Electronic medical records that transfer digital data to printed charts are behind the times, says the American Society of Anesthesiologists.

Anesthesia information management systems (AIMS) can collect vital-signs data and collate patient information faster, better and more comprehensively than any provider could hope to do using paper records, write the authors of an ASA-issued white paper aimed at guiding providers who want to add the technology to their practices.

The white paper points out that AIMS result in reduced anesthetic-related drug costs, improved staff scheduling (and reduced staffing costs), increased anesthesia billing and capture of drug-related charges, and increased reimbursement through improved coding.

Regardless of how individual anesthesiologists feel about adopting the technology, notes the paper, the reality is that the government has stepped in and required its use by eligible professionals and hospitals within the next 5 years.

ASA President-Elect Jerry Cohen, MD, believes the healthcare industry is "near the convergence of capacity, technology, and necessity to mandate the widespread adoption of meaningful electronic records, including AIMS."

He suggests AIMS can become the foundation for data-based decision-making that drives quality improvement, better outcomes, greater efficiency, science-based practice guidelines, public policy and cost containment. "It is time to move forward," he says, "while our future is still in our hands."

Daniel Cook

Spurred on by hepatitis outbreaks, safety violations and press coverage of sentinel events in the state's surgical facilities, the Nevada legislature has considered numerous bills promoting healthcare transparency during its 2011 session, which adjourned for a between-session interim period last week.

The Las Vegas Sun recently reviewed the status of the state Senate bills that had passed or which were deemed likely to once the lawmakers reconvene.

How much can a hospital expect to charge for one of the most commonly performed spinal surgeries these days? The answer varies widely, depending on the surgeon performing the single-level anterior cervical discectomy/fusion (1-ADF) and the supplies and instrumentation that surgeon chooses to use, according to a retrospective analysis of 102 surgeries performed at a single hospital.

Total surgical charges, which include operative, instrumentation and supply charges, varied from $11,540 to $53,533 per case among the 15 surgeons who performed the spinal fusion surgery at the hospital in 2008, the study shows. The difference in total hospital charges was even greater at more than $100,000, due in large part to wide variations in inpatient lengths of stay.

"Both the surgeons' choice of instrumentation and the choice of surgeons contributed to the large variations in total hospital charges" for the 102 patients studied, writes lead author Nancy Epstein, MD, of the Albert Einstein College of Medicine in New York and her colleagues in the journal Spine.

Actual charges for the instrumentation used in performing 1-ADF ranged from $4,062 to $40,409. The authors note that "the number of combinations of instrumentation and supplies" from which spine surgeons can choose is "enormous," creating a wide range of associated costs. You must take the rate of complications and outcome measures associated with different equipment into account when performing a cost/benefit analysis of instruments and supplies, they write, but "the published data suggests that using more expensive combinations... would not necessarily reduce costs."

Hospital charges also vary widely from surgeon to surgeon, with one of the 6 higher volume surgeons studied far outpacing the other 5 in total hospital charges for his 1-ADF patients. Based on these findings, the researchers conclude that "spine surgeons can take proactive steps to reduce the total hospital charges associated with 1-ADF."

Irene Tsikitas

In recent years the number of surgical facilties has skyrocketed, while the number of surgeons has remained relatively stable. Given those facts, you could easily imagine that the ratio of surgeons to surgical facilities would be shrinking. Help us find out. Tell us how many surgeons are credentialed at your facility in this week's InstaPoll. Check back here next week for the results.

How do you ensure hand hygiene compliance? For nearly three-fourths (73%) of the 106 respondents to last week's poll, it's direct observation. Another 16% use a combination of measures, including observation, tallying used bottles of hand gel and employing hand hygiene monitoring equipment. But 8% don't measure compliance.

Dan O'Connor