100% Adherence to GuidelinesAn Expert System for Preoperative Screening

Anesthesia?

• Before the invention of anesthesia surgeons had to be strong and quick

• Conscious patients endured excruciating pain

• Alcohol, opium or other botanicals sometimes helped

• Many patients died during surgery

Anesthesiologist?

• Doctor that keeps the patient alive during surgery

• Uses evidence based medicine (guidelines) to reduce risks

• Risk of death from general anesthesia alone is 0,01-0,016% (Lienhart 2006, Arbous 2001)

• Risk increases with morbidity and the extent of surgery

Preoperative Screening?

• Prior to every surgical procedure under anesthesia

• 15000 screenings per year• Screening:– Identify and optimize relevant medical

conditions– Estimate and reduce perioperative risks– Inform the patiënt

• 10 minutes per screening• Needs to be thorough, efficient and smart

Epic® Anesthesia?

• Module of the Epic® EMR• Configurable by end users• Free sharing of build within the worldwide

usergroup• Epic® UserWeb as a vehicle to share ideas

and solutions• With smart configuration we created the

expert system that won the Spider Award

Problem Definition

• Numerous extensive guidelines

• The relevant clinical rules are in there somewhere

• No time for reading during preoperative screening

• Results in poor adherence to guidelines

Objectives for Configuration

• Lean screening• Automated text

generation• 100% adherence to

guidelines• Uniform high standard

of care• Elimination of

medication errors• Quality of care

reporting• Research readiness

Configuration: First Step

• Create flow charts from guidelines

• Crossroads are rules• Combinations of rules

are criteria• Treatment is warrented

when criteria are met

Configuration: Second Step

• Create OrderSets for each treatment• Preconfigure each order to eliminate

medication errors or omission• All orders are ready to sign for the end

user

Configuration: Third Step

• Create Best Practice Alerts• Triggered by criteria• Presents the evidence based OrderSet for

the required treatment

Configuration: Fourth Step

• Incorporate the rules in the preoperative screening form

• Use scripting to show follow-up questions only when needed

• Add other smart stuff

Configuration: Fifth Step

• Document everything automatically• Organize the information logically• Be specific and to the point

Live Demonstration