Letters to the Editor: Letters & Announcements
In Dr. Lane’s letter on my article (1), he writes that the “paper severely constrains our ability to derive meaningful conclusions about AIS and its role in liability reduction and risk management.” I agree that the question of the impact of AIS on malpractice exposure remains open and that the information available from the article is not definitive. Any survey has major sampling limitations and more importantly, the investigator cannot control the quality of the data collected. Dr. Lane does however seem to have misinterpreted some of the information presented in the article that I would like to reiterate.
In the introduction to the article, I described opposing arguments supporting the contentions that AIS increase and decrease malpractice exposure. One of my primary goals in this study was to find evidence supporting either one of these arguments as they have heretofore been based solely on opinion. Unfortunately, evidence from legal precedent could not be identified and the survey was the only instrument for collecting any form of data. Of the departments responding to the survey, there was not one report that the AIS increased malpractice exposure. As I stated in the article, “The results of the survey lend credibility to the argument that AIS help to reduce malpractice exposure.” This conclusion was not intended to be a definitive statement about the role of AIS in malpractice exposure, only an assessment of the evidence collected by the survey.
Dr. Lane also seemed to misinterpret the discussion regarding discoverability of electronic data. This is a very important point that is worthy of clarification. The article clearly states that a high resolution electronic version of the data collected during anesthesia is created by the AIS in addition to the printed version placed in the patient’s medical record. Although I could not find evidence to date that the electronic data has been part of the discovery process, there is no question in my mind that it will be in the future. As AIS are adopted, risk managers will need to consider not only the impact of the printed record on malpractice exposure but also the impact of the high-resolution electronic archive.
Not only are AIS proliferating, there is momentum building on the national level to make the entire patient record electronic. We will undoubtedly have to address not only the malpractice implications, but also all of the complexities that will be introduced by this technology. I certainly look forward to more definitive evidence from actual malpractice proceedings to document the role of AIS in the malpractice process and to continued constructive dialogue on this important question.
Jeffrey M. Feldman, MD, MSE
Department of Anesthesiology; Children’s Hospital of Philadelphia; Philadelphia, PA; firstname.lastname@example.org
1. Feldman JM. Do anesthesia information systems (AIS) increase malpractice exposure? Results of a survey. Anesth Analg 2004;99:840–3.