1. 100% Adherence to Guidelines An Expert System for Preoperative Screening

2. Anesthesia? Before the invention of anesthesia surgeons had to be strong and quick Conscious patients endured excruciating pain Alcohol, opium or other botanicals sometimes helped Many patients died during surgery

3. Anesthesiologist? Doctor that keeps the patient alive during surgery Uses evidence based medicine (guidelines) to reduce risks Risk of death from general anesthesia alone is 0,01-0,016% (Lienhart 2006, Arbous 2001) Risk increases with morbidity and the extent of surgery

4. Preoperative Screening? Prior to every surgical procedure under anesthesia 15000 screenings per year Screening: – Identify and optimize relevant medical conditions – Estimate and reduce perioperative risks – Inform the patiënt 10 minutes per screening Needs to be thorough, efficient and smart

5. Epic ® Anesthesia? Module of the Epic ® EMR Configurable by end users Free sharing of build within the worldwide usergroup Epic ® UserWeb as a vehicle to share ideas and solutions With smart configuration we created the expert system that won the Spider Award

6. Problem Definition Numerous extensive guidelines The relevant clinical rules are in there somewhere No time for reading during preoperative screening Results in poor adherence to guidelines

7. Objectives for Configuration Lean screening Automated text generation 100% adherence to guidelines Uniform high standard of care Elimination of medication errors Quality of care reporting Research readiness

8. Configuration: First Step Create flow charts from guidelines Crossroads are rules Combinations of rules are criteria Treatment is warrented when criteria are met

9. Configuration: Second Step Create OrderSets for each treatment Preconfigure each order to eliminate medication errors or omission All orders are ready to sign for the end user

10. Configuration: Third Step Create Best Practice Alerts Triggered by criteria Presents the evidence based OrderSet for the required treatment

11. Configuration: Fourth Step Incorporate the rules in the preoperative screening form Use scripting to show follow-up questions only when needed Add other smart stuff

12. Configuration: Fifth Step Document everything automatically Organize the information logically Be specific and to the point

13. Live Demonstration