Lubarsky D A, Sanderson I C, Gilbert W C, King K P, Ginsberg B, Dear G L, Coleman R L, Pafford T D, Reves J G
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Anesthesiology. 1997 May;86(5):1161-9. doi: 10.1097/00000542-199705000-00020.
Medical informatics provide a new way to evaluate the practice of medicine. Anesthesia automated record keepers have introduced anesthesiologists to computerized medical records. To derive useful information from the stored data requires programming that is not currently commercially available. The authors describe how they custom-programmed an automated record keeper's database to perform cost calculations, how they validated the programming, and how they used the data in a successful pharmaceutical cost-containment program.
The Arkive (San Diego, CA) automated record keeper database was programmed at Duke University Medical Center as an independent noncommercial project to calculate costs according to standard formulae and to follow adherence to Duke University Department of Anesthesiology's prescribing guidelines for anesthetic drugs. Validation of that programming (including analysis of discarded drugs) was accomplished by comparing database calculated costs with actual pharmacy distribution of drugs during a 1-month period.
Validation data demonstrated a 99% accuracy rate for total costs of the drugs studied (atracurium, vecuronium, rocuronium, propofol, midazolam, fentanyl, and isoflurane). The study drugs represented approximately 67% of all drug costs for the period studied.
Programming of an anesthesia automated record keeper's database yields essential information for management of an anesthetic practice. Accurate economic evaluation of anesthetic drug use is now possible. In the future, as definitive identification of best anesthetic practices that yield optimal patient outcomes and higher measures of patient satisfaction is pursued, large numbers of patients should be studied. This is only possible through database analysis and complete computerization of the perioperative medical record.
医学信息学为评估医疗实践提供了一种新方法。麻醉自动记录系统已将麻醉医生引入计算机化医疗记录领域。要从存储的数据中获取有用信息，需要进行当前市面上尚无的编程。作者描述了他们如何对自动记录系统的数据库进行定制编程以进行成本计算，如何验证该编程，以及如何在一个成功的药品成本控制项目中使用这些数据。
在杜克大学医学中心，将Arkive（加利福尼亚州圣地亚哥）自动记录系统的数据库作为一个独立的非商业项目进行编程，以便根据标准公式计算成本，并跟踪是否遵守杜克大学麻醉学系的麻醉药物处方指南。通过比较数据库计算的成本与1个月期间实际药房药品分发情况，对该编程进行验证（包括对废弃药物的分析）。
验证数据表明，所研究药物（阿曲库铵、维库溴铵、罗库溴铵、丙泊酚、咪达唑仑、芬太尼和异氟烷）的总成本准确率为99%。在所研究期间，这些研究药物约占所有药物成本的67%。
对麻醉自动记录系统的数据库进行编程可为麻醉实践管理提供重要信息。现在可以对麻醉药物的使用进行准确的经济评估。未来，在追求明确确定能产生最佳患者预后和更高患者满意度指标的最佳麻醉实践时，应研究大量患者。这只有通过数据库分析和围手术期医疗记录的完全计算机化才能实现。
