Artigo recomendado: The Value Proposition of Anesthesia Information Management Systems

Christoph B. Egger Halbeis, MD, DEAA,MBA^a,*,

Richard H. Epstein, MD, CPHIMS^b

^{Anesthesia Information Management Systems (AIMS) are information technology (IT) systems that are used as electronic anesthesia record keepers and allow the collection and analysis of anesthesia-related perioperative data. AIMS can be stand-alone systems or integrated modules of a clinical information system (CIS). AIMS are not yet widely established. It is estimated that these systems are currently deployed in less than 10% of all hospitals, although hard data supporting this figure are lacking. This low penetration rate is surprising for several reasons:}

IT systems for other ancillary hospital services (eg, radiology, pharmacy) are deployed almost universally.¹

Use of information systems technology has been widely touted as a means to improve patient care and safety.^2–4

AIMS have been available for more than 15 years.

A typical scenario for many anesthesiology departments or groups is that they would like to install AIMS, but the hospital declines to provide funds for the project. 

One explanation for this resistance is that the hospital believes such an expenditure of money and resources would create a situation that economists refer to as ‘‘nonintegrated positive externalities;’’ that is, the hospital pays for the AIMS but doesnot benefit from the investment. There are several ways a hospital might benefit from AIMS installations, however. In this article, we review tangible and intangible values of these systems and highlight the evidence basis for such assertions, where existent.

We have attempted to highlight those areas in which results from the published literature are ambiguous or the potential impact of the value added is limited in scope. We anticipate that this summary will provide a structure and methodology for anesthesiology departments and hospitals to assess the potential outcomes of an AIMS installation and support their managerial decision making for investing in this technology.

Areas of values from anesthesia information management systems referenced in the scientific literature

In general, IT projects are not optimal candidates for being evaluated with traditional valuation tools such as the return on investment (ROI) or the net present value approach.⁵ Because IT projects typically have a high degree of uncertainty (eg, technical difficulties, additional labor costs, time in which benefits start to be obtained is variable) and have indirect returns (eg, via changing the behavior of health care providers), alternative valuation tools such as the real option¹ pathway have been suggested. For example, the real option approach helps executives to clarify the role of uncertainty in the project evaluation and structure a CIS implementation project as a sequence of managerial decisions over time. Even if more complex valuation approaches were to be included in a hospital’s cost-benefit analysis of AIMS installation, it would be misleading to only include the monetary value in the decision making to invest in AIMS because many of the indirect or clinical benefits are hard to translate into cash flows. For example, if the availability of specific performance metrics captured by AIMS supports managerial decision, how should this be monetized?

O’Sullivan and colleagues⁶ recently examined the scientific evidence of how AIMS may reduce the cost of and the improve reimbursement for providing anesthesia services and found four evidence-based factors that contribute to a positive ROI:

• Reduction in anesthesia-related drug costs
• Improvement in staff scheduling and reducing staffing costs
• Increased anesthesia billing and capture of anesthesia-related charges
• Increased hospital reimbursement through improved hospital coding

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