CENTRICITY PERIOPERATIVE ANESTHESIA
Oregon Health & Science University, Portland, Oregon
Stephen T. Robinson, MD
Associate Professor of Anesthesiology and Perioperative Medicine
Vice Chair for Finance
Practice environment
 Academic practice
 45 operating rooms at 5
sites plus L&D and Out-of-OR
locations
 Perform 34,000 cases per year
 System used on 80% of cases
 Staff includes 65 faculty,
37 residents, 6 fellows,
and 28 CRNAs
 Staffing includes medical
direction of residents and CRNAs
and some solo practice
System
 General Electric Centricity
Perioperative Anesthesia (CPA)
 Preop Installation: November
2006 replaced Departmentdeveloped preoperative system
 Intraop Installation : November
2007 replaced paper records
EMR and AIM systems
 AIMS Service: Available
throughout the hospital and any
remote terminal; activity used in
all ORs (except MRI rooms), L&D,
preoperative clinic, some Out-ofOR sites
 AIMS Uses: Preoperative
documentation, intraoperative
documentation, postoperative
notes, procedure notes
 AIMS Interfaces: ADT (EPIC);
Scheduling (CPM); laboratory
 EMR vendor: EPIC used by all
providers including nursing for
perioperative documentation
 Use of EPIC by anesthesiologists:
Order entry, chart review including
PACs access, some clinical
documentation
 Relationship between CPA and
EPIC: ADT, cut-and-paste
Under the hood
Lessons learned
 Offsite servers
 Connection via Citrix servers
 Monitor data stream converted
and forwarded by Capsule
Technologies to MDIL to CPA
 Clinical data maintained in a
cluster with one server and one
on standby.
 SQL restore points every 15
minutes
 Tape backup once a day
 Report server updated daily
RFP
 Know why you want an AIMS
 Engage all elements of your
hospital to develop
 Understand both your users‘
needs and what is realistic for
an AIMS to achieve
Site visits
 Look at like organizations
 Use a wide variety of team
members: IT, nursing, etc.
Vendor contract
 Define all hardware,
software, and installation
requirements and costs
 Set specific installation and
performance requirements
and include general
functionality expectations
 Have consequences with
teeth
User training
 Don’t scrimp
 Training the trainers is as
important as the training
itself
Effort involved in purchase,
installation, and maintenance
 Primary Driver: Department
 Secondary Driver: Hospital and IT
 Goals: Convert internal
preoperative record into
commercial product and create
electronic record for more
accurate and searchable records
 Implementation timeline: 8 months
for preoperative go-live; 20 months
for intraoperative go-live
 FTE for implementation: Highly
variable; at peaks Department 3-4,
hospital and IT 2, vendor 2-3
 FTE for maintenance: 2-4 with
primary tasks assigned to 6
individuals and secondary tasks to
others
User interface
Professional billing
 A clean record provides the
greatest benefit to support
billing
 Billing modules offer
incremental value if they work
Benefits of AIMS
 Template for documentation of
a legible record
 Ability to electronically monitor
compliance
 Ability to drive care process
 Ability to look at processes and
outcomes in a large database
Detriments of AIMS
 Requires ongoing support
 Challenging when not working
 Limitations requiring
workarounds