Our stories - Centricity: Providing safer, higher-quality, lower-cost anesthesia care


The University of Michigan Health System was involved in developing one of the most successful clinical information systems in the world.

Imagine a computer system that helps hospitals run their anesthesiology services like well-oiled machines. With a glance at the computer screen, the anesthesiologist would know, in real time, patients’ arrival times; their allergies, weight, diseases and medications; and a myriad of other pieces of information crucial to the anesthesiology puzzle. Having all of this in place means that the health care staff doesn’t have to constantly re-check the information, the patient’s procedure is done as soon as possible and precious operating room time is used well.

Such a clinical information system already exists. In fact, the most successful system – Centricity Perioperative Anesthesia – was developed in cooperation with anesthesiologists at the University of Michigan Health System in the 1990s. Today, 30 to 40 hospitals around the country – and hundreds of physicians – use the system to ensure that they have the latest, most accurate perioperative patient information at their fingertips.

A Vision of the Future
When Kevin K. Tremper, M.D., Ph.D., was hired to chair U-M’s Department of Anesthesiology 15 years ago, he accepted the position with a requirement: He wanted to put in place a real-time perioperative clinical information system that would efficiently manage the Health System’s operating rooms. He envisioned that the system would improve clinical care while assisting in education and at the same time provide a clinical database for outcomes research. Tremper is the Robert B. Sweet Professor and chair of the U-M Department of Anesthesiology. 

His journey to find a secure, seamless system ended at a small IT company in Ann Arbor. Systems Engineering Consultants Inc. was owned and operated by Vik Kheterpal, M.D. – a physician trained at the University of Michigan Medical School. This medical software startup company had already developed a system for the University of Michigan’s Emergency Department.

By working closely with SEC, associate professor of Anesthesiology Michael O’Reilly, M.D., and Tremper were able to get the features they wanted and needed, including real-time data through interfaces to laboratories, the pharmacy, radiology and dictation, including EKG results; the viewing of multiple organ systems on a computer screen; automatic paging or e-mail to alert staff of abnormal laboratory values prior to surgery; and automatic paging to alert staff when the patient is ready.

“This was a radical change in the way data was collected and managed,” says O’Reilly. “but there was little resistance by anyone on staff.”

“During surgery, there are multiple people who need the same information at the same time in order to make the right care decisions for the patient,” Tremper says. “Clinical information systems allow for a free flow of patient data to clinicians when and where they need it. The clinical data now flow from one provider to another automatically.”

Once the nurse enters data into the system showing that the patient is on certain medications and has an allergy, that data will flow from the Pre-op nurse’s phone call into the Holding Room nurse’s information and subsequently to the anesthesia evaluation, then into the surgical history and physical.

At each step, each provider needs to reconfirm the information, but providers do not have to start with the same questions. For example, once the patient has been asked if they have any allergies and they state they are allergic to penicillin, the next provider will ask, “I see that you are allergic to penicillin?” instead of “Do you have any allergies?”

“Asking the same question over and over again does not instill confidence, it only implies we are not communicating,” says Tremper. “This system also speeds up the workflow and improves accuracy.”

With 70 operating rooms and 200 post-anesthesia care unit beds at the University of Michigan Health System, Centricity has been put to great use.

GE bought SEC in 2000, and U-M’s Department of Anesthesiology has remained the development site. “GE has full rights to the software, but we get a great deal,” says O’Reilly.  “Most importantly, we have tremendous influence over the development of additional functionality to make the system smarter in order to provide decision support and enhance patient safety.”

Value Added
Not only does the system keep tabs on rooms, patients and physicians, but it adds the kind of value that could have been defined only by the anesthesiologists themselves.

For example, pull up the screen on Patient A who is scheduled tomorrow morning for a triple bypass, and you will learn whether or not he is asthmatic, what he is allergic to and what medications he takes. If you are the anesthesiologist, an anesthesia plan specific to the patient’s procedure will be generated. Input the medication you will administer during surgery, and the medication will appear on the screen – with the amount adjusted for the patient’s weight. The system prompts the provider to administer critical medications such as antibiotics and immunosuppressive drugs for patients undergoing organ transplants. And if he has been a patient in your hospital in the past, you will even know if he was difficult to intubate during his last surgery or had trouble with the oxygen mask.

O’Reilly says, “Centricity gives us the data to make the connection between what we do and the patient.” 

The system also is an incredible reference site, with anesthesiology approaches to more than 150 diseases and practice guidelines for all the procedures. “As anesthesiologists, we’re not just managing the patient’s anesthesia during surgery. We also manage their other diseases,” O’Reilly says, “and how those diseases react with their anesthesiology care.”

The anesthesiologist used to have to write patient vital sign information by hand every five or fifteen minutes. Now the information is recorded electronically, every minute. Because it is so streamlined, the system improves work processes for clerks, medical assistants, nurses, residents and faculty alike.

And O’Reilly has taken the story of the making of Centricity on the road to health care organizations around the country, such as Mayo Clinic and Baylor University, which are interested in acquiring the system.

What’s Next
Information acquired through Centricity becomes an extension of the Health System’s database, which has been in operation since 1993 and now includes more than 210,000 anesthesia cases.

“Ultimately, we will be able to do very large outcomes research because of the large databases,” says Tremper. Already, UMHS researchers have tapped into Centricity’s power to cull data for articles in some of the field’s most prestigious journals, such as Anesthesiology, and Anesthesia and Analgesia. O’Reilly, who is the director of Liver Transplant Anesthesia, is excited at the possibilities for outcomes research.

“This will really change the practice of anesthesiology,” says Tremper. It already has.