The State of AIMS Adoption

Carlos M. Nunez, M.D.
Chief Physician Executive, Picis®, Wakefield, MA

Although still far from achieving mainstream adoption, anesthesia information management systems (AIMS) have made significant strides in market penetration over the last five years. Commercially viable AIMS solutions have been available for more than two decades, but it is only recently that the notion of implementing an automated anesthesia record has become widespread within the practice of anesthesiology. Perhaps the federal government’s push to increase the adoption of electronic health records (EHRs) as a part of the recently passed “stimulus package” will lead to near universal acceptance of AIMS, but there are other forces at work that have moved AIMS from being an interesting experiment to a vital tool for the management of anesthesia patient information.

First and foremost, the leading AIMS solutions have matured in ways that reflect not only the progress of technology, but also the realities of modern clinical practice. Even the most basic systems can recreate the paper anesthesia record; capturing data from monitors and anesthesia machines, as well as input from the user to document things such as medications, fluids and clinical notes. However, more advanced systems such as Picis® Anesthesia Manager have moved beyond simple record keeping, and now offer decision support tools and remote access that extend the usefulness of the electronic record. There have also been advances in configurability, usability and stability that have made AIMS easier to implement and more transparent to the workflow of the average user. Probably the most significant technological advance that has directly increased adoption of AIMS has been the integration and interoperability of these systems with the information infrastructure of the hospital.

The most successful AIMS solutions are those that allow the electronic anesthesia record to operate seamlessly with the other information systems installed in the hospital. The interoperability begins in the operating room and extends as far as the outpatient areas. In fact, the event that led to the largest market expansion of AIMS was the availability of the first commercially viable suite of perioperative automation solutions, Picis CareSuite, in 2003. By combining a traditional operating room management system (ORMS) with the clinical solutions for preoperative evaluation, anesthesia automation, and recovery room (PACU) documentation, AIMS adoption in the United States jumped in one single year from a handful of systems to almost 100. Vendors offering stand-alone systems began to suffer and in some cases disappear, while the traditional hospital information system (HIS) vendors attempted to enter the market.

While interoperability of AIMS solutions was a welcome development for the IT management of the hospital, it was the gains in usability that began to turn the tide with anesthesia providers in terms of user acceptance. For example, the availability of patient data from outside the perioperative period, such as allergies, medications, lab and other test results, has helped drive the acceptance of anesthesia automation and streamline workflow. One of the most important immediate benefits is the ability to quickly access a patient’s previous anesthesia management details without sifting through paper charts. This is especially useful for patients who have difficult airways or other notable pathology that could affect the delivery of anesthesia. The ability to copy forward portions of the patient’s previous pre-anesthesia evaluation(s) also saves a great deal of time and eliminates redundancy. As a result, the pre-anesthesia evaluation and immediate preoperative preparation of the patient became less of a paper chase and improvements in the reliability of data captured from medical devices helped make anesthesia providers more comfortable with the automation of clinical record keeping. Advanced user interface design and flexible configuration options pushed the acceptance of AIMS even further. The evidence is clear in the marketplace: those AIMS solutions that offer comprehensive interoperability beyond the four walls of the OR and integrate well into the unique workflow of anesthesia have established themselves as the leaders.

The final inherent trait of AIMS that provides tremendous incentives to hospitals is the ability to use their collected data to facilitate both clinical and administrative functions. The growing use of decision support is an excellent example of how vast amounts of data collected across the perioperative period can be available to the end users of AIMS, at the point of care. AIMS-based decision support systems enable users to create their own rules, providing clinicians with timely notifications based on patient data that can help the clinician guide the course of care. Imagine the AIMS screen displaying a colored icon or sending a text message to an anesthesiologist when a patient with a history of Malignant Hyperthermia has a recorded body temperature that is rising. The collection of data at the point of care also makes remote access to the anesthesia record possible, so that clinicians have access to patient information from any OR or PACU bed, anywhere they happen to be. Then, after the episode of care is complete, all of that data is available to generate billing (professional fees, supplies, pharmacy, etc.) as well as research and quality reporting. The ability to generate reports with AIMS data, as required by the Surgical Care Improvement Project (SCIP), is vital in today’s healthcare environment. The information that is documented in an AIMS, such as time from antibiotic dose to incision, appropriate sterile technique, use of beta-blockers, insulin use and glucose levels, and the use of intraoperative warming devices, can also be used to justify improved contract rates for insurers that are willing to compensate for proof of improved quality of care.

The American Recovery and Reinvestment Act of 2009 (ARRA) included nearly $20 billion to stimulate the adoption of electronic health records. Beginning in 2011, the federal government will reward hospitals with incentive payments for demonstrating the “meaningful use” of information technology. After 2015, the incentive payments go away; they replaced with financial penalties for those hospitals that do not meet the government’s goals. A large part of the meaningful use criteria center around the established and growing requirements for quality reporting as mandated by the Centers for Medicare and Medicaid Services (CMS). The perioperative care areas of the hospital are where a great deal of the data that CMS requires for its quality measures reporting program are collected, such as SCIP. ARRA may provide the final push necessary to arrive at near universal adoption of AIMS in the coming years. For more information on getting to meaningful use in high acuity areas of the hospital, such as the perioperative suite, Picis invites you to visit http://www.picis.com/Picis-Advocacy and download our position papers.

Carlos Nunez, MD, is Picis’s Chief Physician Executive. He can be reached at Carlosnunez@picis.com.