AIS Development of an anesthetic information system VUmc Amsterdam H.H. Ros N. van Schagen K. Gigengack A. van Dusseldorp

AIS  Time and Money: 1985  Multichannel data acquisition  Renewal anesthetic equipment  Philosophy  Structure  Demands  Implementation  Demonstration

AIS - History  Separate units for each monitoring function  High number of single units  Different Manufacturers  PDMS: not existing or adapted to specific hardware  “Total Design” systems  Hardware and Software mutual dependent  Simple and not structural output (analog / RS232 )  Changing setup

AIS - History II  Equipment central in development  IT – development neglected / rejected  No standardization  Of software  Of interfaces

AIS – History III  Limited functionality  Number of signals / parameters  Methods of sampling fixed  Information transfer fixed  All equipment different (interface) protocols

AIS – History IV  Alarm strategy not standardized  Depending the manufacturer  Systems not flexible  New development = buying new system  Each OR an own / separate system  Limited role of the anesthesiologist

Patient Situation before development AIS Monitor(s) Anesthetic Equipment Anesthetics Drugs etc Display/control Display/controle Anesthesiologist Outside World

Full disclosure – overgang ECG

AIS – Concepts  Information System – ” Information Brains”  Efferent stream of data  Afferent stream of data  Data acquisition – full disclosure  No discussions about the dataset  All parameters will be recorded (if possible)  The chosen filter will display what is needed or wanted.  Processing data in IS independent of recording

AIS – Concepts II  Transducers outside IS  Intelligence in IS:  Feedback to anesthesiologist  Individual adaptation of alarms, performance of IS system subject to users  Standard human interface

AIS – Open System Architecture  Constructed for several hardware platforms  No dedicated software for communication and data acquisition:  Standard commercial software / freeware  Direct connections to the outside world  Full disclosure possible  Plug and Play  Worldwide standard supported  Simple maintenance with easy access - standard technology  Automatization considered as a process

AIS – OUTSIDE WORLD  Libraries – digital support systems  Laboratories  Other OR’s / wards  Hospital information system  Decision support / expert system  Management support  Quality assurance  Medical Audit  Reports –including anesthetic chart  Research  Education and training  Internet etc  Servers for recorded data.

AIS- implementation  Use of existing hardware  Use of existing software  Afferent data acquisition  Full Disclosure  No operating of equipment - efferent  If possible standard available software

Patient Situation before development AIS Monitor(s) Anesthetic Equipment Anesthetics Drugs etc Display/control Display/controle Anesthesiologist Outside World

Patient Situation after implementation of the AIS Monitor Anesthestic equipment Anesthetics, Drugs Display/control Anesthesiologist Communication Outside world Information system

Outside World: Patient ID and data Preoperative assessment data Pharmacy – reference Bloodgasanalyzer HL7 General terminal: web, mail, medicating system Report generators (web based) Anesthetic List as web application Monitor Anesthetic Equipment Information system: AIS Other recording possibilities: Infusion pumps, ECC, WEB-devices Display and control Planning, Pharmacy, Waiting list, Clients Operation Complex, Management, Upload to Hospital Information System, DB of operations

Full disclosure – ECG normaal

Full Disclosure: ECG abnormaal

Full Disclosure – ECG weer naar normaal