Data Management in Anesthesia and Intensive Care Medicine

The following papers have been presented at the symposium “Data Management in Anesthesia and Intensive Care Medicine”, held at the Castle Rauischholzhausen, May 11th - 12th, 2001. This conference took place in expectation of changes in our health system, characterized by the terms “pressure of expenses” and “expense limitation”. The “Fallpauschalengesetz” was passed by the federal parliament and contains the introduction of a new honorarium system enforcing new levels of quality control at the same time.

The planned introduction of the salary system based on Diagnoses Related Groups in 2003 also puts heavy demands on anesthesia and intensive care medicine [2] [3]. These two specialties are very much under-represented in the German Refined Diagnoses Related Groups (GR-DRGs) [4]. Although 20 % of the hospital expenses are due to intensive care medicine [1], the GR-DRGs take only the terms “tracheotomy” and “duration of ventilation” as relevant factors into consideration. Thus the new honorarium system will lead to internal billing systems. It will be of importance of any department of anesthesia and intensive care medicine to document any work performed within this internal budgeting in order to receive an adequate salary for patient care from the hospital. Therefore, we need excellent documentation tools.

Companies without any information technology (IT) are not successful in today's economic world. Both controlling and quality management are doomed to fail without reliable data. This undeniably influences the competitiveness of any company. Moreover, computer-supported information technologies play an important rolle in the economic decision-making process. In contrast to this, hardly any changes can be found in medical data processing. Until now, manual paper documentation and communication are still the most commonly used methods. In the past, one hardly can find a rationalizing or an economizing of the clinical workplace. Although data from medical processes are extremely complex in their nature, there is reason to believe that in our highly technical and modern medical world we can improve diagnostics, communication and documentation when using modern data processing tools.

The following articles will demonstrate that clinical online workplaces with nearly a complete digital patient chart could not yet be fully established in daily routine, despite the fact that most technical requirements have been met. This is due to departmental politics, organization and financial reasons, as well as characteristics of the various systems used.

The increased need and use of computer-supported systems in our specialty has changed the classical clinical workplace. Using a digital patient chart, we can save all assessed patient data in a central patient file. This new documentation thus allows us to share our medical information and analyses with colleagues - within and beyond our department - using telecommunications software and networked computers. An important effect of introducing IT systems is the new organization of work flow. This allows for expense transparency and homogenizes the clinic in unifying the shared data processed. The requirements for standards as a foundation for quality control are thereby met. Quality is an important argument for legitimacy of certain expenses when dealing with insurance carriers. We need valid and comprehensive data in order to define and defend this argument.

The economic development of anesthesia departments as “service centers” can only be effective when practical and useful data processing and telecommunication systems support the work process. The same applies for competence and practice networks for optimizing, economizing and increasing quality of shared patient care. The development and full-scale implementation of these systems in out-patient and in-house clinical routine is a feature that can only be accomplished through the closer cooperation between clinicians, computer engineers and technicians.

Literatur

• 1 Barckow D. Wirtschaftliche Grenzen in der Intensivmedizin - Können wir uns Intensivmedizin im Jahre 2000 noch leisten?.  Z Ärztl Fortbild Qualitätssich. 2000;  94 828-833
• 2 Clade H. Krankenhäuser: Rahmenbedingungen für Fallpauschalen.  Dt Ärztebl. 2000;  97 A-2816
• 3 Roetman B, Zumtobel V. Klinische Informationssysteme: Strategien zur Einführung.  Dt Ärztebl. 2001;  98:A 892
• 4 Schleppers A. Der Weg von den Australian Refined DRGs zum German Refined DRG-System. Teil 3.  Anästh Intensivmed. 2001;  42 697-698