Anesthesia Information Management Systems.

Anesthesia information management systems (AIMS) have evolved from simple, automated intraoperative record keepers in a select few institutions to widely adopted, sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system and used to manage and document a patient's entire perioperative experience. AIMS implementations have resulted in numerous billing, research, and clinical benefits, yet there remain challenges and areas of potential improvement to AIMS utilization. This article provides an overview of the history of AIMS, the components and features of AIMS, and the benefits and challenges associated with implementing and using AIMS. As AIMS continue to proliferate and data are increasingly shared across multi-institutional collaborations, visual analytics and advanced analytics techniques such as machine learning may be applied to AIMS data to reap even more benefits.

IT in the ED: past, present, and future.

Over the past 40 years, information technology in the emergency department (ED) has evolved from primitive tracking, order entry, and laboratory reporting systems to complex multifunctional applications that permeate all aspects of patient care and ED operations. Spurred by incentive programs and technological improvements, both ED physicians and administrators view these systems as a way to increase staff efficiency, to improve patient care quality and safety, to satisfy compliance and reporting obligations, and to reduce costs. As organizations implement and optimize systems, it is helpful to look back at how these technologies were developed, to review the current impacts and effects of their use, and to glimpse the future of information technology in the ED.

Physician professionalism for a new century.

During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society.

Getting from A to C: lifecycle lessons for e-health deployment.

The 35-year history of continuous development of hospital information systems and the current efforts to develop an electronic health record in outpatient settings suggest a lifecycle that must take place before electronic technology is adopted in the highly decentralised US healthcare system. This six-stage lifecycle, called the ABCs of change, involves Acceptance of the need for change, Alignment of the actors to fulfil that need, Breadboard development of the desired, integrated system, a Blueprint for the system to be commercialised, Configuration methods for adapting the system to individual provider and patient needs, and Capital sources for the desired change. This article shows how that six-stage model is relevant to understanding prior development attempts and how current efforts to bring electronic health records to small, primary-care practices follow it. We conclude that it is a useful model for insight and for future planning.

The early days of health computing in the UK.

The invention of RAM in Manchester, UK, in 1948 and the subsequent commercial production of computers paved the way for their wide-spread use in industry and commerce. This Paper details the problems and the successes as computers were introduced into the UK National Health Service. It covers the computers and their uses and lists also the personnel involved. On a broader front it sets the UK scene against the wider international scene, again mentioning those other pioneers elsewhere in the world. It should bring a sense of nostalgia to some and helpful advice to those countries about to go down a similar road.