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COMMENTARY
Year : 2019  |  Volume : 63  |  Issue : 10  |  Page : 784-785  

Automated anaesthesia record system - Expensive toy or a change whose time has come?


Consultant Anesthesiologist, Breach Candy Hospital, Mumbai, Maharashtra, India

Date of Submission30-Sep-2019
Date of Decision30-Sep-2019
Date of Acceptance30-Sep-2019
Date of Web Publication10-Oct-2019

Correspondence Address:
Dr. Hemant Shinde
A 31 Gajanan Society, Dilip Gupte Road, Mahim, Mumbai - 400 016, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_743_19

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How to cite this article:
Shinde H. Automated anaesthesia record system - Expensive toy or a change whose time has come?. Indian J Anaesth 2019;63:784-5

How to cite this URL:
Shinde H. Automated anaesthesia record system - Expensive toy or a change whose time has come?. Indian J Anaesth [serial online] 2019 [cited 2019 Dec 7];63:784-5. Available from: http://www.ijaweb.org/text.asp?2019/63/10/784/268724



The first paper records in anaesthesiology were developed in the 1890s, and remain little changed.[1] The anaesthesia record is designed to document not only what was done to a patient during the surgical experience, but also how the patient responded. The patient record is extremely important and must be carefully chronicled with every anaesthetic procedure. The anaesthetic record is used for patient care during anaesthesia administration and in the post anaesthesia care unit (PACU), the intensive care unit (ICU) and the postsurgical ward. The recorded information is used for billing, tabulating patient statistics, and reviewing previous anaesthetic procedures. Finally, advances in quality improvement methods assist in peer review and legal defence.[2] As the anaesthesia record has evolved, it has become a significant document on a number of levels.[3] Initially designed as a medical record and communication tool, it has now become a medical-legal document that may be used to demonstrate that standards of care were met in the care of patients who may have had adverse outcomes.[4]

The practice of anaesthesia requires a medical record system that can capture patient's data in real time from the devices in the operating room. Traditionally, it has been done manually by the attending anaesthesiologist. Observer bias, missed readings, and errors of memory which affect manual anaesthetic records may cause significant inaccuracy and may be avoided by using automated records generated by information management systems.[5]

The concept of automating the anaesthesia record has intrigued academicians for decades. The first known example of an automated anaesthesia recordkeeping device dates to 1929. An electronic medical records system integrates clear and concise information across the entire hospital system. This can help improve quality of care, reduce errors, decrease risks, and improve revenue capture.

The advantages of an Anaesthesia record system are as follows:

  1. Capturing high quality data in real time
  2. Alerting the anaesthesia provider of deviations from preset physiologic limits
  3. Communicating with various patient databases
  4. Generating an accurate, understandable record at the end of the procedure, and
  5. Reduction in the workload of the anaesthesiologist
  6. Generation of large databases to help audit and research.


The disadvantages of automated anaesthesia record systems are as follows:

  1. Vital information may be lost when the data are recorded fully automatically-without active involvement on the part of the anaesthetist which may lead to loss of vigilance
  2. Repeated training of the staff is required as it involves change from manual to automatic data recording
  3. The software needs to be tailor made for each hospital according to the need
  4. These systems are expensive and need constant updating which may lead to recurrent expenditure.


In this issue of the IJA, Palaniswamy et al. publish their findings after 1000 neurosurgical cases, and the results are in tune with the other findings in literature.[6] It is easy to fathom that junior anaesthesiologists were completing the records better than the seniors as they are supervised and more technologically savvy than the seniors. Similarly, more incomplete records were seen in emergency cases, perhaps because the attention of the anaesthesiologist was more towards the clinical requirement in the emergency cases. The second case of the day showed more incomplete entries. In the institute where I work, we had a similar experience. The reluctance to change from manual to automated systems was seen more with seniors, the reasons being computer phobia, personal biases and fear of litigation due to artifact inclusion in the records. Till date, the available literature does not show any evidence of litigation against anaesthesiologist due to artifacts in records.

There is no denial that more and more hospitals are adapting to the change and implementing the automated anaesthesia records. As the banks adapted the automation and did away with teller-based transactions, in the future, there will be residents who have graduated without writing the anaesthesia records!

There is no question that these systems provide more detailed access to patient's medical history and previous anaesthesia records. But when it comes to billing the patient it relies heavily on the manual override function in the software. No software can guarantee complete capture of every detail needed for the accuracy of the billing.

The real question that needs to be answered is, have these automated systems impacted the quality of care provided to the patient? There is no doubt that they reduce the workload of the anaesthesiologist and capture a far more and detailed, concise data. But having this data in possession does it necessarily mean we are giving better care to the patient? As these systems are expensive does the expense really justify its usage? Or is it adding one more layer of expenses to an already expensive system?

Unless these questions are answered by more conclusive evidence which is lacking at this point in time these systems will remain expensive toys in the hands of a select few instead of a change whose time has come, especially so in a resource limited country like India!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sundararaman LV, Desai SP. The anesthesia records of Harvey Cushing and Ernest Codman. Anesth Analg 2018;126:322-9.  Back to cited text no. 1
    
2.
Penn F, Coplin PL, Kirzecky ML. The anesthesia record. Am J Hosp Pharm 1988;45:1558-63.  Back to cited text no. 2
    
3.
Gravenstein JS. The uses of the anesthesia record. J Clin Monit 1989;5:256-65.  Back to cited text no. 3
    
4.
Gravenstein JS. The automated anesthesia record. Int J Clin Monit Comput 1986;3:131-4.  Back to cited text no. 4
    
5.
Thrush DN. Are automated anesthesia records better? J Clin Anesth 1992;4:386-9.  Back to cited text no. 5
    
6.
Palaniswamy SR, Jain V, Chakrabarti D, Bharadwaj S, Sriganesh K. Completeness of manual data recording in the anaesthesia information management system: A retrospective audit of 1000 neurosurgical cases. Indian J Anaesth 2019;63:797-804.  Back to cited text no. 6
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