What Ails Anesthesiology Today

As a board-certified anesthesiologist who happens to be an owner of a hotel—COVID-19 disruption and resultant wipeout notwithstanding—it strikes me as odd that what was traditionally a mom-and-pop business, handing out keys at the front desk of a highway motel, was an early adopter of information technology (IT), data mining and analysis, predictive models, competitive and dynamic rate optimization, meaningful benchmarking, and other detailed actionable reports. Anesthesiology, by contrast, a hard-core scientific, research-based endeavor with very serious impacts on health outcomes and indeed life and death, lacks a reliable, universal, standardized database of intraoperative anesthesia data to this day, and relies on unreliable handwritten notes and documents uploaded via a scanner as well as anecdotal data to publish scientific papers.

Digital charting in anesthesiology is still in its infancy as digital data is not downloadable directly from the monitors and thus is open to artifact, with unreliable data going unscreened. Anesthesiology must be the only scientific endeavor I know of that is so out of sync with today’s reality, in which everything is data-based and -driven and where machine learning and artificial intelligence have evolved scientific understanding to the cutting edge—while we in anesthesiology are still dabbling in tech from the ’50s and ’60s, without a reliable, standardized and mineable database.

I have researched this issue and the problem is head-bangingly pitiful. Technically, all anesthesia monitors, hemodynamic monitors, neurologic monitors, c-arms, radiology monitors and telemetry monitors reliably produce digital data (as opposed to analog data, which is less reliable) in real time. As such, creating a central, reliable, standard, universal and mineable database of all ORs throughout the United States (for starters), and ideally the world, should be a breeze in this day and age—for that is the scope of the repository of data needed to draw meaningful and reliable conclusions using machine learning and AI.

So, what, you may ask, is the issue? In short, the greed of the “medical–industrial complex.” Let me explain. Each monitor used in an OR is outfitted with a specific chip that prevents you from downloading the data—even to a USB that you could download to your laptop. You can handwrite the data, print off segments on a strip, etc., but you cannot download the digital data in real time, routinely off a proprietary monitor.

The logic is that the monitor company will sell you hospital-wide systems for millions of dollars if you wish the monitors to talk to one another. Some rich hospitals have invested in these hospital-wide monitoring systems that talk to one another, but the data collected are minimal, isolated to that hospital and completely unusable. These huge systems are unaffordable for anyone but the richest hospitals.

What is truly needed at this point is an act of Congress to create a scientific committee that includes IT experts, anesthesiologists, lawyers and governmental regulatory bodies to standardize raw digital data collection from all anesthesia sites, including ORs, ICUs, ambulatory surgery centers and offices, into a central nationwide repository that is secure and accessible to researchers and IT companies, in order to mine trends, model therapies and monitor outcomes. The medical–industrial complex should be induced to participate or be penalized for restrictive behavior.

I am surprised that none of our esteemed anesthesiology university program heads and anesthesia research teams have felt intellectually naked without the existence of such a database and are content with the current state of the art from the ’50s, mining unreliable, limited data sets and publishing pseudo-results—“garbage in, garbage out.” It is truly a sad state of affairs in the anesthesiology research world and I have yet to hear a word about this from any notable anesthesiology honcho.

Retail anesthesia has largely been usurped by the CRNAs, with MD anesthesiology in a secondary/optional role in a handful of states that still mandate supervision. That academic anesthesia is a crumbling edifice in the wake of this massive transformation of anesthesiology as a specialty is laid bare by the gaping lack of interest in the otherwise dire need for a standard, universal and reliable digital database encompassing all anesthesia locations.

When I talk to my IT friends about this dilemma, they laugh their heads off and assure me that an undergrad IT senior could fix this problem in his spare time. The fact that it is not the most burning issue in the world of anesthesiology is scary. Potentially, all of our studies published to date are based on flawed data and so, therefore, are the conclusions. The issue is that the heyday of any serious research in anesthesiology is behind us. This is the sad state of anesthesiology today. No new concepts or cutting-edge conclusions are possible without a reliable database. So, the only “new research” published is rehashing old concepts already proven.

Having witnessed the massive transformation of the non–life-and-death hotel industry firsthand, which was brought on by the IT revolution to create a now fully data-driven and super-efficient business—agile enough to withstand a world calamity like COVID—I am convinced that the dividends accrued from setting up a single repository of anesthesiology data will be astounding. A whole new understanding of and basis for anesthesiology would emerge, as would a new industry.

Unfortunately, we lack leadership, enthusiasm and the will to work hard. The new generation of MD anesthesiologists brag about their shift-work lifestyle and their paychecks without any qualms about giving back to research or medicine. Like everything these days, the thrust toward data-driven science in anesthesiology will come from India or China, and we will gladly tag along shamelessly.

It behooves our anesthesia leadership to wake up and take the bull by the horns, and get a secure, standardized, mandatory, central repository database of all peri-/intra-/postoperative anesthesia digital data in real time, set up in the United States, if need be by an act of Congress—the medical–industrial complex notwithstanding.

Editor’s note: The views expressed in this commentary belong to the author and do not necessarily reflect those of the publication.