Brian Woods, M.D., chief medical officer at NorthStar Anesthesia P.A., says that it might come as a surprise to many executives that anesthesiologists work in care settings beyond the operating room. "The impression seems to be that we spend our entire day under the big lights of the OR, but that couldn't be more wrong. We're all over the place, and what we're doing is the 'quick and messy' kind of clinical documentation-anesthesiologists are in the room for a few minutes and then we're off to another department."
As a result, automation has nearly passed anesthesiologists by-few medical facilities have been able to develop information systems that can keep up with the specialists, and the few that have, have done so at enormous cost, Woods says. In NorthStar Anesthesia's case, the practice works with 43 different facilities, and to get them all in agreement on how to meld anesthesia documentation into their EHRs-if they had one-was an uphill climb, to put it mildly. "I spent four years hunting for a system, but I didn't have much to show for it," he says.
But that didn't stop him from looking, since he knew that working with pen and paper was a clinically and financially risky way to do business. "Even the sexiest and most advanced automation tools require us to deal with a user interface when we're spending less than six minutes on average in a room and having to run all over the place-to the cath labs, MRI suites, endoscopy, you name it," says Woods, who spent seven years of his career in the Air Force, where he served as chief of aerospace medicine and flight surgeon for the 28th Bomb Squadron.
Unable to force the issue of automation, Woods found another solution-combining a pen and paper workflow with digital automation using technology tools from Shareable Ink. The documentation system, called StarScribe, utilizes "digital" paper and specialized pens that enable users to write on printed forms and have all that information converted to electronic data.
The paper is standard printer paper with microscopic patterns of dots printed on each using a laser printer. A pen outfitted with an infrared camera records the coordinates of each pen stroke. The pattern of dots is unique to each documentation form. NorthStar Anesthesia has 13 different documentation forms it stacks in the most common clinical areas its anesthesiologists work in.
After a user fills out the form, they dock their pen by putting it in a cradle attached to a network-connected PC, or by triggering a wireless transmission through a Bluetooth-enabled device. Shareable Ink's servers interpret the handwriting, converting it to digital text. NorthStar's client sites interface the data into their electronic systems in various ways, Woods says, or just use the printed form as documentation.
"The beauty of it is that we can meet them wherever they want in terms of data exchange-we can integrate directly with their hospital information system, interface with an EHR, or even hand them a piece of paper," Woods says.
In addition, that documentation data is all stored and analyzed by Woods and others at NorthStar for adherence to quality and efficiency metrics established by the practice, as well as those required for the CMS Surgical Care Improvement Project (SCIP).
"We were able to improve our clinical practices significantly with minimal disruption to our workflows and the I.T. infrastructures of our clients," Woods says. "It's truly a case where everybody wins."