Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T11:50:58.609Z Has data issue: false hasContentIssue false

Chapter 16 - The Electronic Health Record as a Monitor for Performance Improvement

Published online by Cambridge University Press:  28 April 2020

Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
Get access

Summary

The anesthesia record is more than just a historic snapshot of clinical care. It also serves as a clinical monitor in itself. In electronic form, and as a component of an electronic health record (EHR), its utility is extended to provide data to drive clinical decision support, compliance, research, administrative, and human resource functions with an overall goal of performance improvement.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Zeitlin, GL. History of Anesthesia Records. American Society of Anesthesiologists Newsletter. www.woodlibrarymuseum.org/news/pdf/Zeitlin.pdfGoogle Scholar
Piepenbrink, JC, Cullen, JI Jr, Stafford, TJ. The use of video in anesthesia record keeping. Biomed Instrum Technol 1990;24:1924.Google ScholarPubMed
Kenney, GNC. Implementation of computerized anaesthetic records. Baillière’s Clinical Anaesthesiology 1990;4:16.Google Scholar
Stol, IS, Ehrenfeld, JM, Epstein, RH. Technology diffusion of anesthesia information management systems into academic anesthesia departments in the United States. Anesth Analg 2014;118:644–50.Google Scholar
Levin, MA, Wanderer, JP, Ehrenfeld, JM. Data, big data, and metadata in anesthesiology. Anesth Analg 2015;121:1661–7.CrossRefGoogle ScholarPubMed
Loeb, RG. Manual record keeping is not necessary for anesthesia vigilance. J Clin Monit 1995;11:913.CrossRefGoogle Scholar
Allard, J, Dzwonczyk, R, Yablok, D, Block, FE Jr, McDonald, JS. Effect of automatic record keeping on vigilance and record keeping time. Br J Anaesth 1995;74:619–26.CrossRefGoogle ScholarPubMed
Wax, DB, Lin, HM, Reich, DL. Intraoperative non-record-keeping usage of anesthesia information management system workstations and associated hemodynamic variability and aberrancies. Anesthesiology 2012;117:1184–9.CrossRefGoogle ScholarPubMed
Thrush, DN. Are automated anesthesia records better? J Clin Anesth 1992;4:386–9.CrossRefGoogle ScholarPubMed
Lerou, JG, Dirksen, R, van Daele, M, Nijhuis, GM, Crul, JF. Automated charting of physiological variables in anesthesia: a quantitative comparison of automated versus handwritten anesthesia records. J Clin Monit 1988;4:3747.CrossRefGoogle ScholarPubMed
Devitt, JH, Rapanos, T, Kurrek, M, Cohen, MM, Shaw, M. The anesthetic record: accuracy and completeness. Can J Anaesth 1999;46:122–8.Google Scholar
Reich, DL, Wood, RK Jr, Mattar, R, et al. Arterial blood pressure and heart rate discrepancies between handwritten and computerized anesthesia records. Anesth Analg 2000;91:612–16.Google Scholar
Feldman, JM. Do anesthesia information systems increase malpractice exposure? Results of a survey. Anesth Analg 2004;99:840–3.CrossRefGoogle ScholarPubMed
Vigoda, MM, Lubarsky, DA. The medicolegal importance of enhancing timeliness of documentation when using an anesthesia information system and the response to automated feedback in an academic practice. Anesth Analg 2006;103:131–6.Google Scholar
Wanderer, JP, Gruss, CL, Ehrenfeld, JM. Using visual analytics to determine the utilization of preoperative anesthesia assessments. Appl Clin Inform 2015;6:629–37.Google ScholarPubMed
Bowman, S. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag 2013;10:1c.Google ScholarPubMed
Meeks, DW, Smith, MW, Taylor, L, Sittig, DF, Scott, JM, Singh, H. An analysis of electronic health record-related patient safety concerns. J Am Med Inform Assoc 2014;21:1053–9.CrossRefGoogle ScholarPubMed
Shaarani, I, Taleb, R, Antoun, J. Effect of computer use on physician-patient communication using a validated instrument: patient perspective. Int J Med Inform 2017;108:152–7.CrossRefGoogle ScholarPubMed
Blijleven, V, Koelemeijer, K, Jaspers, M. Identifying and eliminating inefficiencies in information system usage: a lean perspective. Int J Med Inform 2017;107:40–7.Google Scholar
Denham, CR, Classen, DC, Swenson, SJ, Henderson, MJ, Zeltner, T, Bates, DW. Safe use of electronic health records and health information technology systems: trust but verify. J Patient Saf 2013;9:177–89.Google Scholar
Tsou, AY, Lehmann, CU, Michel, J, Solomon, R, Possanza, L, Gandhi, T. Safe practices for copy and paste in the EHR. Systematic review, recommendations, and novel model for health IT collaboration. Appl Clin Inform 2017;8:1234.Google Scholar
Gálvez, JA, Rothman, BS, Doyle, CA, Morgan, S, Simpao, AF, Rehman, MA. A narrative review of meaningful use and anesthesia information management systems. Anesth Analg 2015;121:693706.CrossRefGoogle ScholarPubMed
McWilliams, JM. MACRA: big fix or big Problem? Ann Intern Med 2017;167:122–4.Google Scholar
Epstein, RH, Dexter, F, Patel, N. Influencing anesthesia provider behavior using anesthesia information management system data for near real-time alerts and post hoc reports. Anesth Analg 2015;121:678–92.Google Scholar
Simpao, AF, Tan, JM, Lingappan, AM, Gálvez, JA, Morgan, SE, Krall, MA. A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems. J Clin Monit Comput 2017;31:885–94.Google Scholar
Nair, BG, Gabel, E, Hofer, I, Schwid, HA, Cannesson, M. Intraoperative clinical decision support for anesthesia: a narrative review of available systems. Anesth Analg 2017;124:603–17.CrossRefGoogle ScholarPubMed
Belard, A, Buchman, T, Forsberg, J, et al. Precision diagnosis: a view of the clinical decision support systems (CDSS) landscape through the lens of critical care. J Clin Monit Comput 2017;31:261–71.Google Scholar
Sadeghi-Bazargani, H, Tabrizi, JS, Azami-Aghdash, S. Barriers to evidence-based medicine: a systematic review. J Eval Clin Pract 2014;20:793802.Google Scholar
Kumanan, W. Evidence-based medicine. The good the bad and the ugly. A clinician’s perspective. J Eval Clin Pract 2010;16:398400.Google Scholar
Prasad, V, Cifu, A. Medical reversal: why we must raise the bar before adopting new technologies. Yale J Biol Med 2011;84:471–8.Google ScholarPubMed
Varghese, J, Kleine, M, Gessner, SI, Sandmann, S, Dugas, M. Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. J Am Med Inform Assoc 2018;25(5):593602.CrossRefGoogle ScholarPubMed
O’Reilly, M, Talsma, A, VanRiper, S, Kheterpal, S, Burney, R. An anesthesia information system designed to provide physician-specific feedback improves timely administration of prophylactic antibiotics. Anesth Analg 2006;103:908–12.Google Scholar
Wax, DB, Beilin, Y, Levin, M, Chadha, N, Krol, M, Reich, DL. The effect of an interactive visual reminder in an anesthesia information management system on timeliness of prophylactic antibiotic administration. Anesth Analg 2007;104:1462–6.Google Scholar
Nair, BG, Newman, SF, Peterson, GN, Wu, WY, Schwid, HA. Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases. Anesth Analg 2010;111:1293–300.CrossRefGoogle ScholarPubMed
Nair, BG, Newman, SF, Peterson, GN, Schwid, HA. Automated electronic reminders to improve redosing of antibiotics during surgical cases: comparison of two approaches. Surg Infect 2011;12:5763.Google Scholar
Schwann, NM, Bretz, KA, Eid, S, et al. Point-of-care electronic prompts: an effective means of increasing compliance, demonstrating quality, and improving outcome. Anesth Analg 2011;113:869–7.Google Scholar
Kooij, FO, Klok, T, Hollmann, MW, Kal, JE. Decision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. Anesth Analg 2008;106:893–8.CrossRefGoogle ScholarPubMed
Kappen, TH, Vergouwe, Y, van Wolfswinkel, L, Kalkman, CJ, Moons, KG, van Klei, WA. Impact of adding therapeutic recommendations to risk assessments from a prediction model for postoperative nausea and vomiting. Br J Anaesth 2015;114:252–60.CrossRefGoogle ScholarPubMed
Nair, BG, Horibe, M, Newman, SF, Wu, WY, Peterson, GN, Schwid, HA. Anesthesia information management system-based near real-time decision support to manage intraoperative hypotension and hypertension. Anesth Analg 2014;118:206–14.CrossRefGoogle ScholarPubMed
McCormick, PJ, Levin, MA, Lin, HM, Sessler, DI, Reich, DL. Effectiveness of an electronic alert for hypotension and low bispectral index on 90-day postoperative mortality: a prospective, randomized trial. Anesthesiology 2016;125:1113–20.CrossRefGoogle ScholarPubMed
Vigoda, MM, Lubarsky, DA. Failure to recognize loss of incoming data in an anesthesia record-keeping system may have increased medical liability. Anesth Analg 2006;102:1798–802.Google Scholar
Ehrenfeld, JM, Epstein, RH, Bader, S, Kheterpal, S, Sandberg, WS. Automatic notifications mediated by anesthesia information management systems reduce the frequency of prolonged gaps in blood pressure documentation. Anesth Analg 2011;113:356–63.Google Scholar
Nair, BG, Horibe, M, Newman, SF, Wu, WY, Schwid, H. Near real-time notification of gaps in cuff blood pressure recordings for improved patient monitoring. J Clin Monit Comput 2013;27:265–71.CrossRefGoogle ScholarPubMed
Freundlich, RE, Grondin, L, Tremper, KK, Saran, KA, Kheterpal, S. Automated electronic reminders to prevent miscommunication among primary medical, surgical and anaesthesia providers: a root cause analysis. BMJ Qual Saf 2012;21:850–4.Google Scholar
Sanborn, KV, Castro, J, Kuroda, M, Thys, DM. Detection of intraoperative incidents by electronic scanning of computerized anesthesia records. Comparison with voluntary reporting. Anesthesiology 1996;85:977–87.Google Scholar
Benson, M, Junger, A, Fuchs, C, et al. Using an anesthesia information management system to prove a deficit in voluntary reporting of adverse events in a quality assurance program. J Clin Monit Comput 2000;16:211–17.Google Scholar
Grant, C, Ludbrook, G, Hampson, EA, Semenov, R, Willis, R. Adverse physiological events under anaesthesia and sedation: a pilot audit of electronic patient records. Anaesth Intensive Care 2008;36:222–9.Google Scholar
Wax, DB, McCormick, PJ, Joseph, TT, Levin, MA. An automated critical event screening and notification system to facilitate preanesthesia record review. Anesth Analg 2018;126:606–10.Google Scholar
Pedersen, NE, Rasmussen, LS, Petersen, JA, Gerds, TA, Østergaard, D, Lippert, A. A critical assessment of early warning score records in 168,000 patients. J Clin Monit Comput 2018;32:109–16.Google Scholar
Blankush, JM, Freeman, R, McIlvaine, J, Tran, T, Nassani, S, Leitman, IM. Implementation of a novel postoperative monitoring system using automated Modified Early Warning Scores (MEWS) incorporating end-tidal capnography. J Clin Monit Comput 2017;31:1081–92.Google Scholar
Breighner, CM, Kashani, KB. Impact of e-alert systems on the care of patients with acute kidney injury. Best Pract Res Clin Anaesthesiol 2017;31:353–9.Google Scholar
Schmidt, PE, Meredith, P, Prytherch, DR, Watson, D, Watson, V. Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual Saf 2015;24:1020.Google Scholar
Ljungqvist, O, Scott, M, Fearon, KC. Enhanced recovery after surgery: a review. JAMA Surg 2017;152:292–8.Google Scholar
Kruger, GH, Tremper, KK. Advanced integrated real-time clinical displays. Anesthesiol Clin 2011;29:487504.Google Scholar
Nair, BG, Newman, SF, Peterson, GN, Schwid, HA. Smart Anesthesia Manager™ (SAM) – a real-time decision support system for anesthesia care during surgery. IEEE Trans Biomed Eng 2013;60:207–10.CrossRefGoogle Scholar
Kheterpal, S, Shanks, A, Tremper, KK. Impact of a novel multiparameter decision support system on intraoperative processes of care and postoperative outcomes. Anesthesiology 2018;128:272–82.Google Scholar
Wetmore, D, Goldberg, A, Gandhi, N, Spivack, J, McCormick, P, DeMaria, S Jr. An embedded checklist in the anesthesia information management system improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting. BMJ Qual Saf 2016;25:739–46.Google Scholar
Shear, T, Deshur, M, Avram, MJ, et al. Procedural timeout compliance is improved with real-time clinical decision support. J Patient Saf 2018;14(3):148–52.Google Scholar
Patel, S, Carmichael, JM, Taylor, JM, Bounthavong, M, Higgins, DT. Evaluating the impact of a clinical decision support tool to reduce chronic opioid dose and decrease risk classification in a veteran population. Ann Pharmacother 2018;52:325–31.Google Scholar
Quan, KA, Cousins, SM, Porter, DD, et al. Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity. Am J Infect Control 2016;44:438–43.Google Scholar
Kahn, SR, Morrison, DR, Cohen, JM, et al. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev 2013;7:CD008201.Google Scholar
Jenkins, I, Doucet, JJ, Clay, B, et al. Transfusing wisely: clinical decision support improves blood transfusion practices. Jt Comm J Qual Patient Saf 2017;43:389–95.Google Scholar
Nair, BG, Grunzweig, K, Peterson, G, et al. Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol. J Clin Monit Comput 2016;30:301–12.Google Scholar
Schulz, L, Osterby, K, Fox, B. The use of best practice alerts with the development of an antimicrobial stewardship navigator to promote antibiotic de-escalation in the electronic medical record. Infect Control Hosp Epidemiol 2013;34:1259–65.Google Scholar
Chen, YY, Chi, MM, Chen, YC, Chan, YJ, Chou, SS, Wang, FD. Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections. Am J Crit Care 2013;22:105–14.Google Scholar
Karbing, DS, Allerød, C, Thomsen, LP, et al. Retrospective evaluation of a decision support system for controlled mechanical ventilation. Med Biol Eng Comput 2012;50:4351.Google Scholar
Nair, BG, Peterson, GN, Newman, SF, Wu, WY, Kolios-Morris, V, Schwid, HA. Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors. Jt Comm J Qual Patient Saf 2012;38:283–8.Google Scholar
Krasowski, MD, Chudzik, D, Dolezal, A, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center. BMC Med Inform Decis Mak 2015 February 22;15:11.Google Scholar
Schneider, E, Zelenka, S, Grooff, P, Alexa, D, Bullen, J, Obuchowski, NA. Radiology order decision support: examination-indication appropriateness assessed using 2 electronic systems. J Am Coll Radiol 2015;12:349–57.CrossRefGoogle ScholarPubMed
Epstein, RH, Gratch, DM, Grunwald, Z. Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions. Anesth Analg 2007;105:1053–60.Google Scholar
Epstein, RH, Gratch, DM, McNulty, S, Grunwald, Z. Validation of a system to detect scheduled drug diversion by anesthesia care providers. Anesth Analg 2011;113:160–4.Google Scholar
Wax, DB, McCormick, PJ. A real-time decision support system for anesthesiologist end-of-shift relief. Anesth Analg 2017;124:599602.Google Scholar
Bhutiani, M, Jablonski, PM, Ehrenfeld, JM, McEvoy, MD, Fowler, LC, Wanderer, JP. Decision support tool improves real and perceived anesthesiology resident relief. Anesth Analg 2018;127(2):513–19.CrossRefGoogle ScholarPubMed
Wanderer, JP, Charnin, J, Driscoll, WD, Bailin, MT, Baker, K. Decision support using anesthesia information management system records and accreditation council for graduate medical education case logs for resident operating room assignments. Anesth Analg 2013;117:494–9.CrossRefGoogle ScholarPubMed
Was, A, Wanderer, J. Matching clinicians to operative cases: a novel application of a patient acuity score. Appl Clin Inform 2013;4:445–53.Google Scholar
Blum, JM, Kheterpal, S, Tremper, KK. A comparison of anesthesiology resident and faculty electronic evaluations before and after implementation of automated electronic reminders. J Clin Anesth 2006;18:264–7.Google Scholar
Rusa, R, Klatil, F, Fu, R, Swide, CE. Impact of faculty-specific electronic reminders on faculty compliance with daily resident evaluations: a retrospective study. J Clin Anesth 2009;21:159–64.Google Scholar
Sessler, DI, Makarova, N, Riveros-Perez, R, Brown, DL, Kimatian, S. Lack of association between blood pressure management by anesthesia residents and competence committee evaluations or in-training exam performance: a cohort analysis. Anesthesiology 2016;124:473–82.Google Scholar
Lubarsky, DA, Sanderson, IC, Gilbert, WC, et al. Using an anesthesia information management system as a cost containment tool. Description and validation.Anesthesiology 1997;86:1161–9.Google Scholar
Nair, BG, Peterson, GN, Neradilek, MB, Newman, SF, Huang, EY, Schwid, HA. Reducing wastage of inhalation anesthetics using real-time decision support to notify of excessive fresh gas flow. Anesthesiology 2013;118:874–84.Google Scholar
Wax, DB, Hill, B, Levin, MA. Ventilator data extraction with a video display image capture and processing system. J Med Syst 2017;41:101.Google Scholar
Reich, DL, Kahn, RA, Wax, D, Palvia, T, Galati, M, Krol, M. Development of a module for point-of-care charge capture and submission using an anesthesia information management system. Anesthesiology 2006;105:179–86.Google Scholar
Spring, SF, Sandberg, WS, Anupama, S, Walsh, JL, Driscoll, WD, Raines, DE. Automated documentation error detection and notification improves anesthesia billing performance. Anesthesiology 2007;106:157–63.Google Scholar
Kheterpal, S, Gupta, R, Blum, JM, Tremper, KK, O’Reilly, M, Kazanjian, PE. Electronic reminders improve procedure documentation compliance and professional fee reimbursement. Anesth Analg 2007;104:592–7.CrossRefGoogle ScholarPubMed
Foglia, RP, Alder, AC, Ruiz, G. Improving perioperative performance: the use of operations management and the electronic health record. J Pediatr Surg 2013;48:95–8.Google Scholar
Van Winkle, RA, Champagne, MT, Gilman-Mays, M, Aucoin, J. Operating room delays: meaningful use in electronic health record. Comput Inform Nurs 2016;34:247–53.Google ScholarPubMed
Reich, DL, Galati, M, Krol, M, Bodian, CA, Kahn, RA. A mission-based productivity compensation model for an academic anesthesiology department. Anesth Analg 2008;107:1981–8.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×