Electronic Anesthesia Charting in Private Practice?

[checkov]

Just out of curiosity, I was wondering if any private practice attendings use electronic charting systems in their practice (i.e. true real-time electronic charts, not just paper charts scanned into Epic/Hyperspace).

While on the interview trail, I've noticed that a few institutions (MGH, Stanford, Michigan) boast that their electronic charting systems increase OR efficiency, improve quality of care, and facilitate clinical outcomes-based research. However, I'm skeptical if this is a real / perceived advantage, and am curious if electronic charting is cost-effective enough to make it to the private sector.

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[narcusprince]

Just out of curiosity, I was wondering if any private practice attendings use electronic charting systems in their practice (i.e. true real-time electronic charts, not just paper charts scanned into Epic/Hyperspace).

While on the interview trail, I've noticed that a few institutions (MGH, Stanford, Michigan) boast that their electronic charting systems increase OR efficiency, improve quality of care, and facilitate clinical outcomes-based research. However, I'm skeptical if this is a real / perceived advantage, and am curious if electronic charting is cost-effective enough to make it to the private sector.

Coming from a residency that has one of those boasted electronic charting systems and now rotating at a hospital that has paper charting. The fidelity of the anesthesia record is much better in an electronic format. Also, a paperless chart allows you to have your hands free to stay on the patient and not have to worry about pluggin in vitals. Also, their are sections on the paper chart for billing purposes that can get omitted(most likely from user error) that in an electronic charting you would be prompted to finish these billing sections before closing the record.

 

[2win]

Just out of curiosity, I was wondering if any private practice attendings use electronic charting systems in their practice (i.e. true real-time electronic charts, not just paper charts scanned into Epic/Hyperspace).

While on the interview trail, I've noticed that a few institutions (MGH, Stanford, Michigan) boast that their electronic charting systems increase OR efficiency, improve quality of care, and facilitate clinical outcomes-based research. However, I'm skeptical if this is a real / perceived advantage, and am curious if electronic charting is cost-effective enough to make it to the private sector.

I am totally against electronic charting. I know that the administration is pushing them )in "close" collaboration with the vendors) BUT I don't see any real advantages. Instead to focus on the patient you have to justify any false readings and actually the liability instead to be decreased (as they claim) is increased. Expensive - there are not valid data to support an increased in reimbursement (as again THEY claim...). It is BS.
I see the "utility" in some big places interested in research.
Narcus - seems that er posted in the same time - it was never a problem for me to chart 10 minutes later- the back data is available for most of the anesthesia monitors. Regarding the billing - it was a recent study ( I have to google it) that shows that there is no advantage using EMR-s (financially). I know that this is a blow for Obama stupid reform who sees EMR-s as the savior of the modern medicine....

 

[pgg]

you have to justify any false readings and actually the liability instead to be decreased (as they claim) is increased.

Yeah, on paper charts those BP dips somehow always seem to get smoothed up a box or two ... Odd phenomenon, that.


We had electronic records at my residency program. It was a very nice system. Some attendings complained that new residents would be so distracted by the nifty computer that they'd ignore the patient; I thought it was great because I could ignore the record and watch the patient. We're getting the same system at my current hospital, and I am looking forward to it.

But cost effective? Hard for me to believe that the improved billing an electronic chart MAY facilitate can overcome the cost difference between all the computer hardware & software ... and a couple pieces of paper and a room full of filing cabinets.

(And in my particular case, at a gov't hospital, it's not like there's any billing at all going on, so there won't be any capturing of previously-unbilled $ to offset the cost.)


In 3 years of using the system as a resident, I can only point to a handful of occasions when the ability to pull up an old anesthetic record led to a revelation that changed my plan. (The system was new though; maybe in 10 or 20 years there will be enough old charts in the system to make those aha moments more common.) And at the paper-record hospitals, old paper records (usually) magically showed up with charts in preop, so it's not like we were in the dark without computers.

Given the way technology drives healthcare costs, I think this is probably one area in which the money could be better spent.

 

[psychbender]

PGG, does that electronic system integrate with Essentris or AHLTA in any way? One gripe I hear from the Medicine and MICU folk here is that they have no idea what was given to their patients when they go down to the OR.

 

[2win]

Yeah, on paper charts those BP dips somehow always seem to get smoothed up a box or two ... Odd phenomenon, that.


We had electronic records at my residency program. It was a very nice system. Some attendings complained that new residents would be so distracted by the nifty computer that they'd ignore the patient; I thought it was great because I could ignore the record and watch the patient. We're getting the same system at my current hospital, and I am looking forward to it.

But cost effective? Hard for me to believe that the improved billing an electronic chart MAY facilitate can overcome the cost difference between all the computer hardware & software ... and a couple pieces of paper and a room full of filing cabinets.

(And in my particular case, at a gov't hospital, it's not like there's any billing at all going on, so there won't be any capturing of previously-unbilled $ to offset the cost.)


In 3 years of using the system as a resident, I can only point to a handful of occasions when the ability to pull up an old anesthetic record led to a revelation that changed my plan. (The system was new though; maybe in 10 or 20 years there will be enough old charts in the system to make those aha moments more common.) And at the paper-record hospitals, old paper records (usually) magically showed up with charts in preop, so it's not like we were in the dark without computers.

Given the way technology drives healthcare costs, I think this is probably one area in which the money could be better spent.

Absolutely. I cannot agree more.
2win

 

[pgg]

PGG, does that electronic system integrate with Essentris or AHLTA in any way?

No. Looks like the OR will still be a black hole in that regard.

We just got Essentris last month. Our paper anesthesia records go into the paper chart. Maybe at some point they get scanned in. Supposedly Innovian (computerized anes record) is coming to our ORs "real soon now" but AFAIK there is no proposed plan to spend the money to enable Essentris to import drugs/fluids/vitals/etc from Innovian.

One gripe I hear from the Medicine and MICU folk here is that they have no idea what was given to their patients when they go down to the OR.

Part of that turnover problem has always been that we anesthesia types usually give report to the ICU nurses and then disappear. Half the time the nurses act like they know the patient better than me already and aren't listening. If the ICU docs are around I'll give them a rundown of what I did but I have to confess I don't go looking for them unless something really important needs to be passed on.

For med floor patients the PACU nurse gives report to the floor nurse and the documentation of that exchange is usually on a napkin or the like for the floor nurse's benefit.

At Portsmouth, pre-Essentris, the computer anesthesia record always got printed and put in the paper chart for other docs to see.

 

[2ndyear]

Don't have it at my PP gig. Hospital buys the equipment, we supply the service and bill for it. They don't care how much we lose on the billing. Since they would foot the bill for the system, there would have to be a large benefit for them. In academics it makes gathering data easier, by a lot. We cover enough sites that it would be a large investment. And not total...how do you chart electronically for an endo? We don't even have a machine there.

I think that an iPhone billing app that would spit out the codes and synch automatically to a remote biller would make the most sense. Ubiquitous technology. Cheap. Easy to do. They even have the bar code technology now with the iPhone camera so data entry would be minimal.

 

[sevo85288]

In our pp we have the Innovian system by Drager. It is ok. Not great. A bit distracting. You can make your own templates. I don't love it. But it is the future...