Information Management

What is the position of anesthesiology in the modern clinical information management?

Prof. Dr. Walter R. Menzel
Hospital Business Management, Information Systems, and Communication
Niederrhein University of Applied Sciences
Faculty of Industrial Engineering / Public Health

Email: walter.menzel@hs-niederrhein.de

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Today there exists a constant demand for more information more rapidly. New, ever-increasing demands from the market and the medical field, along with new and more complex forms of treatment with new controls and regulations are a part of our daily life. Especially in public health, the customers expect better service. One problem in this connection is that the half-life of knowledge gets shorter and shorter.

The vision for a modern hospital is the absolutely paperless, electronic patient record (EPR). The EPR has the following advantages:

• Unbeatable access time
• High reliability
• Protection of privacy of personal data
• No uncontrolled increase in the cost of archiving
• High transparency of the processes
• Consequent quality management

Many changes have taken place in the hospital of 2001. It has become a service enterprise with medical core competence, and turns towards the customer. There are external (patients, ambulant working doctors, and health insurance firms) and internal customers (each member of the staff). Anesthesiology is such a "classical" service with external and internal customers. From the very beginning, teamwork, structured processes, security management, and exact documentation have been daily routines in the anesthesia department. That leads to the development of patient data management systems (PDMS) for example, which have reached a very high level of sophistication. The same can be said of the documentation systems of the clinical anesthesia. Next to these, there are systems for the operating department with more or less the same requirements. Even here, the essential part is optimizing resources, controlling, documenting the operation time, and optimizing processes. From the management’s point of view, the connection between the systems is useful. One precondition is to follow similar targets, and that should not be a problem.

However, what are the reasons that this connection is not realized? Essentially, it is a question of unclear distribution of competences, and different points of view within the management of an operating department or an intensive care unit (ICU). To some extent in German operating rooms and intensive care units, one finds chaotic forms of organization without clear, recognizable structures. Apart from that, the anesthetists often have the problem of lacking acceptance; they are conditioned by outdated methods of guidance from the other branches. Mutual objectives are missing.

On the contrary, the target should be unified management with mutual tasks and delegation of responsibility, as the coordinators of today’s anesthesia services need modern management skills.

Mutual data banks make it easier and more efficient to compare objective data. The hospital information system (HIS), which is found in many clinics, supports anesthesiology in many ways. One basic problem are other information technology (IT) systems that are not connected to the HIS. In the hospital, a large amount of data is collected. However, the hospital is not necessarily aware of the extent of data it possesses. Information systems use should be enhanced and utilized more often. Modern business organizations have been aware of this problem for quite a long time, and they use knowledge management with great success, but the clinics are far behind.

Really, modern knowledge management represents a further development of the abilities of successful enterprises. Since the introduction of evidence based medicine, medical knowledge management has become extremely important. Everyone is more than ever obliged to bring his knowledge up-to-date. Those who do not follow these rules have to expect consequences, such as an accusation of malpractice. We can see the medical benefit e.g. through coaching of young future doctors by using expert knowledge (‘who knows what?’). Training and online information are also a reality for all.

Knowledge management is more than management of documents or expert systems. Knowledge management creates new ideas regarding methods, products, and knowledge about customers and competitors. These points become relevant in public health. The development of products or services, and the understanding of customers and markets benefits from knowledge management.

The success of knowledge management is mainly determined through business culture, structures, and processes. Awards for staff actually play no role. The important improvements are cost reduction and improvements of the processes with a improved openness, as well as an orientation towards the customers and their satisfaction.

Enterprises having teamwork and lean management have better preconditions for the exchange of relevant knowledge, which should lead to a new attitude.

Where lies the benefit for anesthesiology? With this concept of team orientation, anesthesia has a historic opportunity to be the pioneer and to become an example for all of the other departments in the hospital. Openness creates trust. It can realize advantages concerning the internal competition of budgets.

The information system will be accepted if all people work with it naturally. Only then can one see a benefit from the fact that one has more time for the customer, the "patient".

The vision is the electronic patient record, optimal structures of information to internal and external customers, knowledge management, and modern methods of guiding the staff. Leading doctors are coordinators and not solvers of problems in a team.

Where is anesthesiology positioned? It is a highly technical branch, similar to radiology, and brings a service of high quality and costs in relation to limited resources. It is the pioneer of teamwork with qualifications in management and organization in the hospital. It has excellent competence in software and hardware.

That is why anesthesiology can derive and claim a leading role in the organization of cost intensive units with an increasing economical relevance in the near future. With the methods of knowledge management of extensive information systems, it will be a pioneer in this environment.

Literature:

1. Report Wissensmanagement, Herausgeber: Prof. Dr. C. H. Antoni, Dr.-Ing. T. Sommerlatte, div. Autoren.
   

Last updated: 1 January 2002Created
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