Multifaceted Anesthesia

Evolution of information management in anesthesia and critical care

Case example from the Westpfalz Klinikum, Kusel, Germany

Dr. Ulrich Korell, M.D. Director, Intensive care department Institut für Anaesthesiologie und Notfallmedizin II Westpfalz Klinikum, Kusel, Germany http://www.westpfalz-klinikum.de/

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Information technology in the hospital

Even though we normally do not think about it, our daily medical work is almost totally dependent on various types of information. In the past, it was quite natural just to keep various details in your mind until you had time to write them down. Over the last few years, information and communication technology (ICT) has grown to hold a major role in many areas of health care, whenever we need to capture, exchange, process, or store information.

Today, diverse ICT systems may exist in the hospital. In addition to the hospital information system, there may be a hospital-wide computer based medical imaging service, and possibly also a laboratory system. Anesthesia and critical care departments may have automated documentation or record keeping systems - and it would be impossible to give a comprehensive list of the innumerous departmental systems developed for special purposes in a major hospital.

One can seldom talk of a transparent integration between such separate ICT systems. However, there usually is a need for data transfer and integration – particularly when information should be displayed to the human end user. Maintenance of the fragmented ICT system is time consuming and fault sensitive. It is particularly important not to forget various legal and data security issues, which may rise from improperly controlled transfer and display of healthcare data. All in all, one can only hope that existing fragmented systems would stress the need for a comprehensive electronic patient record in the future.

It seems that the future role of ICT in the healthcare will be even more prominent, and I would say that there is no way to escape that development. Economic pressure is one factor, as we need to develop clinical processes for efficiency and better performance will emphasize use of ICT-based methods. In fact, to handle huge amounts of information there is no alternative to ICT.

Clearly, the traditional way of manually handling large amounts of information can no more be practical, as the amount of new information is skyrocketing, and old information is rapidly becoming obsolete. In the author's opinion, it is clear that we should be ready for ICT in healthcare, but the question should be "when and how" to manage that change.

In anesthesia and critical care, the patient side situation looks very similar. During care, we collect a huge amount of data from the patient monitors, and we have to digest and store that information. That collected information and clinicians' expert knowledge, are the basis to make care decisions.

Figure: Anesthesia setup in the Westpfalz Klinikum [Photo by Dr. Korell]

An evolutionary approach for implementation

In my opinion, there is no "quantum leap" into an electronic patient record. The organization's pathway to information management should always be carefully planned beforehand. In our 1350 bed teaching hospital, we developed the evolutionary approach principle as a method to manage the project. What this means is that we wanted to plan every single developmental step with organizational stability in mind. Proceeding this way helped us to reach our goal of not impairing daily work performance.

Figure: Network structure at the anesthesia and critical care units in the Westpfalz Klinikum.

In the beginning, we found it important to design the presentation of our information so that it followed our existing tradition, and planned our displays so that they resembled our old paper records. That way we felt that it would be smoother for the staff to start utilizing computerized information. However, we had also made preliminary plans for optional implementation pathways and backup concepts, in case of potentially sticky situations during implementation.

Using this approach, we implemented electronic recording with no major problems for both the anesthesia and the intensive care unit. In our department, we installed Deio Clinisoft, AIM, Anesthesia planner, and Web Viewer products. They were connected at the bedside to Hamilton Galileo ventilators and Alaris infusion pumps via a docking station. Utilizing the Datagate Communication Server, we established communication to both the hospital information system and to the laboratory system.

During implementation, we were able to shorten our expected duration of duplicate parallel recordings, and we had only minimal problems with user acceptance.
A typical source of complaints may result from the performance of the system. End-users are very sensitive to the system's response time when they have to wait for the information in front of the computer. At the moment, we do all of our department documentation electronically. We only make printouts of the patient records for archiving and for information transfer to the hospital’s other departments. In very special issues, like medico-legal questions, a printed report may be used to facilitate communication. Finally, our staff has given us positive feedback, as they feel that with the implementation of electronic documentation the documentation workload has been reduced and the time they have with the patient has increased.

Figure: A typical bedside view from our hospital’s post-operative care unit. [Photo by Dr. Korell]

Future aims

We have passed the implementation stage, yet there are still many things to do. In the future, we may have our care guidelines stored in our data management system. This may facilitate the use of standardized protocols for both physicians and nurses. Eventually, we would like to integrate new quality indices to our patient care, and improve the evaluation for quality management and benchmarking.Currently, we are in the process of moving entire hospital's patient data collection system into electronic format. It means that we hope to totally abolish paper based patient records in near future.

Figure: Westpfalz Klinikum, Kusel, Germany [Photo by Dr. Korell]

Last updated: 25 March 2004 Created
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