Patient data management systems in anaesthesia: an emerging technology

Two open access, high-quality datasets from anesthetic records

OBJECTIVE

To provide a set of high-quality time-series physiologic and event data from anesthetic cases formatted in an easy-to-use structure.

MATERIALS AND METHODS

With ethics committee approval, data from surgical operations under general anesthesia were collected, including physiologic data, drug administrations, events, and clinicians' comments. These data were de-identified, formatted in a combined CSV/XML structure and made publicly available.

RESULTS

Two separate datasets were collected containing physiologic time-series data and time-stamped events for 34 patients. For 20 patients, the data included 400 physiologic signals collected over 20 h, 274 events, and 597 drug administrations. For 14 patients, the data included 23 physiologic signals collected over 69 h, with 286 time stamped comments.

DISCUSSION

Data reuse potentially saves significant time and financial costs. However, there are few high-quality repositories for accessible physiologic data and clinical interventions from surgical cases. De-identifying records assists with overcoming problems of privacy and storing the data in a format which is easily manipulated with computing resources facilitates access by the wider research community. It is hoped that additional high-quality data will be added. Future work includes developing tools to explore and visualize the data more efficiently, and establishing quality control measures.

CONCLUSION

An approach to collecting and storing high-quality datasets from surgical operations under anesthesia such that they can be easily accessed by others for use in research has been demonstrated.

Quality improvement using automated data sources: the anesthesia quality institute

The Anesthesia Quality Institute has created the National Anesthesia Clinical Outcomes Registry to automatically capture electronic data specific to anesthesia cases. Data come from billing systems, quality management systems, hospital electronic health care records, and anesthesia information management systems. Aggregation of this data will allow for calculation of national and cohort-specific benchmarks for anesthesia outcomes of interest. Provision of this data to anesthesia practitioners through periodic private reports will motivate improvements in the quality of care.

A Comparison of Electronic and Handwritten Anaesthetic Records for Completeness of Information

Complete documentation in anaesthetic records is important for patient management, research and quality assurance and has medicolegal implications. This study compares the completeness of information contained in electronic versus handwritten intraoperative anaesthetic records.

A sample of 70 handwritten records was randomly selected from anaesthesia performed in the month prior to implementation of the Integrated Injectable Drug Administration and Automated Anaesthesia Record System and compared to a similar sample of electronic records generated eight months later. A comprehensive scoring system, based on the Australian and New Zealand College of Anaesthetists’ guideline PS6, was used to compare the completeness of information throughout the entire intraoperative record.

There was no significant difference in the total score for completeness between electronic (78%) and handwritten (83%) records (P=0.16). Handwritten records were more complete with respect to weight (P <0.0001), American Society of Anesthesiologists’ physical status score (P <0.0001), the size and type of artificial airway used (P=0.003) and a record of the surgeons involved (P=0.0004). Electronic records were more complete with respect to a record of drug administration including intravenous drugs (P <0.0001), vapour (P=0.0001) and nitrous oxide/oxygen (P <0.0001), a record of end-tidal carbon dioxide monitoring (P=0.006) and the level of trainee supervision (P=0.0002).

There was no overall difference in the completeness of electronic versus handwritten records. Several differences did exist however, highlighting both clinically important advantages and deficiencies in the electronic system. Records from both systems sometimes lacked important information.

Evaluation of the suitability of a patient data management system for ICUs on a general ward

The development of the ICUData patient data management system (PDMS) for intensive care units (ICU), by IMESO GmbH, Hüttenberg, Germany, was based on the assumption that processes and therapies at ICU are the most complex with the highest data density compared with those in other wards. Based on experience with the system and on a survey conducted among users at our pain clinic, we evaluated whether the concept of the present software architecture, which sufficiently reproduces processes and data at an ICU, is suitable as a PDMS for general wards. The highly modular and client-centric approach of the PDMS is founded on a message-based communications architecture (HL7). In the beginning of the year 2000, the system was implemented at the pain management clinic (12 beds) of our hospital. To assess its user friendliness, we conducted a survey of medical staff (n=14). From April 1st 2000 to August 31st 2000, all clinical and administrative data of 658 patients at the pain management clinic were recorded with the PDMS. From the start, all users had access to data and information of other connected data management systems of the hospital (e.g. patient administrative data, patient clinical data). Staff members found the system mostly useful, clearly presented, practical, and easy to learn and use. Users were relatively satisfied with stability and performance of the program but mentioned having only limited knowledge of the program's features. The need for external support during a computer crash was rated negatively. Despite the need for further usage training and improved program performance, the software architecture described seems to be a promising starting point for the construction of a PDMS for general wards.