Eight year’s experience with automated anesthesia record keeping: Lessons learned—new directions taken

Abstract

For the past eight years, an automated anesthesia record keeping system, COMANDAS (COMputerized ANesthesia Data Acquisition System) has been used in the cardiovascular operating rooms at Mayo Clinic. The automated anesthesia record is designed to match the traditional hand-written record and becomes part of the official medical record. COMANDAS is interfaced with the physiologic monitor and mass spectrometer in each OR, and a number of other computers within the Mayo Medical Center. Since the introduction of COMANDAS over 24,000 surgical procedures have been charted. The anesthesia record is more complete, consistent in organization, and legible when compared to a hand-written record. Recently, it was determined that the computers and peripherals that make up COMANDAS were wearing out and that the vendors would no longer support or replace the equipment. A process to find a replacement for COMANDAS was then begun. Although the cardiovascular anesthesia group was satisfied with the automated anesthesia record, there were a number of areas in which improvement was desired. A systematic evaluation of the system was begun with a survey of the users. The majority of those surveyed felt that COMANDAS was a useful system which made parts of their job easier. The user interface, method of manual data entry, time to produce the record and difficulty learning the system were the source of the greatest dissatisfaction. Artifacts, networking, interfacing with other devices and computers were also issues for the replacement system. Most commercial systems were found wanting in one or more areas of significance. The most practical solution appeared to be the modification of a currently available intensive care unit patient data management system.

Determinants of Success of Inpatient Clinical Information Systems: A Literature Review

“…40 Seven studies assessed the impact on patient care. 14,21,22,28,30,33,40,42 In two studies, time saved from documenting increased time spent on patient care. 22,36 In one study the physicians saved time documenting, but lost time due to technical difficulties with the information system or coupled systems.…”

Anesthesia Information Management System Implementation: A Practical Guide

“…Even with good design, however, the inevitable need for some text entry into the AAR may generate some initial user dissatisfaction. 17 Privacy considerations and the varied needs of departmental clinicians, researchers, administrators, and financial personnel require secure log-on and electronic signatures with multiple levels of access to the AIMS PD, EDW and report-generating software. A list of authorized users and their privileges should be easy to create and maintain.…”

Innovation & Market Consolidation Among Electronic Health Record Vendors: An Acute Need for Regulation

“…While some of these important innovations have been subsequently implemented elsewhere [19], doing so required creating a new software system from scratch. Only a handful of other medical centers have invested the resources needed to develop novel functionality [20][21][22] and instead most rely on vendor driven updates. This is problematic for fields like anesthesiology, where the size of the market is relatively small, and vendor updates are typically incremental rather than pioneering.…”