Florida Anesthesia Computer and Engineering Team
©
University of Florida, 1996
The development of intraoperative record keepers for anesthesiologists preceded that of preoperative systems, perhaps because of the tedium of entering vital signs for hours, and because the needs of the physician were similar to that of the ICU nurse, for whom several systems had already been constructed.
The first automated anesthesia record keeping system produced in significant commercial quantity in the United States was the Datascope DATATRAC, which was co-developed by members from our department. It is rumored that less than 200 were ever sold. While quite usable, the system was limited by an extremely slow information bus (300 characters per second) and by an absolute inability to adapt to equipment from other manufacturers.
The first relatively successful anesthesia record keeping system was the Diatek ARKIVE, which in one of its earlier implementation, even included voice recognition. With these new systems, data began to accumulate on the expected variation of physiologic variables during surgery. Such systems began to provide explanations of events during surgery. Despite the relative success, Diatek recently filed for bankruptcy protection.
The uneven response to these earlier systems generated study into improved user interfaces. The advent of graphical user interfaces such as the Macintosh and the Microsoft Windows system allowed considerably more facile user interfaces. Currently marketed intraoperative anesthesia recordkeepers include the OS/2-based MI2 product, and the DOS-going-to-windows CIS recordkeeper. Of these, only the MI2 product is based on a multi-tasking environment and readily utilizes mouse control.
Hewlett-Packard is expected to introduce a DOS-based, but mouse-compatible record keeper in the near future. Diatek is expected to debut a Windows-based intraoperative record keeper in the near future, which will provide better competition for the MI2 product.
* Handwriting
None of the systems will likely become very popular until complete PEN INPUT is provided. Even using a mouse or trackball in the operating room is difficult. Systems are being developed now that will allow the physician's handwriting to be electronically stored. While handwriting recognition systems are not yet capable of recognizing most physician's handwriting, systems in the future may do so, and may be used to retrospectively convert existing records.
* Financial Guidance
One of the likely driving forces for these systems will be an oversight system that will remind the physician of the costs of therapeutic options. The system will likely allow the physician to immediately see a graph is his/her "costliness" as compared to the group's mean. This will allow the group to ratchet down to cheaper ways of doing business without unduly pinching any member.
* Operating Room Management
As will be discussed at the Summary, Anesthesiologists are likely to become the managers of the operating room. Their record keepers (powerful computers doing nothing much of the time, working for a very bright professional who is also often bored) will become displays of cases to be done, staffing patterns, preoperative information, delay information and path options to get home earlier. Physicians who can adapt to an increased responsibility will financially benefit.
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