Surgical IT AIMS to Transform OR Care
As facilities race to meet meaningful use compliance deadlines, operating rooms will need to overhaul paper-based systems and consider adding an anesthesia information management system (AIMS). Linking the AIMS to disparate systems within the hospital will be no easy feat. The best advice from veterans? Get started now, as an AIMS can gather data and run reports for benchmarking purposes, improve patient records and potentially boost patient safety and revenues.
As patients with more comorbidities began requiring more complex procedures, staff at the Indiana Surgery Center (ISC) Noblesville in Noblesville, Ind., faced information overload and dwindling revenues. The center began looking into anesthesia IT systems to help improve care, documentation and rejuvenate profits.
ISC Noblesville faced other operational challenges—a manual drug capture process that was losing revenue, rejected claims due to incomplete documentation, and time-consuming coding processes that sometimes missed comorbid conditions.
Five years ago, ISC Noblesville replaced its paper system with an AIMS (McKesson Anesthesia Care) integrated with its EHR.
"With the new system, all the medications we enter into the EMR—medications, allergies, among others—are filtered through the AIMS database and we have the instant ability to create a cross check of drug-drug interactions," says Gregory Bray, MD, medical director and chief of anesthesiology at ISC Noblesville, which is part of the Indianapolis-based Community Health Network, a five-hospital, 12-surgery-center network.
"With a paper-based system, it was nearly impossible to keep track of the 40 drugs in the anesthesia tray and the multiple comorbidities a patient was diagnosed with," says Bray. "There was almost no way to correctly connect all the cross reactivity and potential adverse reactions."
Also, the center has seen marked patient safety improvements. For example, the staff now is automatically alerted to a penicillin allergy or an asthmatic patient with high blood pressure who should not be administered a beta-blocker due to contraindications.
Most striking, though, is the drop in the number of rejected claims that ISC has realized in the six months following system integration. Prior to go-live, 4 percent of claims were rejected, amounting to about 100 cases per year. In the six months following the AIMS implementation, ISC saw only just one rejected claim. In five years, the anesthesiologists still have seen only three rejected claims. Bray says this has led to a huge time savings, as each claim that was rejected delayed payments by six months.
Similarly, the Hospital of University of Pennsylvania (HUP) in Philadelphia integrated a DocuSys (now Merge) AIMS six years ago to improve the readability and searchability of anesthesia records.
"If you are doing clinical effectiveness and quality assessment and want to know details of the 2,000 patient cases you did of a certain type within the last two months, now these data are at your fingertips," says Stanley Muravchick, MD, PhD, professor of anesthesiology and critical care at HUP.
The AIMS allowed the hospital staff to monitor and document anesthesia protocols and the Centers for Medicare & Medicaid Services' Surgical Care Improvement Project (SCIP) measures, including time from antibiotic dose to incision, sterile techniques to avoid surgical-site infection, use of beta-blockers, insulin use and glucose levels, and the use of intraoperative warming devices.
The AIMS also allows HUP to align with Joint Commission mandates that require legible and retrievable records to be maintained for each patient encounter.
The two components of an AIMS are the automated anesthesia record (AAR) and perioperative database that houses patient-specific information. It's imperative for the preoperative, intraoperative and postoperative components of the AIMS to interact as one system, Muravchick notes.
A major challenge to integration is figuring out where the AIMS fits into the mix of disparate hospital systems. The AIMS must be configured and connected to systems that are not under the OR's control. Complicating things further are the lack of standardized guidelines or protocols for data exchange.
At HUP, implementation required IT teamwork from anesthesiology, surgery/perioperative services, nursing, medical records, clinical engineering and biomedical support, ADT, billing and regulatory compliance, laboratory, pharmacy, materials management, house staff education and security.
With the involvement of so many departments, even little problems could become huge stumbling blocks, Muravchick says. For example, UPenn had a major problem interfacing patient medical record numbers, because some patient ID bracelets within other hospital departments used eight digits and others used 12. The IT team solved the problem by adding four leading zeros for the systems that used 12 digits, so patient information could still be sent and recognized by systems that used eight-digit patient ID numbers.
"It is imperative to work with the various hospital IT systems to ensure that all datasets are matched and able to be sent and interfaced with other internal hospital systems," says Muravchick.
To avoid roadblocks, Andrew Watt, MD, CIO and CMIO at the Southern New Hampshire Health System and its Medical Center (SNHMC) in Nashua, recommends including anesthesiologists in the integration process. The physician's willingness to learn will make or break you, he says. He also recommends performing a workflow analysis. At SNHMC, holding anesthesiologists responsible for imputing patient data helps decrease duplications in documentation and eliminate discrepancies.
"These are expensive systems, but we haven't questioned the costs due to the increases we have seen in revenue," says Watt. "Now we also have a safer operating room and numerous workflow optimizations."
Muravchick estimates that AIMS cost approximately $10,000, but these are vendor-dependent. In addition, the estimated clinical workstation costs to automate each anesthesia location will run a hospital $4,000 to $9,000, while administrative workstations can cost a facility $2,000 to $3,000.
Bray concludes that the expensive upfront costs and arduous integration efforts must be forgotten because "facilities need to realize that if they are going to maintain business, they will need an AIMS."
As patients with more comorbidities began requiring more complex procedures, staff at the Indiana Surgery Center (ISC) Noblesville in Noblesville, Ind., faced information overload and dwindling revenues. The center began looking into anesthesia IT systems to help improve care, documentation and rejuvenate profits.
ISC Noblesville faced other operational challenges—a manual drug capture process that was losing revenue, rejected claims due to incomplete documentation, and time-consuming coding processes that sometimes missed comorbid conditions.
Five years ago, ISC Noblesville replaced its paper system with an AIMS (McKesson Anesthesia Care) integrated with its EHR.
"With the new system, all the medications we enter into the EMR—medications, allergies, among others—are filtered through the AIMS database and we have the instant ability to create a cross check of drug-drug interactions," says Gregory Bray, MD, medical director and chief of anesthesiology at ISC Noblesville, which is part of the Indianapolis-based Community Health Network, a five-hospital, 12-surgery-center network.
"With a paper-based system, it was nearly impossible to keep track of the 40 drugs in the anesthesia tray and the multiple comorbidities a patient was diagnosed with," says Bray. "There was almost no way to correctly connect all the cross reactivity and potential adverse reactions."
Also, the center has seen marked patient safety improvements. For example, the staff now is automatically alerted to a penicillin allergy or an asthmatic patient with high blood pressure who should not be administered a beta-blocker due to contraindications.
Most striking, though, is the drop in the number of rejected claims that ISC has realized in the six months following system integration. Prior to go-live, 4 percent of claims were rejected, amounting to about 100 cases per year. In the six months following the AIMS implementation, ISC saw only just one rejected claim. In five years, the anesthesiologists still have seen only three rejected claims. Bray says this has led to a huge time savings, as each claim that was rejected delayed payments by six months.
Similarly, the Hospital of University of Pennsylvania (HUP) in Philadelphia integrated a DocuSys (now Merge) AIMS six years ago to improve the readability and searchability of anesthesia records.
"If you are doing clinical effectiveness and quality assessment and want to know details of the 2,000 patient cases you did of a certain type within the last two months, now these data are at your fingertips," says Stanley Muravchick, MD, PhD, professor of anesthesiology and critical care at HUP.
The AIMS allowed the hospital staff to monitor and document anesthesia protocols and the Centers for Medicare & Medicaid Services' Surgical Care Improvement Project (SCIP) measures, including time from antibiotic dose to incision, sterile techniques to avoid surgical-site infection, use of beta-blockers, insulin use and glucose levels, and the use of intraoperative warming devices.
The AIMS also allows HUP to align with Joint Commission mandates that require legible and retrievable records to be maintained for each patient encounter.
Clearing integration hurdles
The AIMS replaces unreliable paper-based anesthesia systems with "legible, comprehensive, objective documents that outline a patient's perioperative anesthesia course," says Muravchick. But it was no easy process to get there.The two components of an AIMS are the automated anesthesia record (AAR) and perioperative database that houses patient-specific information. It's imperative for the preoperative, intraoperative and postoperative components of the AIMS to interact as one system, Muravchick notes.
A major challenge to integration is figuring out where the AIMS fits into the mix of disparate hospital systems. The AIMS must be configured and connected to systems that are not under the OR's control. Complicating things further are the lack of standardized guidelines or protocols for data exchange.
At HUP, implementation required IT teamwork from anesthesiology, surgery/perioperative services, nursing, medical records, clinical engineering and biomedical support, ADT, billing and regulatory compliance, laboratory, pharmacy, materials management, house staff education and security.
With the involvement of so many departments, even little problems could become huge stumbling blocks, Muravchick says. For example, UPenn had a major problem interfacing patient medical record numbers, because some patient ID bracelets within other hospital departments used eight digits and others used 12. The IT team solved the problem by adding four leading zeros for the systems that used 12 digits, so patient information could still be sent and recognized by systems that used eight-digit patient ID numbers.
"It is imperative to work with the various hospital IT systems to ensure that all datasets are matched and able to be sent and interfaced with other internal hospital systems," says Muravchick.
To avoid roadblocks, Andrew Watt, MD, CIO and CMIO at the Southern New Hampshire Health System and its Medical Center (SNHMC) in Nashua, recommends including anesthesiologists in the integration process. The physician's willingness to learn will make or break you, he says. He also recommends performing a workflow analysis. At SNHMC, holding anesthesiologists responsible for imputing patient data helps decrease duplications in documentation and eliminate discrepancies.
Realizing ROI
The team at 188-bed SNHMC decided to automate the OR in 2001 and installed an AIMS (Picis Anesthesia Manager) in 2006, after it looked into ways to address various OR needs. While the upfront costs were hefty for training, software and hardware, SNHMC realized a 73 percent increase in anesthesia facility revenue through billing improvements after implmentation. Now the patient record is transmitted electronically at the time of case closure and transmitted immediately to billing, reducing the cycle from days to minutes. This has improved charge capture, which has resulted in a direct reduction in the costs surrounding billing."These are expensive systems, but we haven't questioned the costs due to the increases we have seen in revenue," says Watt. "Now we also have a safer operating room and numerous workflow optimizations."
Muravchick estimates that AIMS cost approximately $10,000, but these are vendor-dependent. In addition, the estimated clinical workstation costs to automate each anesthesia location will run a hospital $4,000 to $9,000, while administrative workstations can cost a facility $2,000 to $3,000.
Bray concludes that the expensive upfront costs and arduous integration efforts must be forgotten because "facilities need to realize that if they are going to maintain business, they will need an AIMS."