Dr. Eric Fishman, CEO EHRtv interviews Thomas Marsh, Product Manager from McKesson Anesthesia Care.
Dr. Eric Fishman: This is Dr. Eric Fishman with EHRtv, and today we have the pleasure of speaking with Thomas Marsh, Product Manager for McKesson Anesthesia Care. And Thomas, thank you for taking the time today to speak with us.
Dr. Eric Fishman: McKesson obviously a tremendous health information technology company is pervasive throughout the hospital space, and yet McKesson Anesthesia Care is not as well-known as one would expect it to be. I understand there is a tremendous number of new facilities that are coming on board; can you explain the progress over the last five years?
Thomas Marsh:Over the last five years, we’ve contracted with about one-hundred different facilities. We have about a quarter of – fifth to those implemented so far, and a lot more coming on in the next year because we’re not associated with anesthesia machines; we don’t make the anesthesia machines ourselves. We’re a little less known in the industry. People don’t necessarily think of us for that, but the hospitals that have our EMRs obviously think of us that for that. But we do have a mix of hospitals with different EMR systems that we fit in to. We’ve been highly focused on the anesthesia experience, so it was actually developed by an anesthesiologist; so the workflow is very specific to anesthesia. But yet it’s been a bit of a challenge to become well-known in this industry because again, we don’t have the anesthesia machines and we’re just not thought of as an anesthesia company.
Dr. Eric Fishman: And let me address the anesthesiologist humor himself for a moment because obviously there’s a lot of interested parties in the acquisition of an AIMS product. What do the anesthesiologists who are using your software think of it?
Thomas Marsh:The anesthesiologists that use it like it very much. It’s very user friendly.
Dr. Eric Fishman: What do they see its strong points? What do they say what differentiates it from the others?
Thomas Marsh:If they’re using our surgical products and our clinical products, then the integration is very beneficial to them. They can complete their pre-assessment with clinically collected data on the patient assessment, the allergies, the home medications, all of those things, very quickly, save some time on that but it also increase the accuracy of it. For the intra-operative record, its touch screen based application; very fast, very easy to use we have it – even in ambulatory surgery center where they do twenty plus cases a day in one room. And when they’re done with the case, they’re finished with their documentation.
Dr. Eric Fishman: As an orthopedic surgeon, I longed for turnover times like that.
Thomas Marsh:And we also do that. We have extensive analytic so we can really delve into what is causing problems with turnover times. We can look at different milestones, in room to induction, induction to incision, emergent-strata room – things like that so we can really get to the bottom of different situations. We also have an Optional Coding Modules so they can actually code the ICD 9, the CPT, and also get the anesthesia crosswalk for that as well. So when they’re finished with their case, they could actually be done with most of their billing as well. They can document the Comorbid conditions. So we’ve tried to focus on satisfying the anesthesiologist, getting that billing information together, its ease of use, speed of use, but also focusing on the hospital administration as well, giving them a reason for it.
Dr. Eric Fishman: Never mind that, I was going to ask of other interested parties.
Thomas Marsh:So those Comorbid conditions, they affect the hospital. They affect the DRG payment, they can make a big difference in the length of stay; a very big differentiator for that. Also sending those administered medications and things back to our core clinical system, things like that that can help with the medical reconciliation and those kinds of things. So there’s a lot interest in it for the hospital as well. So we’ve really been trying to satisfy both sides.
Dr. Eric Fishman: What about a third interested party; how does it improve patient care?
Thomas Marsh:We do use First Data Bank or actually Multum as well to scan drugs against allergies and existing home medications and other administered medications. We do provide those alerts. You can also build any other kind of alerts that you want based on physiologic states or pre-existing conditions, patient weight, and any other drug class and drug-to-drug interaction, things like that. You can build a lot of different checks into it. You can also – if you do have a reaction, we do use the First Data Bank monographs so that you can find out more about that particular drug if you’re not familiar with it. We have what we call an academic data base; you can actually link to any resource on the net so you can go out and get information about different protocols and medications and things like that as well.
Dr. Eric Fishman: Clinical decision support?
Thomas Marsh:Yeah, you can link to all of that. And then, we also, with our perioperative nursing system, have the hand off of the vital signs; we have pre-operative and post-operative. We also have incorporated the snow-med coding that was developed by the Anesthesia Patient Safety Foundation so we can go back and look at outcomes that have occurred in each case, look at pre-operative case mix, pre-existing conditions, things like that.
Dr. Eric Fishman: Let’s discuss the perioperative period for just a moment. Is it – does it connect to the surgeon’s office, any of the information systems?
Thomas Marsh: It doesn’t connect directly to – again it would depend upon what system they have. They can access certain modules like the pre-assessment piece of it or the post-assessment piece from their offices, and review and add information – depending upon what system they have and what data they could send; it is possible to share some of that data. It depends.
Dr. Eric Fishman: But it does – it would be considered a complete AIMS – and it does all of the hospital based facilities the – you know, pre-operative room, the recovery room, the ICU.
Thomas Marsh:Yes, you can use it in any environment you want; labor and delivery, endoscopy – whatever other – any place that you do anesthesia. You could even use it for pain or anything like that. It really – and you can customize your configurations for those locations as well.
Dr. Eric Fishman: Let’s discuss the anesthesia machines themselves for a moment. You said that since you don’t produce one, that it’s attached to that it’s compatible with all of them. Is that broad compatibility so that essentially any anesthesia machine is compatible?
Thomas Marsh:Yes, we use a third party vendor for that – for the drivers that connect the systems – they’re well known. And actually we’re – we have one that we partnered with mainly, but we can use others as well. So they do have a complete list of drivers for all of these different anesthesia machines. Basically all of them are covered except the very newest ones. And as they – as newer ones come on to the market, then they do build those drivers, work with those new companies to build those new drivers; so it’s universal.
Dr. Eric Fishman: Let’s discuss one more compatibility, which will be the hospital information systems. There are a lot of hospitals that are using McKesson technology, but obviously not all. Is your software, the McKesson Anesthesia Care appropriate for hospitals that are not using the McKesson product?
Thomas Marsh:Yes, we do have – we currently do have hospitals that are on other clinical systems. There are – we have tried to be both integrative with the McKesson products but also available for interfacing with external systems as well. So it’s more of the matter of what data they will send us or what data they will accept from us.
Dr. Eric Fishman: How long does an implementation take generally?
Thomas Marsh:The standard timeline is six months. We give you a lot of the preconfigured information, preformatted notes, and things like that. And you can edit them as much as you like, and customize them as much as you like, so can spend some extra time or less time, and then you can continue to make changes as you go; so it’s very customizable. The standard is six months.
Dr. Eric Fishman: So Thomas, if you could briefly go through the McKesson Anesthesia Care software itself, I would appreciate that.
Thomas Marsh:Okay. We can start with our pre-anesthesia evaluation – again, after using a surgical manager, a lot of this information would be here automatically, but we can receive patient and scheduling information from any system and have that available. You can have lab results come in from any system and have that available as well. And medical history; that can come in from our nursing perioperative system – they can also add information very easily. If they choose to, they can also code these conditions – code them for ICD 9.
Dr. Eric Fishman: And soon ICD 10 I assume?
Thomas Marsh:Yes, we’ll be ICD 10 compliant as well. And at this point, they can screen for any home medications and allergy – allergic reactions against the planned medications for this case as well before they finalize the pre-assessment. This final pre-assessment will be sent to their electronic data imaging system or wherever they’d like that to go. They can go back and reference information or update it any point in time, and even finalize the separate ones. For residents doing one and then a physician would come and do another one later; that’s possible. The system itself; we collect the information directly from the anesthesia machines; they can add any other information they like – the checklist – whichever checklists are appropriate for their procedure. They can very quickly do this. This module is designed to be used for the touch screen so be very fast. They can add any types of notes that they want; preformatted notes is what we call these – so they can have different options within them so very quickly they can put a very customized note on a case and have all the details covered.
Dr. Eric Fishman: How would an anesthesiologist put in unique data? Is it typing? Is there speech recognition?
Thomas Marsh:Free text typing – and we do provide keypads – on screen keypads to put any extra data in. And even within the notes, there can be options to add free text as well. So these can be single choice, multiple choice, etcetera. And they can come back at any time and update this information. They can put the correct time on it if they’re doing it after the fact. They can do multiple notes at the same time; really collect any type of data that they want – the actual case data as well as PQRS data and any other kind of codes – we can collect along with those notes. A block place for post-operative pain – we automatically grab that CPT and put it on the record for them. They can trigger time stamps just with a touch of a finger on the screen. They can deliver medications. They can even deliver the full panel of pre-induction medications with the multiple select and enter all of those at once. And again, if they need to retrospectively time this; they can, and will carry that time stamps for all of those meds. Any medication alerts will show up automatically for them, they can choose to have the pop up which should come up, or they can choose to avoid that and just have it in the banner here so that they never lose the information. All the information is provided in the reports which can be customized to whatever degree they want, and they can pick and choose which reports they want to include in their final record and any information they want to include in their final record. We also have a professional services report where everything is summarized for the professional billing including any coding that they might have done or included in that, and then they can trigger any particular note to show up in this as well that is relevant to the billing company. And do inputs, outputs – really anything that they need to document – even an artifact – a reason – an artifact that has occurred and a reason for that artifact at any point in time. Everything is manageable. Everything is editable. Everything is under their control.
Dr. Eric Fishman: Things certainly have changed in anesthesia record over the last number of years.
Thomas Marsh:Things have been changing very rapidly. It’s still a low adaption but a lot’s been changing. The profession is very demanding; they want a system that does a lot of things. And so few of us have been around long enough to be able to do that. We’ve been really focusing like I said on satisfying the needs of the anesthesiologist, the clinical users, but also the hospital and the facilities. You really can chart anything you like; you can do the post-operative review as well. And when you’re finished with your case, you can actually be finished with your documentation, send that to your billing company and move on to the next.
Dr. Eric Fishman: As it should be done. Thomas I think we’ll be speaking again and I thank you very much.
Thomas Marsh:Sure, thank you.
Dr. Eric Fishman: This is Eric Fishman with EHRtv. We’ve been speaking with Thomas Marsh, Product Manager for McKesson Anesthesia Care. Thank you.