Technology Diffusion of Anesthesia Information Management Systems into Academic Anesthesia Departments in the United States

BACKGROUND:Anesthesia information management systems (AIMS) are electronic health records that automatically import vital signs from patient monitors and allow for computer-assisted creation of the anesthesia record. When most recently surveyed in 2007, it was estimated that at least 16% of U.S. academic hospitals (i.e., with an anesthesia residency program) had installed an AIMS. At least an additional 28% reported that they were in the process of implementing, or searching for an AIMS. In this study, we updated the adoption figures as of May 2013 and examined the historical trend of AIMS deployment in U.S. anesthesia residency programs from the perspective of the theory of diffusion of technologic innovations. METHODS:Questionnaires were sent by e-mail to program directors or their identified contact individuals at the 130 U.S. anesthesiology residency programs accredited as of June 30, 2012 by the Accreditation Council for Graduate Medical Education. The questionnaires asked whether the department had an AIMS, the year of installation, and, if not present, whether there were plans to install an AIMS within the next 12 months. Follow-up e-mails and phone calls were made until responses were obtained from all programs. Results were collected between February and May 2013. Implementation percentages were determined using the number of accredited anesthesia residency programs at the start of each academic year between 1987 and 2013 and were fit to a logistic regression curve using data through 2012. RESULTS:Responses were received from all 130 programs. Eighty-seven (67%) reported that they currently are using an AIMS. Ten programs without a current AIMS responded that they would be installing an AIMS within 12 months of the survey. The rate of AIMS adoption by year was well fit by a logistic regression curve (P = 0.90). CONCLUSIONS:By the end of 2014, approximately 75% of U.S. academic anesthesiology departments will be using an AIMS, with 84% adoption expected between 2018 and 2020. Historical adoption of AIMS has followed Roger’s 1962 formulation of the theory of diffusion of innovation.

[1]  F Dexter,et al.  Mediated Interruptions of Anaesthesia Providers using Predictions of Workload from Anaesthesia Information Management System Data , 2012, Anaesthesia and intensive care.

[2]  Shu-Fang Newman,et al.  Feedback Mechanisms Including Real-Time Electronic Alerts to Achieve Near 100% Timely Prophylactic Antibiotic Administration in Surgical Cases , 2010, Anesthesia and analgesia.

[3]  C. Goldzweig,et al.  Costs and benefits of health information technology: new trends from the literature. , 2009, Health affairs.

[4]  Anesthesia information management systems as a cost containment tool. , 1997, CRNA : the clinical forum for nurse anesthetists.

[5]  M. Hollmann,et al.  Automated reminders decrease postoperative nausea and vomiting incidence in a general surgical population. , 2012, British journal of anaesthesia.

[6]  K. Tremper,et al.  Electronic Reminders Improve Procedure Documentation Compliance and Professional Fee Reimbursement , 2007, Anesthesia and analgesia.

[7]  Jesse M. Ehrenfeld,et al.  Anesthesia information management systems: a review of functionality and installation considerations , 2011, Journal of Clinical Monitoring and Computing.

[8]  C. Grant,et al.  Adverse Physiological Events under Anaesthesia and Sedation: A Pilot Audit of Electronic Patient Records , 2008, Anaesthesia and intensive care.

[9]  Yan Xiao,et al.  An Algorithm for Processing Vital Sign Monitoring Data to Remotely Identify Operating Room Occupancy in Real-Time , 2005, Anesthesia and analgesia.

[10]  Adoption of anesthesia information management systems by US anesthesiologists , 2011, Journal of Clinical Monitoring and Computing.

[11]  G. Tarde.  The Laws of Imitation , 2009 .

[12]  Jesse M. Ehrenfeld,et al.  Anesthesia information management systems: past, present, and future of anesthesia records. , 2012, The Mount Sinai journal of medicine, New York.

[13]  Marina Krol,et al.  The Effect of an Interactive Visual Reminder in an Anesthesia Information Management System on Timeliness of Prophylactic Antibiotic Administration , 2007, Anesthesia and analgesia.

[14]  K. Tremper,et al.  A randomized trial of automated electronic alerts demonstrating improved reimbursable anesthesia time documentation. , 2013, Journal of clinical anesthesia.

[15]  H. Schwid,et al.  Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors. , 2012, Joint Commission journal on quality and patient safety.

[16]  Alex Macario,et al.  Prevalence of anaesthesia information management systems in university-affiliated hospitals in Europe , 2010, European journal of anaesthesiology.

[17]  J. Feldman,et al.  Do Anesthesia Information Systems Increase Malpractice Exposure? Results of a Survey , 2004, Anesthesia and analgesia.

[18]  F. Bass.  A new product growth model for consumer durables , 1976 .

[19]  M. Stabile,et al.  Review article: The evolving role of information technology in perioperative patient safety , 2013, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[20]  Jesse M. Ehrenfeld,et al.  Real-Time Checking of Electronic Anesthesia Records for Documentation Errors and Automatically Text Messaging Clinicians Improves Quality of Documentation , 2008, Anesthesia and analgesia.

[21]  B. Ryan.  The diffusion of hybrid seed corn in two Iowa communities , 1943 .

[22]  Stephen F Spring,et al.  Automated Documentation Error Detection and Notification Improves Anesthesia Billing Performance , 2007, Anesthesiology.

[23]  J. Ledolter,et al.  Automatic Updating of Times Remaining in Surgical Cases Using Bayesian Analysis of Historical Case Duration Data and “Instant Messaging” Updates from Anesthesia Providers , 2009, Anesthesia and analgesia.

[24]  AkkeNeel Talsma,et al.  An Anesthesia Information System Designed to Provide Physician-Specific Feedback Improves Timely Administration of Prophylactic Antibiotics , 2006, Anesthesia and analgesia.

[25]  Harry F Lukens,et al.  Point-of-Care Electronic Prompts: An Effective Means of Increasing Compliance, Demonstrating Quality, and Improving Outcome , 2011, Anesthesia and analgesia.

[26]  Frank M. Bass,et al.  A New Product Growth for Model Consumer Durables , 2004, Manag. Sci..

[27]  Franklin Dexter,et al.  Implications of Event Entry Latency on Anesthesia Information Management Decision Support Systems , 2009, Anesthesia and analgesia.

[28]  R. Epstein,et al.  Optimizing second shift OR staffing. , 2003, AORN journal.

[29]  Stephen F Spring,et al.  Evaluation of a Mandatory Quality Assurance Data Capture in Anesthesia: A Secure Electronic System to Capture Quality Assurance Information Linked to an Automated Anesthesia Record , 2011, Anesthesia and analgesia.

[30]  Franklin Dexter,et al.  Operating Room Managerial Decision-Making on the Day of Surgery With and Without Computer Recommendations and Status Displays , 2007, Anesthesia and analgesia.

[31]  R. Epstein,et al.  Mean Arterial Pressures Bracketing Prolonged Monitoring Interruptions Have Negligible Systematic Differences from Matched Controls Without Such Gaps , 2011, Anesthesia and analgesia.

[32]  J. Ensor,et al.  Ongoing Provision of Individual Clinician Performance Data Improves Practice Behavior , 2010, Anesthesia and analgesia.

[33]  D. Brammen,et al.  An Anesthesia Information Management System (AIMS) as a tool for controlling resource management of operating rooms. , 2002, Methods of information in medicine.

[34]  G. Simmel.  The sociology of Georg Simmel , 1950 .

[35]  A. Hoeft,et al.  Lack of Effectiveness of the Pulmonary Artery Catheter in Cardiac Surgery , 2011, Anesthesia and analgesia.

[36]  Anesthesia information management systems: almost there. , 2008, Anesthesia and analgesia.

[37]  Michael M. Vigoda,et al.  Changing Medical Group Behaviors: Increasing the Rate of Documentation of Quality Assurance Events Using an Anesthesia Information System , 2006, Anesthesia and analgesia.

[38]  M. Hollmann,et al.  Decision Support Increases Guideline Adherence for Prescribing Postoperative Nausea and Vomiting Prophylaxis , 2008, Anesthesia and analgesia.

[39]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[40]  Paul M Ness,et al.  Variability in Blood and Blood Component Utilization as Assessed by an Anesthesia Information Management System , 2012, Anesthesiology.

[41]  Charlotte H. Mason,et al.  Technical Note---Nonlinear Least Squares Estimation of New Product Diffusion Models , 1986 .

[42]  E. Rogers,et al.  Diffusion of innovations , 1964, Encyclopedia of Sport Management.

[43]  Alex Macario,et al.  Adoption of Anesthesia Information Management Systems by Academic Departments in the United States , 2008, Anesthesia and analgesia.

[44]  Azriel Perel,et al.  The Impact of an Electronic Reminder on the Use of Alarms After Separation from Cardiopulmonary Bypass , 2009, Anesthesia and analgesia.

[45]  R. Epstein,et al.  Implications of Resolved Hypoxemia on the Utility of Desaturation Alerts Sent from an Anesthesia Decision Support System to Supervising Anesthesiologists , 2012, Anesthesia and analgesia.

[46]  D. Meadows-Klue.  The Tipping Point: How Little Things Can Make a Big Difference , 2004 .

[47]  Michael M. Vigoda,et al.  Failure to recognize loss of incoming data in an anesthesia record-keeping system may have increased medical liability. , 2006, Anesthesia and analgesia.

[48]  F. Dexter,et al.  Use of an Automated Anesthesia Information System to Determine Reference Limits for Vital Signs During Cesarean Section , 1998, Journal of Clinical Monitoring and Computing.

[49]  Jesse M. Ehrenfeld,et al.  Automatic Notifications Mediated by Anesthesia Information Management Systems Reduce the Frequency of Prolonged Gaps in Blood Pressure Documentation , 2011, Anesthesia and analgesia.