Actionable Anesthesia Intelligence

White Paper
Actionable Anesthesia Intelligence
Smart hospitals are mining their anesthesia information management
systems for data to optimize performance. From streamlining billing and
operations to improving efficiency, compliance and decision support, a
high-performing AIMS can provide the actionable intelligence needed to
better compete in today’s demanding healthcare environment.
With factual information in hand, users
can stop speculating and defend decisions
with confidence and real numbers.
Getting More From Your Anesthesia Information Management
System
Your anesthesia information management system (AIMS) can be utilized to do much
more than chart a patient’s progress throughout the entire surgical encounter. As an
offshoot of its day-to-day functionality, an AIMS collects volumes of rich data that can
be used by anesthesia management and team members, business managers and hospital administrators to drive process improvements and transform high-acuity care.
Through a combination of operational reporting, business intelligence and data extraction tools, an advanced AIMS can deliver actionable insights across the perioperative
environment. For example:
• Analytics let clinicians and business users drill down to see what’s going on behind the
numbers.
• Best-practice report libraries can inform on personnel performance, case times,
anesthesia milestones and physiologic data.
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Actionable Anesthesia Intelligence
• Data can easily be extracted and optimized for reporting to registries.
• Key information can be organized and presented in a graphical dashboard.
With these tools in hand, you can easily:
• Track perioperative quality indicators
• Investigate relationships within physiologic data
• Analyze productivity and supervision of anesthesia providers
• Evaluate anesthesia case throughput
• Benchmark business performance
• Identify good practices
This paper will examine and illustrate how AIMS data can be leveraged to
help clinicians improve performance, utilization, compliance, billing and
safety.
Performing at a Higher Level
An automated anesthesia system provides a host of features that have a
direct impact on the efficiency of hospital staff and processes. Most AIMS
deliver flexible and robust workflow management tools that streamline work
processes and improve operating room efficiency. In addition, they automate
anesthesia documentation, record data directly from medical devices and
integrate with other systems so that items such as allergies and medications
automatically flow into the chart. With the automatic recording of physiologic data, clinicians can devote more time to the patient. “Our AIMS gives
us the ability to simultaneously document complete multiple data inputs
such as continuous cardiac output, systemic vascular resistance, entropy
values and cerebral oximetry values,” says John MacCarthy, MD, co-director
of Surgical Services at St. Jude Medical Center in Fullerton, California. “We
spend time analyzing and acting on the data gathered rather than wasting time recording it.” The result: more accurate, complete and legible
documentation.
Beyond this core functionality, data analytics and reporting can be used to
further improve performance and efficiency. Dynamic drilling and filtering
help users understand productivity differences and identify areas of potential
improvement. Let’s look at three examples.
Identifying best practices: Analytics offers anesthesia chiefs the ability to
evaluate peer performance and care quality. “We look at milestones that our
Optum Anesthesia system tracks, such as average anesthesia case time, preparation time and emergence time,” says Gary Friedman, MD, vice president
of Nashua Anesthesia Partners. He then delves deeper and analyzes those
numbers by type of surgery, type of medication or inhalation agents, and
anesthesia staff member.
Perception or Reality
Instead of relying on anecdotal evidence,
quantitative data from an AIMS can dispel
myths and provide the hard evidence
needed to make data-driven decisions.
With factual information in hand, users
can stop speculating and defend decisions
with confidence and real numbers.
For example, the perception among a
group of surgeons at a community hospital
in the Northeast was that it was taking
patients who were in the prone (headdown) position during lower back surgery
as much as half an hour longer to wake
up from anesthesia than patients who
received a general anesthetic while supine.
The anesthesia department ran a report
that compared average emergence time
for neurospine surgeons versus all general
anesthesia cases. It revealed that there
were no substantial differences between
the emergence times of prone or supine
patients.
Quantitative information from an AIMS
can also help determine if the existing OR
resources can accommodate more cases
or whether alternatives such as expansion
need to be explored. By analyzing room
utilization by day and hour, you can determine if you have the capacity to handle
add-on cases and emergency surgeries or
if the operating suite is at or near capacity.
Consider the case of a hospital where a
surgeon was having trouble scheduling
surgeries in the middle of the day and was
pressing for the construction of additional
ORs. The utilization report showed that
the capacity problem was confined to the
three days of the week when he was performing surgery; on the other two days,
midday ORs were available. The problem
was resolved by reshuffling the surgeon’s
block assignment rather than a costly construction project.
“We look at our best providers and glean valuable information about what
they’re doing that may be of benefit to the entire group,” says Dr. Friedman.
“This allows us to adopt things practice-wide that our most efficient providers are doing.”
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Actionable Anesthesia Intelligence
Improving staff efficiency: Using reports such as “number of cases by the time
of day” can help better staff the OR. Reports like these provide a snapshot of OR
case activity around the clock for each day of the week. St. Jude Medical Center in
Fullerton, California, uses data from its Optum Anesthesia system to adjust staffing
requirements based on actual use, which reduces expensive overstaffing or justifies
increased manpower if utilization levels are high.
Reducing unnecessary labs: Some AIMS have algorithms built into the system that
help clinicians determine which labs are necessary for each patient based on comorbidities, type of surgery, expected blood loss and other criteria. This added intelligence
ensures that anesthesiologists are not ordering labs on patients simply because they fit
into a certain patient type or age category or other more general categories. Eliminating
unnecessary labs lowers costs and improves patient satisfaction.
Maximizing Operating Room Utilization
The creative use of AIMS data can help improve OR utilization and turnover times. By
looking beneath the top-line numbers, you can identify the root cause of delays and
cancellations and take appropriate steps to improve OR throughput.
Starting the day off right: Breakfast may be optional, but delays at the start of the
OR schedule are not. If the day’s first cases are not on time, it creates a domino effect
that can delay all subsequent surgeries. The costs are obvious both in terms of dollars
and physician and patient satisfaction.
The combination of “delayed cases” reports and system analytics can help provide
the intelligence needed to make operational decisions to alleviate any problems. For
example, you can answer questions such as:
White Paper
“When we implemented Optum
Anesthesia at Southern New
Hampshire Medical Center, we
dramatically improved our revenue
capture since the billing information was now accurate, legible and
current, and included all the required
data elements, both for anesthesia
professional services and for the anesthesia technical component that the
hospital bills.”
Gary Friedman, MD,
Vice president of Nashua
Anesthesia Partners.
Results – Southern New Hampshire
Medical Center
• OR revenue increased by 16%.
• PACU revenue increased by 13%.
• Is the surgeon getting there on time?
• Endoscopy revenue increased by 15%.
• Is there a relationship between the type of surgery and the delay?
• Anesthesia technical component
increased by 73%.
• Does the surgery require a radiologic procedure that is not being completed on time
to meet the anesthesia and surgical schedule?
After the problem or pattern is understood, adjustments can be made to correct the
situation and ensure that it’s a good morning—and afternoon—for everyone.
Preventing unnecessary case cancellations: OR case cancellations represent a very
large cost to a facility. Although all cancellations or delays are not preventable, many
are. An analysis of AIMS data can identify the most common reasons for case cancellations. For example, the patient didn’t follow instructions to refrain from eating or
drinking before surgery, or in other cases, labs, EKGs, X-rays or other preoperative
evaluations weren’t completed. After a trend is revealed, you can drill down further
to see if there are any other patterns. Are a significant number of the patients from
a single surgery group or a single surgeon? Once a pattern is identified you can take
steps—such as working with a surgeon or surgical group—to help prevent delays or
cancellations in the future.
Results – University Hospitals of
Cleveland
• A 27% increase in billable charges
• Improved revenue capture
• Shortened professional billing
submission time
• Reduced billing staff headcount
Compliance Made Easy
AIMS data and reports are instrumental in efficiently meeting hospital- and physicianrequired quality initiatives such as SCIP, PQRI, Medicare and AQI. Data collected as part
of current documentation practices can be mapped to quality measures, eliminating the
burdensome and labor-intensive collection and aggregation of anesthesia and perioperative data.
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Actionable Anesthesia Intelligence
Encouraging perioperative antibiotics documentation: According to Dr. Friedman
of Nashua Anesthesia Partners, his AIMS system helps in compliance with perioperative
antibiotic administration. “Antibiotics must be administered in a timely fashion before
the incision in an operative procedure,” says Dr. Friedman. “Our Optum AIMS helps
ensure our clinicians meet this requirement and then properly document it for reporting
to SCIP and other outside agencies. This has a direct impact on anesthesiologists who
are trying to receive incentive bonuses from CMS for reporting this information, or, in
the future, to avoid a negative penalty adjustment.”
Dr. Friedman points out that the AIMS is also important for collecting and publically
reporting required site infection data. “It allows us to easily report on normothermia,
beta blockers, central line infections and perioperative antibiotic administration. And the
system is flexible enough to track and report on new criteria as requirements change.”
Fulfilling condition of participation (COP) requirements: For every Medicare patient
who receives anesthesia services, discharge notes and a postanesthesia evaluation must
be completed no later than 48 hours after surgery. University Hospitals in Cleveland finds
that their Optum AIMS system helps meet this critical requirement. “The system’s reporting capabilities allow us to remind clinicians to do 48-hour post-op checks and makes it
easier to do the appropriate documentation,” says James R. Rowbottom, M.D., medical
director, Operating Room, University Hospital Case Medical Center.
Optum Anesthesia
Optum Anesthesia is a completely integrated anesthesia information management system that helps anesthesia care
providers chart a surgical patient’s progress from preop through PACU. Optum
Anesthesia also supports administrative
needs such as utilization, service-line
analysis, compliance and quality reporting, and billing.
Optum Anesthesia capabilities
include:
• Preoperative patient management
• Medical device connectivity
• Advanced patient/case tracking
• Configurable documentation templates
• Automated notifications
Billing Capabilities Accelerate ROI
An AIMS automatically abstracts and transmits billing information directly from the
anesthesia record to the billing system or outside service. This is a powerful tool both
for professional billing for the anesthesia practice group and for the hospital’s portion
of the bill. When you bill directly from the electronic anesthesia record, all information
needed by the billing service, insurance companies, and Medicare and Medicaid should
be correct and complete.
“You can get a positive return on investment from an AIMS just in the improvement in
recovering professional fees,” says Dr. Friedman.
• PACU documentation
• Automation of supply and professional
fee billing
• Business intelligence and analytics
• Quality reporting
• Integration with EMR and financial
systems
Conclusion
An AIMS is much more than an automated anesthesia recordkeeping system. Data collected by the system can be used to optimize performance throughout the perioperative environment. By taking full advantage of the system’s reporting capabilities, business intelligence tools, clinical notifications and other advanced features, hospitals and
anesthesia groups have the timely information needed to improve efficiency, increase
revenues, and maximize patient and physician satisfaction.
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