The present and future medicolegal importance of record keeping in anesthesia and intensive care: the case for automation.

The anesthesia record is often crucial to successful defense in a meritless claim, because the adversarial role of the plaintiff's medical expert witness requires an attack on the record. Likewise the record may be pivotal in determining whether a defense should even be mounted as an alternative to an early settlement, because the failure of meaningful, supportive, or exculpatory documentation raises serious questions about the quality of care rendered. Advancing technology has made possible revolutionary changes in real-time monitoring and data recording. Concepts favoring the development and adoption of automated record systems for anesthesia are outlined through historic medicolegal perspectives on record keeping in general and computerization of the monitoring and recording methods in specific as a means of providing the best medicolegal evidence in defense of the anesthesiologist's performance. The analogy is often made between the successful development and acceptance of the flight data recorder and cockpit voice recorder combination in aviation and ongoing software development for automated recordkeeping and the quest for its use and professional acceptance in both anesthesia and intensive care settings.