‘If you use e-mail, you can use a data management system’

Seeing past the challenges of going paperless

JUNE 2007

The early adopters of perfusion data management systems have embraced the opportunity to use new technology to improve their practice and elevate their profession. Other perfusionists are less enthusiastic about introducing new technology in their O.R.’s; they’re concerned about loss of control, distraction from patient care and the extra work that might be needed.

Lance Fristoe, CCP, Chief of Perfusion at Nebraska Methodist Hospital and user of Terumo’s TLink™ Data Management System since its release, admits to being one of the former. But he understands why many perfusionists find the thought of implementing a data management system so challenging.

In a recent interview, he identifies the most frequently cited challenges he’s heard from colleagues and describes his own experience.

Challenge #1:

We have good outcomes. Why should we introduce a change in our protocol that might create stress, pressure and distraction?

Lance: I completely agree that the perfusionist’s primary responsibility is to care for the patient during a case and that changing any protocol can be a potential distraction from that responsibility.

I’d suggest that you evaluate and learn the new data management system on routine cases. Don’t begin with difficult or complex procedures.

Customization was the key for us. We were able to define the system to fit our needs, to mimic our paper record, keeping it familiar and making it easy to use. Once we worked with the system a few days, we found it easy to use and it allowed us to focus on what we needed to the patient and the pump.

Challenge #2:

A data management system with automatic data acquisition might capture an event I wouldn’t want in the pump record.

Lance: First, it is important to know that the TLink system allows you to make changes in the electronic record and enter comments at any time to explain an unusual occurrence.

But also, we’ve been finding that it’s better to have more data in your record than less.

Let’s say the patient’s blood pressure drops to 50mmHg during a case. A perfusionist using a manual record might avoid charting this pressure for fear that the low reading could be associated with an adverse outcome. He ⁄ she would probably try to correct the problem and record the pressure after the blood pressure has risen.

But if they have a system with automatic data acquisition that is set to acquire blood pressure readings every minute, the system may well capture the low reading in the raw data. But that’s not a bad thing – for a few reasons.

First, after you’ve been using electronic records for as little as a few months, and you’ve accumulated a larger set of case data, you’d probably have evidence that 99% of the time a blood pressure of 50 does not result in an adverse outcome.

Second, you can add a comment to the record thereby documenting that you responded to the situation and did your job correctly.

Finally, it’s easier to defend your responses with an electronic record that’s capturing data at frequent intervals, as close to real time as possible, than it is with a record that contains a snapshot taken every 15 minutes. Hand charts with no spikes, high or low, are rarely accurate. And if someone else in the OR, like anesthesia, is also charting blood pressure, your record needs to be accurate and match the others.

Challenge #3:

Using a data management system will take the focus away from the case during the procedure.

Lance: This was only true for us during the evaluation process when we were “double–charting” as part of our validation – entering the data manually while the system was acquiring it automatically. Now we find that we are more focused on the case because the system is doing so much of the work for you.

We do take 10 minutes before each case to enter the case properties (demographic information related to the patient, the case and the procedure – procedure, personnel, equipment, patient info, etc.) but we would do that with a manual record as well.

Challenge #4:

You will have less control over your perfusion record if you use automatic data acquisition.

Lance: This is not true with Terumo’s TLink system. Although the system is designed to automatically collect specific data at time intervals you specify, you have two options that allow you to deviate from the automated collection with the push of a button.

At any moment during the case, whether at a pre–specified time interval or not, you can tell the system to grab the data at that moment by pressing a single button, “Get device data.”

Likewise, you can tell the system to stop collecting data automatically by pressing “Pause.” The system stops collecting the data automatically and you enter it yourself using the virtual (on–screen) keyboard. In essence, you are mimicking a manual data entry process except that you’re not using a clipboard.

Challenge #5:

Working with the hospital administration to change the record policy will add a lot of extra work.

Lance: There is some extra work. We worked with the administrative committee that regulates medical records for our hospital to get our record keeping policy changed. As part of the process we needed to validate the accuracy of the TLink system’s data acquisition functions so we had to double chart every case for a week – about five cases.

But the committee was very supportive, particularly because the features of the TLink system met the hospital’s requirements for record keeping. For instance, the system supports barcode reading and allows us to place the hospital logo on the printouts.

Challenge #6:

You have to be a techno–geek to do a good job of implementing a data management system.

Lance: Not true. It’s easier than you think. If you use e–mail – log in, send, forward, delete a message – you have enough computer skills to implement a data management system.

Challenge #7:

I’d just rather postpone because...

Lance: Going paperless is much easier to roll out when you’re in control rather than waiting until you’re under pressure to implement it quickly. It’s inevitable. It’s only a matter of time. I encourage everyone to try it.