Provider Access to Legacy Electronic Anesthesia Records Following Implementation of an Electronic Health Record System

  • Richard H. EpsteinEmail author
  • Franklin Dexter
  • Eric S. Schwenk
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


Many hospitals are in the process of replacing their legacy anesthesia information management system (AIMS) with an Electronic Health Record (EHR) system, within which the AIMS is integrated. Using the legacy AIMS security access log table, we studied the extent to which anesthesia providers were accessing historical anesthesia records (January 2006 – March 2017) following implementation of an EHR (April 2017). Statistical analysis was by segmented regression. At the time of implementation of the EHR, in 44.8% (SE = 0.3%) of cases, there was a prior anesthetic record for the patient that had been documented in the legacy AIMS. Following EHR implementation, the mean number of preoperative clinical views of all prior anesthetic records divided by the total number of cases performed decreased to 2.3% (0.3%) from the baseline of 25.1% (0.8%). The estimated ratio of the 2 means was 0.18 (95% CI 0.11 to 0.31, P < 0.00001). For views of unique records, the decrease was to 2.2% (0.3%) from the baseline of 18.3% (0.5%). The estimated ratio was 0.23 (95% CI 0.15 to 0.35, P < 0.00001). These results show that, following conversion to an integrated EHR, providing access to historical anesthesia records by maintaining the legacy AIMS is not an effective strategy to promote review of such records as part of the preoperative evaluation process. Because such records provide important information for many patients, providing linked access to such records within the EHR as part of the patient encounter may be a more effective approach.


Medical record systems, computerized Information technology Process assessment (health care) 


Author’s contribution

Richard H. Epstein helped design the study, perform the statistical analyses, and write the manuscript. Franklin Dexter helped perform the statistical analyses and write the manuscript. Eric S. Schwenk secured approval from the Institutional Review Board and helped write the manuscript.

Compliance with ethical standards

Conflict of interest

The Authors have no conflicts of interest.

Ethical approval

This study was approved by the Thomas Jefferson University institutional review board with waiver of patient consent on November 26, 2018 (Control #18D.053).

Supplementary material

10916_2019_1232_MOESM1_ESM.pdf (434 kb)
ESM 1 (PDF 433 kb)
10916_2019_1232_MOESM2_ESM.pdf (76 kb)
ESM 2 (PDF 76 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Perioperative Medicine & Pain ManagementUniversity of MiamiMiamiUSA
  2. 2.Department of AnesthesiologySidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Division of Management Consulting, Department of AnesthesiaUniversity of IowaIowa CityUSA

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