Challenges and opportunities for computerizing the anesthesia record.

Most observers would agree that the goal of computerizing the anesthesia record is a worthy one. Despite the fact that several academic groups and vendors have attempted to develop and provide computerized anesthesia charting, the practice is not widespread. In this review article, we attempt to outline the reasons for this reluctance to use computers for anesthesia charting. Where there are problems to be solved, there also are opportunities. We discuss the development of strategies to solve these problems and thus present opportunities for medical informatics professionals and anesthesiologists to work toward joint solutions. Solving these problems includes the development of consensus standards and working out technical, social, and educational difficulties. Details of the approaches recommended are outlined.

[1]  R M Zollinger,et al.  Man-made versus computer-generated anesthesia records. , 1977, The Journal of surgical research.

[2]  D. Kroll The legal implications of computerized anesthesia records : an admittedly biased review , 1991 .

[3]  C. McDonald Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[4]  R M Gardner,et al.  Computerized management of intensive care patients. , 1987 .

[5]  Jörg H. Hohnloser,et al.  PADS (Patient Archiving and Documentation System): A computerized patient record with educational aspects , 1992, International journal of clinical monitoring and computing.

[6]  R M Gardner,et al.  Medical informatics in the intensive care unit: state of the art 1991 , 1991, International journal of clinical monitoring and computing.

[7]  P. G. Hugenholtz,et al.  A microcomputer based charting system for documentation of circulatory, respiratory and pharmacological data during anesthesia , 1984, International journal of clinical monitoring and computing.

[8]  J. Eichhorn Effect of Monitoring Standards on Anesthesia Outcome , 1993, International anesthesiology clinics.

[9]  Smith Nt,et al.  The anesthesia database, the automated record, and the quality assurance process. , 1992 .

[10]  E L Wiener,et al.  Analysis of Tasks and Human Factors in Anesthesia for Coronary‐Artery Bypass , 1976, Anesthesia and analgesia.

[11]  D. Eddy Clinical decision making: from theory to practice. Anatomy of a decision. , 1990, JAMA.

[12]  W G Cole Integrality and meaning: essential and orthogonal dimensions of graphical data display. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[13]  Reed M. Gardner,et al.  White Paper: Designing Medical Informatics Research and Library-Resource Projects to Increase What Is Learned , 1994, J. Am. Medical Informatics Assoc..

[14]  Joachim S. Gravenstein,et al.  Randomized Evaluation of Pulse Oximetry in 20,802 Patients; II: Perioperative Events and Postoperative Complications , 1993, Anesthesiology.

[15]  B. Sloan,et al.  Computerized patient anesthesia records: less time and better quality than manually produced anesthesia records. , 1993, Journal of clinical anesthesia.

[16]  Sarnat Aj Computerized speech recognition for anesthesia recordkeeping. , 1983 .

[17]  W G Cole,et al.  Metaphor graphics to support integrated decision making with respiratory data , 1993, International journal of clinical monitoring and computing.

[18]  N Govindarajan,et al.  Breath detection algorithm in digital computers , 1990, International journal of clinical monitoring and computing.

[19]  J A Orr,et al.  Intelligent alarms reduce anesthesiologist's response time to critical faults. , 1992, Anesthesiology.

[20]  D N Thrush,et al.  Are automated anesthesia records better? , 1992, Journal of clinical anesthesia.

[21]  O Prakash,et al.  Anesthesia support systems , 1992, International journal of clinical monitoring and computing.

[22]  J. Feldman,et al.  Anesthesia records and automation , 1989 .

[23]  Morten Kyng,et al.  Design at Work , 1992 .

[24]  Abel,et al.  Eight year’s experience with automated anesthesia record keeping: Lessons learned—new directions taken , 1992, International journal of clinical monitoring and computing.

[25]  D M Berwick,et al.  Continuous improvement as an ideal in health care. , 1989, The New England journal of medicine.

[26]  Clement J. McDonald,et al.  Medical-record systems , 1990 .

[27]  Edward H. Shortliffe,et al.  Medical data: their acquisition, storage, and use , 1990 .

[28]  R M Gardner,et al.  Real time data acquisition: recommendations for the medical information bus (MIB) , 1991, International journal of clinical monitoring and computing.

[29]  Dr. Annejet P. Meijler Automation in Anesthesia — A Relief? , 1987, Springer Berlin Heidelberg.

[30]  G. F. Karliczek,et al.  Carola, a computer system for automatic documentation in anesthesia , 1987, International journal of clinical monitoring and computing.

[31]  G Bashein,et al.  A Comprehensive Computer System for Anesthetic Record Retrieval , 1985, Anesthesia and analgesia.

[32]  E. Pierce The development of anesthesia guidelines and standards. , 1990, QRB. Quality review bulletin.

[33]  David C. Classen,et al.  The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. , 1992, The New England journal of medicine.

[34]  J. Osborn Computers in critical care medicine: promises and pitfalls , 1982, Critical care medicine.

[35]  Jan E. W. Beneken,et al.  Computerized Data Acquisition and Display in Anesthesia , 1983 .

[36]  R. F. Gibbs,et al.  The present and future medicolegal importance of record keeping in anesthesia and intensive care: The case for automation , 1989, Journal of clinical monitoring.

[37]  R M Gardner,et al.  Editorial; medical information bus: The key to future integrated monitoring , 1989, International journal of clinical monitoring and computing.

[38]  D. W. Edsall Quality assessment with a computerized anesthesia information management system (AIMS). , 1991, QRB. Quality review bulletin.

[39]  N Govindarajan,et al.  Real-time respiratory monitoring workstation-software and hardware engineering aspects , 1992, International journal of clinical monitoring and computing.

[40]  R M Gardner,et al.  Digital electronic communication between ICU ventilators and computers and printers. , 1992, Respiratory care.

[41]  H T Davenport,et al.  The anaesthetic machine--a study of function and design. , 1980, British journal of anaesthesia.

[42]  J. Eichhorn,et al.  Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. , 1989, Anesthesiology.

[43]  J W Prentice,et al.  Microcomputer-based anaesthetic record system. , 1984, British journal of anaesthesia.

[44]  S. Huff,et al.  Computers in the ICU: Why? What? and So What? , 1992, International journal of clinical monitoring and computing.

[45]  M M Shabot,et al.  The medical device data language for the P1073 medical information bus standard , 1990, International journal of clinical monitoring and computing.

[46]  J. S. McDonald,et al.  Differences between handwritten and automatic blood pressure records. , 1989, Anesthesiology.

[47]  R M Gardner,et al.  Computerized medical care: the HELP system at LDS Hospital. , 1992, Journal of AHIMA.

[48]  R M Gardner,et al.  Computerized detection of arterial oxygen desaturations in an intensive care unit. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[49]  O. Prakash,et al.  A new approach: reusable real-time database for medical instrumentation applications , 1989, International journal of clinical monitoring and computing.

[50]  T A Noel,et al.  Computerized anesthesia records may be dangerous. , 1986, Anesthesiology.

[51]  R. Watt,et al.  Alarms and anesthesia: challenges in design of intelligent systems for patient monitoring , 1993, IEEE Engineering in Medicine and Biology Magazine.

[52]  R M Gardner,et al.  Computerized ICU data management: pitfalls and promises , 1990, International journal of clinical monitoring and computing.

[53]  D. Gaba HUMAN ERROR IN ANESTHETIC MISHAPS , 1989, International anesthesiology clinics.

[54]  D. Eddy Anatomy of a decision , 1990 .

[55]  J. Eichhorn,et al.  Anesthesia record keeping , 1993, International journal of clinical monitoring and computing.

[56]  J. Reggia,et al.  HELP: A Dynamic Hospital Information System , 1991, Computers and Medicine.

[57]  J. Paull Humanising the Computer , 1982, Anaesthesia and intensive care.

[58]  D. Berwick The double edge of knowledge. , 1991, JAMA.

[59]  Integration of Surgery Management and Clinical Information Systems. , 1987 .

[60]  W. Erdmann,et al.  Continuous intra-arterial PO2 monitoring during thoracic surgery. , 1992, Advances in experimental medicine and biology.

[61]  Lawrence J. Kunz Dehumanizing the computer , 1979 .

[62]  M M Shabot,et al.  Standardized acquisition of bedside data: The IEEE P1073 medical information bus , 1989, International journal of clinical monitoring and computing.

[63]  R M Gardner,et al.  Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis. , 1989, Infection control and hospital epidemiology.

[64]  L. Chan,et al.  How much information is lost during processing? A case study of pediatric emergency department records. , 1993, Computers and biomedical research, an international journal.

[65]  Dean F. Sittig,et al.  A strategy for development of computerized critical care decision support systems , 1991, International journal of clinical monitoring and computing.

[66]  Eichhorn Jh,et al.  Pulse oximetry as a standard of practice in anesthesia. , 1993 .

[67]  S. Meiyappan,et al.  Development of software for pulse oximeter and investigation of its realtime response in clinical environment , 1990, International journal of clinical monitoring and computing.

[68]  E Coiera Incorporating user and dialogue models into the interface design of an intelligent patient monitor. , 1991, Medical informatics = Medecine et informatique.

[69]  R M Gardner,et al.  Using a hospital information system to assess the effects of adverse drug events. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.