Let’s have a space for anaesthetists and surgeons to chew the perioperative digital fat.
As we all know, SaferSleep is quite widespread in NZ - and are releasing their refreshed preoperative module soon after partnering with Wellington over the last wee while.
Also, quite a few NZ departments are looking at getting an AIMS at present. It would be good for us to co-ordinate our thoughts on this - particularly as the choice of platforms has national data sharing implications.
I’m very worried about the narrow focus - especially starting with an “AIMS”. I think it’s a consistent problem of being “clinician” centric in our thinking
The value anaesthetic documents usually brings - are that we summarise and bring together all the medical and surgical issues with a patient
So I’m more interested in asking how we get to a curated list of problems - with links to evidence for and against (how certain are we) and associated medications (those that are helping, those that have been tried) which leads to the medication reconciliation and other therapeutic interventions that have been tried
Narrow yes, but we’ve got to start somewhere, Lara! And as I work in a paper-based theatre at the mo, just simple digitisation seems very urgent.
What you suggest is the next generation - the application of AI to build the assessment from the available data before the clinician even looks at the notes. And this would not be limited to anaesthesia - we would need just one curated view. Boy it would save everyone time.
I raised this with IBM/Watson last year. They returned that if they have the data in a high quality, granular, and accessible form then yes it would be doable. We aren’t quite there yet on the data front though!!!
Nooo. Really really really not talking about AI
Talking about basic medical skills we get taught
And truth is -we are all doing - read any good clinic letter, discharge summary or paper (free typed) anaesthetic assessment - and you will find what I want
What people do is cut and paste that - and to an extent - that’s ok
We used to do the same with medication list - then we invented medication reconciliation - is a workflow that allowed easy reconciliation and curation
What I’m wanted added in is an easy way to link back to provenance -
Chronic obstructive airways disease
Type stuff ie the stuff that is the very basic building block of the World Wide Web
That’s what I want in my (preoperative) clinical documentation
Be that in an “AIMS” then it better be visible in my normal workflow and open to all to contribute
Should have been a private comment?
No need to for that to be private, Lara.
Ah - you mean the ability to link to the relevant stuff. Automatically I’m guessing.
I could really see that working - and it wouldn’t even need to be too smart. If patient has COAD - links to relevant investigations automatically inserted. And also links to relevant guidelines appear.
Our preop system in Dunedin (that I developed when down there, and is now run by @damon ) is in the workflow, is visible widely, and open for the whole anaesthetic team to contribute - was a right pain to sort out who is accountable for which bits mind you! Still not quite sorted either. If I still had control of it I would look to add links as you suggest.
The AI thing is the holy grail I reckon. The computer does the work of assimilation into a patient summary / problem list and provides useful links as part of the bargain. I read it quickly and then talk to the patient. Would save me a lot of inefficient staring at the screen and clicking, and improve my doctor/patient relationships massively. But it will remain a pipedream for a while.
What AIMS systems are people considering in New Zealand?
Having discussed this with a few departments around the country, I have found hospitals that are currently using paper anaesthetics records, but are considering getting electronic are considering the following systems:
Is anyone aware of any other electronic anaesthetic records currently under consideration by a NZ public hospital?
Counties Manukau have recently gone live with their co-developed Precept AIMS - just the in-theatre anaesthetic bit. They had originally planned an end to end perioperative solution, but it proved too ambitious to achieve. I hear that they have ‘completed’ the project; this is not good news as talking to users it is very ‘rough around the edges’ and clearly needs more iterative development to blossom into something actually nice to use / efficient. I’ll invite one of the Counties’ anaesthetic geeks to comment once I’ve signed them up.
Also, SaferSleep are due to release their completely rebuilt preop module (co-developed with Capital & Coast) any day now. If what their rep tells me is true (forgive my caution) it will be pretty sweet.
Anyone know a colleague at Welly who has been involved?
Hey Damon, Nathan et al.
As you probably know already, Hawkes bay is looking at an anaesthetic solution, and the current lead contenders are alscripts and Getz.
Of note, safer sleep came last in the tendering process (although I don’t have any details as to why or how the scoring was conducted. I know safer sleep had been proposed by the anaesthesia staff who requested this functionality)
From an intensivists point of view, solutions which have ICU modules seem both intuitive and helpful: although noting the Counties experience, it may be that it’s a leap too far.
Cheers
Mat
?Thanks Matt
Is anyone from Counties able to fill us in on their experience? I think I heard they were developing their own system, is that correct??
Damon
Hey Lara et al
I fully support your comments about the bigger picture need to implement a product which gives some sort of “medical problems” list.
As you are no doubt aware, Orion has a product called “Problems list”, as well as one called “Circle of care” which (allegedly fill this role)
In the central region we have been slow to implement this product, even though it’s one we’ve actually paid for, in part because of the perceived issues associated with curation of said problem list.
I thought the Counties handover tab had a problems list in it, or have I got my knickers in a twist? (If you do have problems list functional, I’d been keen to bounce ideas about it around with you)
Also keen to see how this forum copes with a sub-thread!
Yes am very aware of the product
I thought the Counties handover tab had a problems list in it
Yes - WDHB and CMH are on the same portal - and yes I got it in but am using a cut down version currently - it gives NMWS, iPM WDHB and iPM CMH alerts view only - (I do not pay full license fee!)
I am trying to get the full license fee version though - working through a few issues though
When I say live in MedChart - we pull them into the admission and discharge documents as “view” with a note to update in MedChart
The next issue is that although it allows a bit of “information model” around the problem - it’s insufficient in a few places - notably
but I am hoping to still try and use it soon - happy to share my list of curated SNOMED condition codes with you if you would like (complete with documentation and how I got there - as I moved away from the National Curated lists as just not enough for what I think will be needed - may well still be wrong!)
Hey Damon, the folks to ask at Counties re: Precept would be Engin Ahmed and Mark Freeman.
@NathanK, do I have your blessing to email the two of them w you cc’d in to invite them to join?.. as we ?didn’t have anyone from CMDHB at the CCIO mtg so they wouldn’t know this exists.
No worries, Era.
engin.ahmed@middlemore.co.nz and mark.freeman@middlemore.co.nz are added to the list - I’ve guessed Mark’s email address, please let me know if I’ve got him wrong.
I’ll ask to have the rest of the crew invited now.
Fab thanks! Yes, both addresses are correct 
Hi all,
I’m resurrecting this thread for the anaesthetists among us … all for a good cause:
One of our anaesthesia technicians, Martin Tuberville Smith, has developed a training app for the trainee anaesthesia technicians.
Here is the link to the google App Store: https://play.google.com/store/apps/details?id=net.kiwiroad.quiz&hl=en
And for the web version: https://quiz.kiwiroad.net
Please feel free to share among your staff as they may find it useful.
Cheers,
Era
Hi everyone
I thought I would jump in here as I am currently (for the next 3 weeks until I finish) working at MercyAscot and have been heavily involved in their EMR/PAS project called Compass21. MA have procured a system called TrackCare by international vendor InterSystems. It offers full PAS and EMR features and excellent integration and analytics features.
MercyAscot is a private surgical hospital and currently uses SaferSleep both the Anaesthetic Modules and the MedRec Module which we co-developed with SaferSleep. Overall SaferSleep Anaesthetics is reasonably well adopted here (and there will be some anaesthetists who disagree with me here). The MedRec module is good (in my humble opinion)
The project team have been trying to land on a decision if to keep safersleep or move to Trak’s anaesthetic module which needs some significant development to offer the ease of use and features of safersleep. The challenge for us with safersleep are
The challenges with Trak is the maturity (or lack of) of their anaesthetic module- mainly from a usability perspective. As a private surgical hospital it is imperative that we have a solution that allows rapid documentation of cases.
So we haven’t landed on a decision yet but I thought you all might be interested to know about MA’s project and ask any questions you might have.
Thanks all
Anna-Marie