1. CENTRICITY PERIOPERATIVE ANESTHESIA Oregon Health & Science University, Portland, Oregon Stephen T. Robinson, MD Associate Professor of Anesthesiology and Perioperative Medicine Vice Chair for Finance System  General Electric Centricity Perioperative Anesthesia (CPA)  Preop Installation: November 2006 replaced Department- developed preoperative system  Intraop Installation : November 2007 replaced paper records EMR and AIM systems  AIMS Service: Available throughout the hospital and any remote terminal; activity used in all ORs (except MRI rooms), L&D, preoperative clinic, some Out-of- OR sites  AIMS Uses: Preoperative documentation, intraoperative documentation, postoperative notes, procedure notes  AIMS Interfaces: ADT (EPIC); Scheduling (CPM); laboratory Effort involved in purchase, installation, and maintenance  Primary Driver: Department  Secondary Driver: Hospital and IT  Goals: Convert internal preoperative record into commercial product and create electronic record for more accurate and searchable records  Implementation timeline: 8 months for preoperative go-live; 20 months for intraoperative go-live  FTE for implementation: Highly variable; at peaks Department 3-4, hospital and IT 2, vendor 2-3  FTE for maintenance: 2-4 with primary tasks assigned to 6 individuals and secondary tasks to others Under the hood  Offsite servers  Connection via Citrix servers  Monitor data stream converted and forwarded by Capsule Technologies to MDIL to CPA  Clinical data maintained in a cluster with one server and one on standby.  SQL restore points every 15 minutes  Tape backup once a day  Report server updated daily User interface Lessons learned RFP  Know why you want an AIMS  Engage all elements of your hospital to develop  Understand both your users‘ needs and what is realistic for an AIMS to achieve Site visits  Look at like organizations  Use a wide variety of team members: IT, nursing, etc. Vendor contract  Define all hardware, software, and installation requirements and costs  Set specific installation and performance requirements and include general functionality expectations  Have consequences with teeth User training  Don’t scrimp  Training the trainers is as important as the training itself Professional billing  A clean record provides the greatest benefit to support billing  Billing modules offer incremental value if they work Benefits of AIMS  Template for documentation of a legible record  Ability to electronically monitor compliance  Ability to drive care process  Ability to look at processes and outcomes in a large database Detriments of AIMS  Requires ongoing support  Challenging when not working  Limitations requiring workarounds Practice environment  Academic practice  45 operating rooms at 5 sites plus L&D and Out-of-OR locations  Perform 34,000 cases per year  System used on 80% of cases  Staff includes 65 faculty, 37 residents, 6 fellows, and 28 CRNAs  Staffing includes medical direction of residents and CRNAs and some solo practice  EMR vendor: EPIC used by all providers including nursing for perioperative documentation  Use of EPIC by anesthesiologists: Order entry, chart review including PACs access, some clinical documentation  Relationship between CPA and EPIC: ADT, cut-and-paste