Thomas Bruessel, FANZCA Prof of Anaesthesia Canberra Hospital Canberra, AUS

1. Thomas Bruessel, FANZCA Prof of Anaesthesia Canberra Hospital Canberra, AUS AIMS – ORMS – EMR

2. AIMS – ORMS – EMR Australian Institute of Medical Scientists Australian Institute of Mine Surveyors Australian Institute of Management Australian Institute of Marine Science Australian Institute of Medical Scientists Australian International Motor Show African Institute for Mathematical Sciences Afghanistan Information Management Service Association of International Marathons Races

3. AIMS – ORMS - EMR AIMS Anaesthesia Information Management System ORMS Operating Room Management System EMR Electronic Medical Record

4. AIMS EMR ? AIMS ORMS ORMS EMR eHealth

5. “Ether Chart” Codman EA, Cushing H 1st written record 1894 at MGH On permanent loan from the Treadwell Library of Massachusetts General Hospitalto the Francis A. Countway Library of Medicine

6. Hand written anaesthesia record ~ 100 years

7. Preadmission Clinic Intraoperative Data Post Anaesthesia Care Unit

9. Automated anaesthesia record HR, BP, CVP FiO2, etCO2, SaO2 Temp RR, PIP Sevoet CVP PCWP,CO

12. Automated anaesthesia record Data sampling (RS 232 port) more frequently more accurately medico-legal advantage ?

13. A Anaesthesia I Information M Management S System Server Patient Monitor Anaesthesia machine Communication multiplexer Workstation Serial data Network Connection Other Devices Operating Room

15. Anaesthesia data chart: Missing information ● Position ● Instrumentation ● Type of anaesthesia ● Drugs ● Fluid balance ● Action / interventions ● Events

16. AIMS ● Collects intraoperative physiologic data Collates these with patient information Adds interventions of anaesthetist Stores this information Allows retrieval and analysis ● ● ● ●

17. PAC: information

18. Medication Safety

19. Performance

20. AIMS Data retrieval & Analysis ● Adverse events, near misses Clinical competence/performance Compliance with standards, rules and regulations ● ●

21. AIMS PAC: history, exams, test Intraoperative: data + events PACU: data, pain, discharge info. ORMS

22. Perioperative Setting: Data Flow Scheduling Admissions Central Database “Server” Medical Records Referring Physician PreOp Clinic Holding Area Operating Room PACU ICU/Floor

23. ORMS • ● Scheduling of cases ● Documentation of time stamps ● • Capture of patient information • Documentation of clinical information ● • ● Tracking of patient flow • ● Organisation of postsurgical • placement of patients AIMS Lab Imaging Pharmacy ● ● ● ● • Organisation of clinical and support staff • Organisation of equipment and supplies • Coordination of access to Biomedical engineering ● ● ● • Billing (professional fees)

24. Allow maximal integration Medication Management: Storage /Supply

25. Integration = Application + Platform ORMS AIMS ORMS Data Sharing Redundancy!!!

26. Jerry Stonemetz Keith Ruskin Editors Springer, London 2008

27. Electronic medical record HealthSMART (Vic) National E-Health Strategy File:Electronic medical record.jpg From Wikipedia, the free encyclopedia

28. Electronic Medical Record Medical record generated outside OR Intergration/Linking GPs and Hospitals Providing access to medical staff Very expensive E-Health National E-Health Strategy

29. E-Health

31. E-Health takes time and cost money

32. EMR IDEAL SYSTEM Pathology Pathology AIMS Imaging Physician Order Entry ORMS

33. IDEAL SYSTEM Confidentiality Privacy ?