Anesthesiology And The Electronic Medical Record

The electronic medical record (EMR) has the potential to improve patient care through electronic documentation and viewing, prescription and test ordering, care management reminders and clinician-patient messaging.1 EMRs allow health care providers to collect data on patients’ health conditions and quality of care and share these data with other clinicians.2 Some researchers also argue that EMR systems may provide better security for patients’ health information than do paper records.3 Individual EMRs provide the basis for electronic health record (EHR) systems, which allow patients’ health information to follow them through various geographic areas and medical specialties.4 Not only do EMRs serve as an electronic version of the patient’s health history, but they can also be used to enhance patient safety through tools that help providers monitor care.5 EMR systems are becoming increasingly relevant to anesthesiology, with uses such as data collection, prevention of medical errors and crisis resource management.5 Anesthesia providers should be aware of the myriad capabilities of EMR in anesthesiology and data on EMR efficacy in the field.

EMR has become commonplace in anesthesiology due to technological advances, economic circumstances and complex clinical care needs.6 For example, EMR helps providers keep thorough records, report on patient care and record clinical outcomes in order to support value-based payment strategies.6 Many EMR systems include training and education resources that allow anesthesia providers to learn more about contemporary technologies.7 Additionally, the automation of EMR services frees up staff’s time and gives patients autonomy through online scheduling, electronic intake forms and digital refill requests.7 Patients can also engage in their own health care through interactive apps and patient portals.7 Specifically in anesthesiology, alerts associated with EMR can remind practitioners to avoid certain drugs due to patient contraindications (e.g., high risk for nausea and vomiting) or to respond to events (e.g., blood transfusion) with medications.5 Because anesthesia providers have various intraoperative events and tasks to balance, EMR can be a helpful resource for reducing their cognitive load and potential for error.5 The centralization of helpful information, checklists and cognitive aids can be especially important during intraoperative crises.5 Furthermore, real-time, objective data collection allows anesthesia providers to evaluate their practices and make evidence-based improvements.8 The variety of capabilities of EMR, ranging from education to crisis management to data collection, offer many advantages to the anesthesia provider.

Given that more than 75 percent of physicians in the United States use EMR9 and federal mandates require electronic medical charting,10 paperless charting is not likely to return.7 When integrating EMR into their practices, anesthesia providers should evaluate the efficacy and best uses of EMR systems for anesthesiology. A study by Goudra et al. found that use of Epic, a widely-used EMR system, led to significant intraoperative time saving and reduced medical costs.10 However, the same study showed that pressure to input data in real time—usually to avoid litigation—was a distraction from patient care, ironically leading to compromises in patient safety.10 A case study by Baier et al. found that the EMR system used in their facility did not have straightforward documentation options.11 Redundancies, omissions, inconsistent format of medical record fields and a lack of hard stops interfered with documentation of airway management data.11 On the other hand, Hincker et al. found that EMR alerts led to improvements in the intraoperative administration of repeated doses of cefazolin, a multidose antibiotic.12 In another study, Jang et al. showed that electronic anesthesia records were more complete than paper records, likely due to automatic transfer of items from past records.13 Evidence on the usefulness of EMR in anesthesiology is inconsistent, and often depends on the clinician’s knowledge11 or proper utilization of EMR technologies.7

EMR systems are here to stay, and anesthesia providers will need to incorporate these new technologies into their practices. EMR reduces anesthesia providers’ cognitive loads during surgery, helps them prepare for crises and allows them to interact easily with their patients. While the automated functions of EMR may improve an anesthesiology practitioner’s work, electronic records can also distract from the patient. Future research should directly assess the effects of EMR on patient care and outcomes in anesthesiology. Additionally, engineers should collaborate with anesthesia providers to tailor EMR systems to the field of anesthesiology.

1.         Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp KD, Brown GD. The clinical value of computerized information services. A review of 98 randomized clinical trials. Archives of Family Medicine. 1996;5(5):271–278.

2.         Terry AL, Ryan BL, McKay S, et al. Towards optimal electronic medical record use: Perspectives of advanced users. Family Practice. 2018;35(5):607–611.

3.         Barrows RC, Jr., Clayton PD. Privacy, Confidentiality, and Electronic Medical Records. Journal of the American Medical Informatics Association. 1996;3(2):139–148.

4.         Garets D, Davis M. Electronic medical records vs. electronic health records: Yes, there is a difference. HIMSS Analytics. January 26, 2006:1–14.

5.         Tanoubi I. The electronic medical record in anesthesiology: A standard of quality healthcare and patient safety. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2017;64(7):693–697.

6.         Cohen NH. Electronic Health Records: Understanding the Implications for Anesthesia Practice. ASA Newsletter. 2015;79(5):36–39.

7.         Parvus-Teichmann C, Ranasinghe CT. Electronic Medical Records: Promises, Pitfalls, and Pearls for Pain Physicians. ASRA News. February 2017;17(1):19–21.

8.         Rozental O, White RS. Anesthesia Information Management Systems: Evolution of the Paper Anesthetic Record to a Multisystem Electronic Medical Record Network That Streamlines Perioperative Care. Journal of Anesthesia History. 2019;5(3):93–98.

9.         Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2012. NCHS Data Brief. December 2012(111):1–8.

10.       Goudra B, Singh PM, Borle A, Gouda G. Effect of introduction of a new electronic anesthesia record (Epic) system on the safety and efficiency of patient care in a gastrointestinal endoscopy suite-comparison with historical cohort. Saudi Journal of Anaesthesia. 2016;10(2):127–131.

11.       Baier AW, Snyder DJ, Leahy IC, Patak LS, Brustowicz RM. A Shared Opportunity for Improving Electronic Medical Record Data. Anesthesia & Analgesia. 2017;125(3):952–957.

12.       Hincker A, Ben Abdallah A, Avidan M, Candelario P, Helsten D. Electronic medical record interventions and recurrent perioperative antibiotic administration: A before-and-after study. Canadian Journal of Anesthesia. 2017;64(7):716–723. 13.       Jang J, Yu SH, Kim C-B, Moon Y, Kim S. The effects of an electronic medical record on the completeness of documentation in the anesthesia record. International Journal of Medical Informatics. 2013;82(8):702–707.