1. Electronic Anaesthetic Record Systems SCATA Nov. 2003 Duncan Hancox Royal Preston Hospital

2. Current Situation EPR project under way in my hospital EPR project under way in my hospital Anaesthetics was to be incorporated into the core specification Anaesthetics was to be incorporated into the core specification Was ignored due to funding constraints Was ignored due to funding constraints Per-se do not have an anaesthetic system Per-se do not have an anaesthetic system Now the trust realise they would like an electronic anaesthetic record! Now the trust realise they would like an electronic anaesthetic record!

3. EPR Levels EPRFunctionalityDetail 1 Clinical Admin Patient admin and independent departmental systems 2 Integrated clinical diagnosis and treatment support Integrated master patient index, departmental systems 3 Clinical activity support Electronic clinical orders, results reporting, prescribing, care pathways 4 Clinical knowledge and decision support Electronic access to knowledge bases, embedded guidelines, rules, electronic alerts, expert system support 5 Specialty specific support Special clinical modules, document imaging 6 Advanced multimedia and telematics Telemedicine, other multimedia applications

4. Proposed Solution from EPR Free standing PCs in the theatre Free standing PCs in the theatre PC to be shared with nurses for theatre management PC to be shared with nurses for theatre management Data to be entered manually by the anaesthetist using a keyboard and mouse Data to be entered manually by the anaesthetist using a keyboard and mouse

5. My Theatre PC Anaesthetist

6. Where do we go next? No data set or standards established No data set or standards established Try to write an anaesthetic record system – reinventing the wheel! Try to write an anaesthetic record system – reinventing the wheel! Don’t bother with an electronic record Don’t bother with an electronic record Use a commercial product Use a commercial product Automated records or manual entry? Automated records or manual entry?

7. Standards from the DOH For radiology, the DOH states that information from electronic monitors and equipment should be automatically logged and not entered manually For radiology, the DOH states that information from electronic monitors and equipment should be automatically logged and not entered manually Why isn’t this standard also established for anaesthesia? Why isn’t this standard also established for anaesthesia?

8. Commercial Products Requirements Large scale, enterprise wide Large scale, enterprise wide Integrate with monitors for automated records Integrate with monitors for automated records Integrate with EPR systems Integrate with EPR systems Reports Reports Links to EPR prescribing Links to EPR prescribing

9. Available Systems Philips Philips Drager Recall Drager Recall Winchart Winchart Deio Deio GE Medical GE Medical Docusys Docusys Civica Civica

10. Drager / Recall Installed in the North West Installed in the North West Well automated Well automated ?Links to theatre management systems ?Links to theatre management systems ?Links to EPR ?Links to EPR Costs – relatively expensive - £400k for a 12 theatre setup Costs – relatively expensive - £400k for a 12 theatre setup Working demo on site for a week, good sales response, gave quotes Working demo on site for a week, good sales response, gave quotes

11. Winchart Australian Australian I have not seen a running system I have not seen a running system Well automated Well automated ?Links to theatre management systems ?Links to theatre management systems ?Links to EPR ?Links to EPR Costs – relatively cheap £180K for a 12 theatre system Costs – relatively cheap £180K for a 12 theatre system Came to meet, demo the system and give prices Came to meet, demo the system and give prices

12. Philips Actively marketed in the UK Actively marketed in the UK Good interface Good interface Seems well automated Seems well automated They say it can interface to EPR They say it can interface to EPR Cheap - £72K for a 12 theatre suite Cheap - £72K for a 12 theatre suite Couldn’t get the company to communicate or return calls or arrange information or a demo…. Couldn’t get the company to communicate or return calls or arrange information or a demo….

13. GE Medical Only seems automated when attached to their own monitors and equipment Only seems automated when attached to their own monitors and equipment

14. Docusys Seems to be well automated Seems to be well automated Has an automated pharmacy record system – understands how much of what drug has been given when to the patient automatically! Has an automated pharmacy record system – understands how much of what drug has been given when to the patient automatically! How much? – needs their special drug containers to work fully. How much? – needs their special drug containers to work fully.

15. Deio Only works with one monitor make Only works with one monitor make Seems to be well automated Seems to be well automated ?cost ?cost No EPR integration No EPR integration

16. Civica Galaxy Anaesthesia Uk developed by an anaesthetist Uk developed by an anaesthetist Cost similar to Winchart Cost similar to Winchart Automated recording from monitoring Automated recording from monitoring Custom integration to EPR modules 1 or 2 way Custom integration to EPR modules 1 or 2 way

17. What do WE do next at RPH? Anaesthetic record data set needs to be established rapidly Anaesthetic record data set needs to be established rapidly Implement EPR links (eg xml export) between independent AIMs and EPR systems? Implement EPR links (eg xml export) between independent AIMs and EPR systems? Convince Trusts that AIMs are a mandatory part of EPR rather than an optional extra Convince Trusts that AIMs are a mandatory part of EPR rather than an optional extra Try to persuade the EPR companies to include automated anaesthetic record keeping – how best to do it? Try to persuade the EPR companies to include automated anaesthetic record keeping – how best to do it?

18. Where is the government and industry heading? Procurement strategy for IT 2003/2004 Procurement strategy for IT 2003/2004 22 StHA will make purchasing decisions from PSPs 22 StHA will make purchasing decisions from PSPs Prime Service Providers (2-5) should reduce the number of players dramatically. Prime Service Providers (2-5) should reduce the number of players dramatically. Current EPR projects and procurements are being held back until then. Current EPR projects and procurements are being held back until then. IT companies put development on hold and consider redundancies – if they are excluded from a PSP consortium they will not make any sales in the UK. IT companies put development on hold and consider redundancies – if they are excluded from a PSP consortium they will not make any sales in the UK.

19. Where is the government and industry heading? Consolidation within the EPR industry Consolidation within the EPR industry Torex own Hollowbrook computer services, AAH Medical, Pennine Medical Systems, 20% of the GP contracts and SMS Uk Torex own Hollowbrook computer services, AAH Medical, Pennine Medical Systems, 20% of the GP contracts and SMS Uk Torex recently bought Winchart and Civica Galaxy anaesthetic systems Torex recently bought Winchart and Civica Galaxy anaesthetic systems I-soft bought Torex and claim to have a level 6 EPR system I-soft bought Torex and claim to have a level 6 EPR system Torex are one of the successful PSPs Torex are one of the successful PSPs

20. Thank You