AIS

1
AIS

• Development of an
• anesthetic information system
• VUmc Amsterdam
• H.H. Ros
• N. van Schagen
• K. Gigengack
• A. van Dusseldorp

2
AIS

• Time and Money 1985
• Multichannel data acquisition
• Renewal anesthetic equipment
• Philosophy
• Structure
• Demands
• Implementation
• Demonstration

3
AIS - History

• Separate units for each monitoring function
• High number of single units
• Different Manufacturers
• PDMS not existing or adapted to specific
  hardware
• Total Design systems
• Hardware and Software mutual dependent
• Simple and not structural output (analog / RS232
  )
• Changing setup

4
AIS - History II

• Equipment central in development
• IT development neglected / rejected
• No standardization
• Of software
• Of interfaces

5
AIS History III

• Limited functionality
• Number of signals / parameters
• Methods of sampling fixed
• Information transfer fixed
• All equipment different (interface) protocols

6
AIS History IV

• Alarm strategy not standardized
• Depending the manufacturer
• Systems not flexible
• New development buying new system
• Each OR an own / separate system
• Limited role of the anesthesiologist

7
Situation before development AIS
Patient
Monitor(s)
Anesthetic Equipment
Anesthetics Drugs etc
Display/control
Display/control
Display/controle
Anesthesiologist
Outside World
8
Full disclosure overgang ECG
9
AIS Concepts

• Information System Information Brains
• Efferent stream of data
• Afferent stream of data
• Data acquisition full disclosure
• No discussions about the dataset
• All parameters will be recorded (if possible)
• The chosen filter will display what is needed or
  wanted.
• Processing data in IS independent of recording

10
AIS Concepts II

• Transducers outside IS
• Intelligence in IS
• Feedback to anesthesiologist
• Individual adaptation of alarms, performance of
  IS system subject to users
• Standard human interface

11
AIS Open System Architecture

• Constructed for several hardware platforms
• No dedicated software for communication and data
  acquisition
• Standard commercial software / freeware
• Direct connections to the outside world
• Full disclosure possible
• Plug and Play
• Worldwide standard supported
• Simple maintenance with easy access - standard
  technology
• Automatization considered as a process

12
AIS OUTSIDE WORLD

• Libraries digital support systems
• Laboratories
• Other ORs / wards
• Hospital information system
• Decision support / expert system
• Management support
• Quality assurance
• Medical Audit
• Reports including anesthetic chart
• Research
• Education and training
• Internet etc
• Servers for recorded data.

13
AIS- implementation

• Use of existing hardware
• Use of existing software
• Afferent data acquisition
• Full Disclosure
• No operating of equipment - efferent
• If possible standard available software

14
Situation before development AIS
Patient
Monitor(s)
Anesthetic Equipment
Anesthetics Drugs etc
Display/control
Display/control
Display/controle
Anesthesiologist
Outside World
15
Situation after implementation of the AIS
Patient
Monitor
Anesthestic equipment
Anesthetics, Drugs
Information system
Information system
Display/control
Display/control
Display/control
Anesthesiologist
Communication Outside world
16
Monitor
Anesthetic Equipment
Other recording possibilities Infusion pumps,
ECC, WEB-devices
Outside World Patient ID and data Preoperative
assessment data Pharmacy reference Bloodgasanaly
zer HL7 General terminal web, mail, medicating
system Report generators (web based) Anesthetic
List as web application
Information system AIS
Display and control
Planning, Pharmacy, Waiting list, Clients
Operation Complex, Management, Upload to Hospital
Information System, DB of operations
17
Full disclosure ECG normaal
18
Full Disclosure ECG abnormaal
19
Full Disclosure ECG weer naar normaal