazed the trail with successful computerized medical records systems for general medical use, such as the University of Indiana Regenstrief system, and the Unix-based THERESA system used at the Grady Memorial charity hospital of Emory University Affiliated Hospitals. Such systems tended to have strong points in gathering information from existing computerized sources such as laboratory, and making easy presentation to the physician. The THERESA system may have been the first to successfully utilize physician entry, using keyword phrases on a black&white Unix X-windows terminal.
While these early development systems rarely became utilized at more than their initial development site (an exception being the HELP system of the University of Utah), their developments matured into a thriving industry with commercial systems now available from such vendors as HBOC, SMS, and Compucare.
These commercially available systems take advantage of the development of reliable, fast, self-protecting client-server databases. (The physician's powerful computer is the client, and the huge central computer database becomes the database server, sharing in the work) Using these technologies, the physician will be able to draw medical information easily into just about any comparison graph of any two variables imaginable, and will be able to see longitudinal views of any portion of the patient's progress.
At the University of Florida, an in-house development known as the On-Line Medical Record has flourished and now holds more than 2 Bytes of patient data, including roughly 1 million separate data items. There are over 1,000 users of the Shands OLMR system. The financial advantages to the institution are so far, unmeasured.
A key ability of these developments has been the provision for "cut and paste" of medical information from one report into another, allowing professionals to avoid having to retype large amounts of information that they would like to insert into their report to explain their conclusions. This feature has been found to have significant financial benefit, yet there is concern over the possibility that information may be erroneously transferred into the wrong patient's record. A proposal has been made to require systems to detect and prevent such errors. Nationwide Systems Many medical or anatomic conditions pose significant risks to the patient undergoing anesthesia. In an attempt to record these, the Malignant Hyperthermia registry is maintained by Medic Alert, and recently a Difficult Airway Registry has been created by Medic Alert. A computerized system for gathering incidents of difficult airways has been developed that will utilize mass distribution of enrollment forms through boxes shipped by endotracheal manufacturers. The latter system is being extensively computerized so that computer access will become possible.
None of the existing systems goes very far beyond the functionality offered by simple paper, except for the "cut and paste" feature, and it simply replicates what a copying machine affords. It is likely that future systems will offer advanced features such as:
* Automatic searching of parallel records for allergies and critical medical information
* Automatic searching of nationwide databases holding registries of patients with critical problems -- with immediate announcement to the professional using a computerized system for routine preanesthetic evaluation.
* Automated review of similar patients to determine expected lengths of stay, costs, and rates of complications -- allowing better financial forecasting for the hospital and better information for the patient and caregiver.
* System will allow the user to very easily pull information from vast numbers of patients (without names!) into spreadsheets, databases, graphing packages to create instant displays of outcome, treatment paths and options.
* Improved communication between multiple providers to reduce the "it slipped through the cracks" syndromes that plague the smooth running of operating rooms.
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