Gordon L. Gibby

Availability of Records in an Outpatient Preanesthetic Evaluation Clinic

Objective. Despite efforts to develop electronic access to medical records, there are few data on availability of past evaluations. Typical analyses assess only availability of paper charts. We studied the availability of prior internal and external medical documentation in the preanesthetic clinic of our tertiary teaching institution, which has had access to hospital-wide electronic records for five years. Methods. Residents and clerks answered questions on availability of desired pre-existing records either in a physical chart delivered to our clinic by computer terminal, at the start of the physician interview, and on later success in obtaining desired records not available at start of interview. Patient interview lengths were calculated. Results. 397 responses from 19-9-96 through 25-10-96 were available after 718 patient encounters. The surgeons history & physical was unavailable in 11%. For 114/397 patients (29%) the anesthesiologist desired more pre-existing information than was available in either paper or electronic format. For 32/397 patients (8%), the desired information resided outside the institution (“MISSING EXTERNAL”); for 89/397 (22%), it was within the institution (“MISSING INTERNAL”). Additional information was desired for 41% of ASA 3/4 patients, and for 23% of ASA 1/2 patients. Some or all of desired information was not found for 45% of MISSING INTERNAL, and for 78% (p = 0.12 NS) of MISSING EXTERNAL. MISSING EXTERNAL of any ASA status required significantly longer evaluations (70 ± 39 min) than even ASA 3/4 patients missing no information (51.4 ± 35.7 min, p 0.03). The surgeries of only eight patients (2%) were postponed in the preanesthetic evaluation clinic; half of the postponements were to obtain pre-existing records. Conclusions. Anesthesiologists retrieved, and added to the perioperative evaluation, information from previous encounters for 16% of patients. Despite our hospital-wide electronic records, internal information was missing for 22% of patients. Uneven deployment, and reliance on transcription may contribute to failures. A national electronic medical records system would benefit the 8% (one out of twelve) of outpatients missing external records identified in this study. For many patients, optimal medical understanding was not achieved during the planned preanesthetic evaluation.

Applications of Cross-correlation Techniques to the Quantitation of Wall Motion in Short-axis Two-dimensional Echocardiographic Images

Echocardiography is now a mainstay in the diagnosis of cardiovascular disease. Rapid methods for quantitation of the images would provide an effective tool for the diagnosis of change in left ventricular function. The purpose of this article is to show the feasibility of using the cross-correlation technique to quantify change in left ventricular function over time in two-dimensional short-axis echocardiographic images. Radial histograms of radial distance versus the number of probable specular targets are formed in eight sectors on each frame during the cardiac cycle. These histograms are then shifted to a position of best correlation. The number of radial bins through which the histograms at end systole are shifted to correlate with those of the frame at end diastole defines the regional motion. The methods are described and preliminary findings are presented.

The Internet and Electronic Transmission of Medical Records

Objective. To review, from a legal perspective, the potential for using the Internet for inter-institutional transfer of patient medical records. Methods. Basic issues and recent legislation that relate to protection of both medical data, and those transferring that data over public network systems is reviewed. Results. Many laws already in existence can be applied to Internet transmission, but questions of jurisdiction remain. Providing signatures on requests for information, which are in essence contracts, is a problem. Signatures must both prove the identity of the participants and provide for non-repudiation of the agreement. Cryptographic digital signatures appear secure and effective, but their use is difficult to implement. Simpler methods are fraught with risks, yet are more easily accomplished. The patients rights of privacy must be balanced against the need for access by government, physician, or healthcare institutions to confidential information. In general, information holders must put forth reasonable efforts to keep information confidential. The development of acknowledged standards will provide guidance. Multiple laws provide some deterrence and hence some reassurance to healthcare institutions, for example, by criminalizing acts of electronic interception of patient records in transit. Conclusion. Some believe the expense of secure transfer of medical records by electronic means is a major obstacle; this is false: such transfers are now technologically quite easy. The greatest obstacle to electronic transfer of medical records at this point is the development of workable standards for signing agreements and protecting transmissions, but the perceived advantages will likely drive the necessary developments.

The efficiency of preoperative evaluation: a comparison of computerized and paper recording systems

Objective. We designed and implemented a preoperative evaluation record system with seven networked computers for use by physicians and other medical staff. This study compared the efficiency of the new computerized system with that of the paper system.Methods. We reviewed data from preoperative evaluations completed from November 1990 through December 1992. Data were analyzed automatically (Borland C program) for two intervals: (1) the waiting period, defined as the time the patient entered the waiting room until he or she entered the examination room; and (2) the examination period, defined as the time the patient entered the examination room until an evaluation form was printed. Data were obtained for 2,511 evaluations on paper and 8,342 by computer.Results. The average waiting period with the paper system was 56.1 ± 44.8 min; the average waiting period with the computerized system was 59.1 ± 47.0 min. The average examination period was nearly identical for both systems: 27.5 ± 23.6 min for the paper system; 28.5 ± 22.7 min for the computerized system.Conclusion. The computerized system required no more examination time than the manual system. In addition, we speculate that time is saved at other points of patient care by the legible, instantly retrievable preoperative evaluations that the computerized system produces.RésuméObjectif. Nous avons organisé un systéme enregistreur de l’évaluation préopératoire à l’aide d’un réseau de sept ordinateurs au service des médecins et d’autre personnel médical. Cette étude compare l’efficacité de ce systéme d’enregistrement par ordinateur au systéme d’enregistrement sur papier (manuscript).Méthodes. Nous avons revu les données des évaluations préopératoires effectuées entre novembre 1990 à décembre 1992. Parmis ces données, deux intervalles furent analysés (programme Borland C): 1. la période d’attente, définie comme le laps de temps entre l’entrée du malade en salle d’attente et son entrée dans la salle d’examen; et 2. la période d’examen, définie comme le laps de temps entre l’entrée du malade dans la salle d’examen et la reproduction du document d’évaluation préopératoire. Les données de 2.511 enregistrements manuscripts et de 8.342 enregistrements par ordinateur furent obtenus.Résultats. Pour le systéme manuscript, la période d’attente moyenne fut de 56,1 ± 44,8 minutes et de 59,1 ± 47 minutes pour le systéme par ordinateur. La période d’examen moyenne fut quasi identique pour les deux systemes: 27,5 ± 23.6 minutes pour le systéme manuscript contre 28.5 ± 22,7 minutes pour le systéme par ordinateur.Conclusion. Comparé au systéme manuscript, l’enregistrement par ordinateur ne prolonge pas le temps d’examen. Nous spéculons qu’un gain de temps peut se faire à d’autres étapes des soins médicaux grâce à la disponibilité d’évaluations préopératoires lisibles, délivrées instantanément par ordinateur.AbstractZiel. Ein System für die Dokumentation der präoperativen Patientenuntersuchung (Prämedikation) zur Verwendung durch ärztliches und sonstiges medizinisches Personal wurde entworfen und implementiert basierend auf 7 vernetzten Computern. Inhalt dieser Studie ist ein Vergleich der Effizienz des neuen Computer-gestützten Systems mit dem früheren Papier—gestützten manuellen System.Methoden. Wir untersuchten Datenmaterial aus Prämedikationsprotokollen des Zeitraums von November 1990 bis Dezember 1992. Die Daten wurden bezüglich zweier Zeitdauern automatisiert analysiert (mittels eines Borland C Programms): 1.) die Wartezeit der Patienten, gegeben durch den Zeitpunkt des Eintritts in den Warteraum bis zum Eintritt in das Untersuchungszimmer und 2.) die Untersuchungszeit, gegeben durch den Eintritt in das Untersuchungszimmer bis zum Ausdruck des kompletten Prämedikationsprotokolls. Das Datenmaterial umfa\t 2,511 Papier- und 8,342 Computer-gestützte Untersuchungsprotokolle.Ergebnisse. Die durchschnittliche Wartezeit betrug (56.1 ± 44.8) min. beim Papier-gestützten System und (59.1 ± 47.0) min. beim Computer-gestützten System. Die mittlere Untersuchungszeit war in beiden Fällen nahezu gleich: (27.5 ± 23.6) min. für das Papier- und (28.5 min ± 22.7) min. für das Computer-gestützte System.Folgerungen. Präoperative Untersuchungen, bei denen die Dokumentation mittels des Computer-gesützten Systems erfolgte, benötigten nicht mehr Zeit als solche bei denen manuell dokumentiert wurde. Wir vermuten, da\ aufgrund der Leserlichkeit und sofortigen Verfügbarkeit der vom System erstellten Prämedikationsprotokolle, an anderen Stellen in der Patientenversorgung Zeit eingespart wird.ResumenObjetivo. Disenamos e implementamos un sistema de registro de evaluatión preoperatoria con siete computadores conectados para ser usado por médicos y otro personal clínico. Este estudio comparó la eficiencia del nuevo sistema computerizado con la del sistema basado en registro en papel.Métodos. Revisamos informatión referente a evaluaciones preoperatorias completadas entre noviembre 1990 y diciembre 1992. La informatión fue analizada automaticamente (Programa en C, Borland) para dos intervalos: 1. El período de espera, definido como el tiempo entre la entrada del paciente a la sala de espera hasta que el o ella ingresó a la sala de examen, y 2. El período de examen, definido como el tiempo entre el ingreso del paciente a la sala de examen hasta que se imprimió el formulario de evaluatión. Se obtuvo informatión referente a 2,511 evaluaciones en papel y 8,342 efectuadas con computador.Resultados. El periodo de espera promedio con el sistema basado en papel fue 56.1 ± 44.8 minutos y con el sistema computerizado 59.1 ± 47 minutos. El período de examen promedio fue aproximademente identico para ambos sistemas: 27.5 ± 23.6 minutos para el sistema basado en papel y 28.5 ± 22.7 para el sistema computarizado.Conclusión. El sistema computarizado no requirió más tiempo de examen que el sistema manual. Especulamos que, en otros momentos del cuidado del paciente, el sistema computarizado pudiera resultar en ahorro de tiempo, debido a mejor legibilidad y recuperatión instantánea de las evaluaciones preoperatorias.

Computerized Pre-Anesthetic Evaluation Results in Additional Abstracted Comorbidity Diagnoses

ObjectiveTo study the impact of information from a physician-entry computerized preanesthetic evaluation system on the coding of International Classification of Diseases (ICD-9-CM) diagnoses and on hospital reimbursement due to alterations in diagnosis-related group (DRG) codes.MethodsNonrandomized, unblinded trial conducted at a 570-bed university tertiary care hospital. First without and then with reference to information contained on computer-based preanesthetic evaluation reports, medical charts were coded by the study institutions usual professional coders for ICD-9-CM discharge diagnoses and DRG assignment.ResultsFor 22 of 180 charts studied (12%, 95% confidence limits 7.4% to 16.7%), at least one ICD-9-CM diagnosis was added. Three of 84 DRG-based reimbursements were altered, increasing hospital reimbursement by 1.5%.ConclusionsSupplemental information from a physician-entered, problem-oriented, computerized preanesthetic evaluation system improved discovery of diagnoses in the population studied.

A Method for Evaluation of Enhancement Operations in Two-dimensional Echocardiographic Images

A means of estimating the degree of enhancement of structure and suppression of background noise in filtered two-dimensional echocardiographic images is described. The method is termed the peak-to-background ratio. To test the method, two-dimensional short-axis echocardiographic images were enhanced with Laplacian operations of increasing mask size. There was excellent correlation between the calculated peak-to-background ratio and the subjective opinion of trained echocardiographers. Furthermore, radial length measurements made from images that were thought to be optimally enhanced by the peak-to-background ratio calculation showed the lowest interobserver mean differences. We conclude that the peak-to-background ratio does reflect improvement in characteristics of the image that favor more precise measurement (amplification of peaks and suppression of background) and can be used to help guide a dynamic approach to image processing.

Computer-assisted Doppler monitoring to enhance detection of air emboli

Currently, two of the most sensitive clinical approaches commonly used to monitor for venous air embolism, i.e., precordial Doppler audio and capnography, require the attention of the anesthesiologists eye or ear, which is a distraction from other aspects of care. To assess the feasibility of allowing the computer to relieve the necessity for continuous human monitoring, we developed a computer algorithm for monitoring the precordial Doppler audio. This algorithm extracted (1) the amplitude of certain higher-frequency components of the Doppler audio, (2) a measure of the average value of the envelope of Doppler audio, and (3) the ratio between the average value of the Doppler envelope and the amount of envelope signal variation at heart rate frequency and its multiples. These three features were monitored by an adaptive pattern recognition algorithm that compared each new value for each feature with the previously developed mean and standard deviation for that feature. If the changes in the three features exceeded a detection threshold, an alarm (indicating suspected air embolism) was activated. Implemented as a prototype system, the algorithm was given preliminary testing in 2 dogs and activated alarms at levels of air well below those reported to cause clinically significant hemodynamic changes in dogs. While decreasing the distraction for the anesthesiologist, this early prototype alarm system alerts its user to the need for analysis of the Doppler signals when it senses an air embolus.

Real-time automated computerized detection of venous air emboli in dogs

Objective. My objective was to develop a real-time pattern recognition system to monitor the precordial Doppler and end-tidal CO2 for characteristic changes of venous air emboli. The system also must check the adequacy of the input signals, to allow for unattended operation. The sensitivity of the precordial Doppler monitoring of the resulting system was the focus of this study.Methods. The computerized system electronically sampled systolic sounds, the amplitude envelope of Doppler pulsations, and, optionally, end-tidal CO2. Features were defined and calculated from the samples, the means and standard deviations of which were also calculated. During real-time test administrations of intravenous air in anesthetized dogs, each new sample was compared with previous statistics and, when parameters changed beyond calculated limits, an alarm was activated.Results. The sensitivity of the on-line system to an intravenous air injection of 0.025 ml/kg was 33%; to 0.05 ml/kg, 73%; to 0.1 ml/kg, 90%; and to 0.2 ml/kg, 100%. A confounding factor, air lodging in the veins, was detected in the smaller injections; when this was corrected, the sensitivity of the system improved beyond these results.Conclusion. An on-line, real-time system, developed for continuous observation of precordial Doppler, has a sensitivity comparable to human observers. This system may improve clinical monitoring particularly in situations where the occurrence of a venous air embolism is not a high probability and, therefore, monitoring is not currently used because of its requirement for human observation. Systems such as the one described may allow many more patients to be monitored for the complication. Ziel. Mein Ziel war, ein Echtzeitsystem zur Mustererkennung zu entwickeln, welches präkordiale Dopplerund endexspiratorische CO2-Signale aufcharakteristische Veränderungen durch venöse Luftembolie überwacht. Das System muß auch die Güte der Eingangssignale prüfen, um Fehlfunktionen zu berücksichtigen. Die Sensitivität des präkordialen Doppler-Monitors des Systems stand im Mittelpunkt dieser Studie.Methoden. Das EDV-gestützte System sammelte elektronisch die systolischen Töne, die Amplitudenhüllkurve der Dopplerpulsation und auch das endexspiratorische CO2. Kenngrößen wurden definiert und anhand der Meßwerte berechnet, Mittelwerte und Standardabweichungen wurden ebenfalls berechnet. Während der Echtzeiterprobung durch intravenöse Luftapplikation bei narkotisierten Hunden wurde jede neue Meßprobe mit vorhergehenden Statistiken verglichen und, falls Parameter über berechnete Grenzen stiegen, wurde ein Alarm ausgelöst.Ergebnisse. Die Sensitivität des Echtzeitsystems betrug bezüglich einer Luftembolie bei 0,025 ccm/kg 33%, bei 0,05 ccm/kg 73%, bei 0,1 ccm/kg 90% und bei 0,2 ccm/kg 100%. Ein Vermengungsfaktor, Festsetzen von Luft in den Venen, wurde bei kleineren Injektionen beobachtet; nach entsprechender Korrektur übertraf die Sensitivität obige Ergebnisse.Schlußflogerung. Ein Online-Echtzeitsystem, entwickelt für die kontinuierliche Überwachung des präkordialen Doppler-Signals, hat eine der Überwachung durch einen Beobachter vergleichbare Sensitivität. Dieses System kann klinische Überwachung insbesondere in Situationen verbessern, in denen das Auftreten venöser Luftembolie nicht sehr wahrscheinlich ist und deshalb derzeit aufgrund der Notwendigkeit der Überwachung durch einen Beobachter auf eine solche Überwachung verzichtet wird. Systeme wie das beschriebene können die Überwachung im Hinblick auf diese Komplikation bei einer viel größeren Anzahl von Patienten ermöglichen. Objetivo. Mi objetivo fue desarrollar un sistema de reconocimiento de patrones, capaz de monitorizar Doppler precordial y CO2 de fin de espiración en tiempo real, con el fin de detectar cambios caracteríisticos de embolia aérea venosa. El sistema debe también verificar la calidad de las señales de entrada, para hacer posible su operación no supervisada. Este estudio fue enfocado hacia la determinación de sensibilidad de la monitorización de Doppler precordial mediante este sistema.Métodos. El sistema computarizado obtiene en forma electrónica muestras de los sonidos sistólicos, de la envolvente de la amplitud de las pulsaciones del Doppler, y del CO2 de final de espiración. Las características fueron definidas y calculadas a partir de las muestras, cuyos promedios y desviaciones estándar fueron tambièn calculadas. Durante pruebas en tiempo real de administración de aire intravenoso a perros, cada nueva muestra fue comparada con las estadísticas previas y, cuando los par%ametros variaron más allá de los límites calculados, se activó una alarma.Resultados. La sensibilidad del sistema en línea para inyección intravenosa de 0.025 cc/kg de aire fue 33%; para 0.05 cc/kg, 73%; para 0.1 cc/kg, 90%; y para 0.2 cc/kg, 100%. Con las inyecciones más pequeñas se detectó un factor confundente causado por aire alojado en las venas; al corregir este error, los resultados mejoraron más allá de lo aquí reportado.Conclusión. Un sistema en línea trabajando en tiempo real, desarrollado para observación permanente de Doppler precordial, posee sensibilidad comparable a observadores humanos. Este sistema puede mejorar la monitorización clínica, particularmente en situaciones donde la existencia de una embolia venosa de aire no tiene una probabilidad alta y, por lo tanto, no se usa monitorización en razón del requerimiento de observador humano. Sistemas similares al descrito pueden permitir que más pacientes sean monitorizados para detectar esta complicación.Objective. My objective was to develop a real-time pattern recognition system to monitor the precordial Doppler and end-tidal CO2 for characteristic changes of venous air emboli. The system also must check the adequacy of the input signals, to allow for unattended operation. The sensitivity of the precordial Doppler monitoring of the resulting system was the focus of this study.Methods. The computerized system electronically sampled systolic sounds, the amplitude envelope of Doppler pulsations, and, optionally, end-tidal CO2. Features were defined and calculated from the samples, the means and standard deviations of which were also calculated. During real-time test administrations of intravenous air in anesthetized dogs, each new sample was compared with previous statistics and, when parameters changed beyond calculated limits, an alarm was activated.Results. The sensitivity of the on-line system to an intravenous air injection of 0.025 ml/kg was 33%; to 0.05 ml/kg, 73%; to 0.1 ml/kg, 90%; and to 0.2 ml/kg, 100%. A confounding factor, air lodging in the veins, was detected in the smaller injections; when this was corrected, the sensitivity of the system improved beyond these results.Conclusion. An on-line, real-time system, developed for continuous observation of precordial Doppler, has a sensitivity comparable to human observers. This system may improve clinical monitoring particularly in situations where the occurrence of a venous air embolism is not a high probability and, therefore, monitoring is not currently used because of its requirement for human observation. Systems such as the one described may allow many more patients to be monitored for the complication.AbstrakZiel. Mein Ziel war, ein Echtzeitsystem zur Mustererkennung zu entwickeln, welches präkordiale Dopplerund endexspiratorische CO2-Signale aufcharakteristische Veränderungen durch venöse Luftembolie überwacht. Das System muß auch die Güte der Eingangssignale prüfen, um Fehlfunktionen zu berücksichtigen. Die Sensitivität des präkordialen Doppler-Monitors des Systems stand im Mittelpunkt dieser Studie.Methoden. Das EDV-gestützte System sammelte elektronisch die systolischen Töne, die Amplitudenhüllkurve der Dopplerpulsation und auch das endexspiratorische CO2. Kenngrößen wurden definiert und anhand der Meßwerte berechnet, Mittelwerte und Standardabweichungen wurden ebenfalls berechnet. Während der Echtzeiterprobung durch intravenöse Luftapplikation bei narkotisierten Hunden wurde jede neue Meßprobe mit vorhergehenden Statistiken verglichen und, falls Parameter über berechnete Grenzen stiegen, wurde ein Alarm ausgelöst.Ergebnisse. Die Sensitivität des Echtzeitsystems betrug bezüglich einer Luftembolie bei 0,025 ccm/kg 33%, bei 0,05 ccm/kg 73%, bei 0,1 ccm/kg 90% und bei 0,2 ccm/kg 100%. Ein Vermengungsfaktor, Festsetzen von Luft in den Venen, wurde bei kleineren Injektionen beobachtet; nach entsprechender Korrektur übertraf die Sensitivität obige Ergebnisse.Schlußflogerung. Ein Online-Echtzeitsystem, entwickelt für die kontinuierliche Überwachung des präkordialen Doppler-Signals, hat eine der Überwachung durch einen Beobachter vergleichbare Sensitivität. Dieses System kann klinische Überwachung insbesondere in Situationen verbessern, in denen das Auftreten venöser Luftembolie nicht sehr wahrscheinlich ist und deshalb derzeit aufgrund der Notwendigkeit der Überwachung durch einen Beobachter auf eine solche Überwachung verzichtet wird. Systeme wie das beschriebene können die Überwachung im Hinblick auf diese Komplikation bei einer viel größeren Anzahl von Patienten ermöglichen.ResumenObjetivo. Mi objetivo fue desarrollar un sistema de reconocimiento de patrones, capaz de monitorizar Doppler precordial y CO2 de fin de espiración en tiempo real, con el fin de detectar cambios caracteríisticos de embolia aérea venosa. El sistema debe también verificar la calidad de las señales de entrada, para hacer posible su operación no supervisada. Este estudio fue enfocado hacia la determinación de sensibilidad de la monitorización de Doppler precordial mediante este sistema.Métodos. El sistema computarizado obtiene en forma electrónica muestras de los sonidos sistólicos, de la envolvente de la amplitud de las pulsaciones del Doppler, y del CO2 de final de espiración. Las características fueron definidas y calculadas a partir de las muestras, cuyos promedios y desviaciones estándar fueron tambièn calculadas. Durante pruebas en tiempo real de administración de aire intravenoso a perros, cada nueva muestra fue comparada con las estadísticas previas y, cuando los par%ametros variaron más allá de los límites calculados, se activó una alarma.Resultados. La sensibilidad del sistema en línea para inyección intravenosa de 0.025 cc/kg de aire fue 33%; para 0.05 cc/kg, 73%; para 0.1 cc/kg, 90%; y para 0.2 cc/kg, 100%. Con las inyecciones más pequeñas se detectó un factor confundente causado por aire alojado en las venas; al corregir este error, los resultados mejoraron más allá de lo aquí reportado.Conclusión. Un sistema en línea trabajando en tiempo real, desarrollado para observación permanente de Doppler precordial, posee sensibilidad comparable a observadores humanos. Este sistema puede mejorar la monitorización clínica, particularmente en situaciones donde la existencia de una embolia venosa de aire no tiene una probabilidad alta y, por lo tanto, no se usa monitorización en razón del requerimiento de observador humano. Sistemas similares al descrito pueden permitir que más pacientes sean monitorizados para detectar esta complicación.

Use of data from a hospital online medical records system by physicians during preanesthetic evaluation.

Objective. There is no data on the use of hospital-wide online edical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinics computer system, and how much data was copied.Methods. In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period. The software allowed the user to search the OLMR system by patient name, retrieve a text listing of the patients record, and then copy and paste desired information into the forms of the preanesthetic system. Using embedded routines, we recorded how many times physicians searched for and retrieved medical records from the hospital OLMR database, as well as how many times they copied data to the preoperative database. As a measure of howmuch data was copied, the number of characters was also recorded.Results. Of 1,080 patients evaluated in the clinic during the study period, electronic searches of the hospital OLMR database for 221 patients (20.5%) were noted. Of these searches, 208 (94.1%, or 19.3% of 1,080 patients) successfullyretrieved data from the patients record. Data wascopied for 170 patients — 81.7% of the successful searches. Of 7,525,153 characters retrieved, 262,269 were copied — an average of 1,543 characters per instance of copying.Conclusion. We conclude that anesthesiologists, given even crude graphical access to a hospital OLMR database, will retrieve and copy data, potentially increasing the accuracy of the medical records and saving time.

13 Pre-anaesthetic evaluation

Pre-anaesthetic evaluation serves the purposes of maximizing both anaesthetic safety and efficiency of healthcare delivery. With the advent of outpatient care, the pre-anaesthetic evaluation clinic has become common. In the emerging American model, computerized records speed the gathering of patient records and the assessment of patient condition. Physician entry of patient evaluation is moving from dictation to direct physician entry, which will accelerate as handwriting and voice recognition systems mature. Purchasers of such systems should consider the security of the system, including authentication, authorization, encryption and storage systems utilized.