Electronic health records (EHR) and anesthesia information management systems (AIMS) are here to stay. Seventy five percent of academic departments have adopted EHR and AIMS (“AIMS: Should We AIM Higher?” APSF Newsletter, June 2015) and hospital and ambulatory settings are quickly following suit.
Many of us feel like we are being forced to adopt large enterprise level AIMS solutions that are created for hospital administrators, not clinicians. EPIC and Cerner are the two most widely used.
These AIMS are usually part of a larger electronic medical records (EMR) purchase, so the software development, upgrades and support can feel like they are not truly customized to meet our needs. This article will discuss tips on managing the transition, how to make the systems work for you, and when and how to seek third-party help.
EMR/AIMS adoption has been encouraged by many promises such as increased legibility, more precise data capture, superior chart completion, better and faster charge capture for billing, enhanced quality data, participation in quality registries, decision support in real time and further prospects for clinical research (“AIMS: Should We AIM Higher?” APSF Newsletter, June 2015).
According to the Center for Medicare and Medicaid Services (CMS), up to 90% of future reimbursements from government, and eventually third-party payers, will be at risk for quality reporting data by 2018. Dr. Rick Dutton, medical director of the Anesthesia Quality Institute (AQI), notes that penalties could rise to as much as 11% of Medicare payments in that time. Anyone wishing to transition to alternative payment models, such as a surgical home, for increased reimbursement will absolutely need to be skilled in EMR-based reporting.
So, how do you make the best of the situation? The first and most important step, according to Mark Corey, a Baltimore-based EPIC systems independent consultant, is to be involved early. Make sure you are part of the design committee so you can create the build you want. After the build is done, it’s almost impossible to make alterations. This is particularly important when utilizing Cerner, according to Roger Whitehouse of Primus Healthcare Consulting, a third-party Cerner specialist.
Unlike EPIC, which focuses on standardization and best practice, Cerner allows you to customize your product more, so you need to be sure the design meets your specifications prior to the build (which may be done remotely). Much like a grocery store, the build puts the right products on the shelves. Macros later put the right products in you shopping cart at the right time. It’s a mistake to think that shared or customized macros can solve design problems after the fact.
Make sure you have the right people from the AIMS on site during the transition. Your “super users” should not working clinically. Multiple hour turnovers and delays are frequently reported between cases as providers and nurses adjust from clinical work to troubleshoot problems. Time is money, so avoid lost income and a transition failure by investing in adequate support.
The transition to an AIMS can be a multiyear process, says Moed Azam, an anesthesiologist for JLR and USAP who helped create a Cerner collaborative among several national hospitals. Considering input from stakeholders, deciding how to craft the intraoperative documentation and biomedical device integration are all individually time-consuming processes and all are part of the transition. When you can, “pull the extract” for the build and macros from a collaborative. You will get a working solution that can help you with common reporting and benchmarks, but that is only part of the process.
Converting to an electronic anesthesia record (EAR) can be a daunting experience for an anesthesia provider, write Roger Whitehouse and Brian Koelliker, also of Primus Healthcare Consulting. The anesthesia environment is unique among EHR’s because it is the only place where such a tool is used in real time in cases which can last 20 minutes or less. Delays in this area, caused by suboptimal design and build, directly result in lowered throughput and increased costs. More importantly, a successful effort cannot risk pulling the practitioner’s attention to the EAR rather than the patient. The right project approach, scope and team can serve to mitigate these problems and make the transition to AIMS a positive experience.
Whitehouse and Koelliker summarize five key factors for a successful transition:
- Craft an overall approach and plan before you even start with design of your EAR. Structuring how this will happen, who needs to participate and how to leverage expertise are all factors in success.
- Involve clinicians. Those who will use the EAR must be directly involved in designing, testing, training and championing the tool. The primary goal should be to create a system that fits the established workflow of the providers and minimizes clicks.
- Learn from others. These tools are working for other practitioners across the country and around the world. What is best practice? Knowing what works for others and refining it to meet the specific needs of your organization will increase the likelihood of success. Seek out consortiums of hospital groups, similar to the Pediatric Electronic Anesthesia Record (PEAR) Group, which will allow you to download and share reporting macros and useful knowledge.
- Scope the project to encompass every element of the practitioners’ workflow. Anesthesia practitioners don’t just use the EAR. What supports them in the pre-op environment? In the pre-admission environment? In PACU? And how do these seamlessly integrate with and flow to and from the rest of the organization’s EHR?
- Look to the future. Electronic data are only helpful if they become useful for quality and outcome improvement and other learning efforts. A host of quality reporting agencies exist. Design and build should drastically simplify reports for those agencies and a project must have this requirement in mind.
With physician involvement from the start and a good design, you can successfully convert to an AIMS with little or no impact on your current clinical schedule. Only then will you truly have a comprehensive set of tools to support you amidst the changing health care environment.