Skip to Content

Advances in Perioperative Clinical Informatics

The transformation of clinical care and anesthesia informatics is occurring in parallel and in response to a shift in focus to population and individualized health initiatives. Conversations with our anesthesiology and surgical colleagues have shifted from increasing institutional adoption of “big data” to utilizing predictive analytics to support timely triaging and medical decision-making. Improved access to healthcare data exchanges and improved integration of application programming interfaces (APIs) to connect electronic medical records with patient-centric applications have contributed to significant advances within perioperative care.

In the past decade, international perioperative sustainability initiatives addressing greenhouse gas emissions have been booming. National consortiums and task forces, enterprise and specialty-specific objectives, and university-affiliated hospital “Greening The OR” projects are aligned in their pursuit of carbon neutrality within the next ten years.1 Several departments have conducted surveys and organized educational curriculums to approach these objectives locally. Many of these projects benefit from a coordinated effort with informatics tools such as computerized clinical decision support (CDS) that encourages anesthesiologists to closely monitor and optimize fresh gas flows based on real-time data capture during inhaled anesthetic delivery in the operating room. Similarly, best practice advisories (BPA) are now routinely used alongside machine learning to provide just-in-time data and an impetus for action for items such as acknowledging patient refusals for blood transfusions, compliance with intraoperative antibiotic re-dosing, and managementof intraoperative hypotension.2,3 Furthermore, data pooling between institutional networks have strengthened quality improvement programs across anesthesia departments by promoting robust analyses and dissemination of best practices and patient safety initiatives.

Perioperative process improvements continue to draw on timely and accurate data and require significant effort from physician informaticist champions, analysts, and report writers. Data aggregators such as Anesthesia Quality Institute NACOR and MPOG continue to grow in number and inclusivity and provide robust information for perioperative informatics research across a wide geographic consortium.4,5 Locally, however, individual- and department-level reporting dashboards and graphical displays are becoming increasingly adopted to provide the anesthesia care team a more focused scope of the elements of their practice within their own institution. These tools are also being utilized in lieu of traditional run-charts as they offer a granular view of a system (and its outliers) as well as the ability to stratify data and track personal practice improvement. Owing to the abundance of information available and the impetus to expeditiously identify trends pertaining to clinical outcomes, early warning systems show much promise in identifying high-risk patients.6,7 The medical record-based problem list, considered the standardized repository of the clinical diagnoses of a patient across different encounters, can be utilized in addition to vital sign and laboratory data to provide triggers for specialty-specific communication and targeted BPAs as mentioned above.

Hand-in-hand with patient safety improvements, clinical documentation integrity (CDI) has garnered much recent attention in light of the CURES Act and the subsequent availability of select portions of the medical records to patients.8 Within perioperative care, emphasis on the “digital front door” has manifested through smartphone-friendly patient portals which are increasingly used for patients to complete pre-operative anesthesia and surgical questionnaires prior in advance to optimize care provided during in-person appointments.9 Furthermore, telehealth encounters enable efficient screening of a growing patient population, allowing triaging of patients with whom only a chart review is necessary prior to surgery. SMS-based reminders and “nudges” are becoming more helpful in bolstering the delivery and comprehension of pre-operative instructions to patients with different levels of digital health literacy.10 Ensuring CDI and fulfilment of compliance measures is resource-heavy, requiring efforts from quality assurance officials and perioperative billing specialists to review and reconcile documentation for individual cases with the practicing anesthesiologist. Anesthesia clinical informatics works with these multidisciplinary teams to ensure CDI through close encounter checks and other automated reminders.

Social media networks and online communities have become a significant source of information for patients. Interactive digital multimedia applications such as TikTok, though initially adopted by youth, have achieved a user base across all age groups. All venues share the ability for the patient the ability to communicate both up-to-date information and personal opinions regarding their experiences within healthcare. Medical professionals and organizations alike are increasingly finding ways to connect with patients via these digital networks.11 Perioperative informatics will undoubtedly continue to evolve with digital health innovations as healthcare continues to shift its focus towards one that is patient-centered and patient-driven.

References:

  1. Ramaswamy P, Shah A, Kothari R, Schloemerkemper N, Methangkool E, Aleck A, Shapiro A, Dayal R, Young C, Spinner J, Deibler C, Wang K, Robinowitz D, Gandhi S. An Accessible Clinical Decision Support System to Curtail Anesthetic Greenhouse Gases in a Large Health Network: Implementation Study. JMIR Perioper Med 2022;5(1):e40831. PMID:36480254
  2. Palla K, Hyland SL, Posner K, Ghosh P, Nair B, Bristow M, Paleva Y, Williams B, Fong C, Van Cleve W, Long DR, Pauldine R, O’Hara K, Takeda K, Vavilala MS. Intraoperative prediction of postanaesthesia care unit hypotension. Br J Anaesth 2022;128(4):623-35. PMID:34924175
  3. Nair BG, Grunzweig K, Peterson GN, Horibe M, Neradilek MB, Newman SF, Van Norman G, Schwid HA, Hao W, Hirsch IB, Patchen Dellinger E. Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol. J Clin Monit Comput 2016;30(3):301-12. PMID:26067402
  4. Jones JH, Fleming N. The problem with dichotomizing quality improvement measures. BMC Anesthesiol 2022;22(1):297. PMID:36123624
  5. McIlroy DR. Translating evidence into practice: still a way to go. Br J Anaesth 2022;129(3):275-8. PMID:3592709
  6. Becker S, Shah AC. “EPIC-based Early Warning System for Inpatients with Difficult Airways.” EPIC XGM 2022, Verona, WI. May 3-4, 2022
  7. Wijnberge M, Geerts BF, Hol L, Lemmers N, Mulder MP, Berge P, Schenk J, Terwindt LE, Hollmann MW, Vlaar AP, Veelo DP. Effect of a Machine Learning-Derived Early Warning System for Intraoperative Hypotension vs Standard Care on Depth and Duration of Intraoperative Hypotension During Elective Noncardiac Surgery: The HYPE Randomized Clinical Trial. JAMA 2020;323(11):1052-60. PMID:32065827
  8. Giardina TD, Choi DT, Upadhyay DK, Korukonda S, Scott TM, Spitzmueller C, Schuerch C, Torretti D, Singh H. Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes. J Am Med Inform Assoc 2022;29(6):1091-100. PMID:35348688
  9. Kuehner G, Wu W, Choe G, Douaiher J, Reed M. Telemedicine implementation trends in surgical specialties before and after COVID-19 shelter in place: Adjusting to a changing landscape. Surgery 2022;172(5):1471-7. PMID:35999062
  10. Stevens JA, Findlay BR. How to close the gaps between evidence and practice for perioperative opioids. Anaesth Intensive Care 2022;50(1-2):44-51. PMID:35170349
  11. Sommerfield A, Sommerfield D, Bell E, Humphreys S, Taverner F, Lee K, Frank B, von Ungern-Sternberg BS. Consumer research priorities for pediatric anesthesia and perioperative medicine. Paediatr Anaesth [published online: September 30, 2022]. 10.1111/pan.14564 PMID:36178177
Back to Top