Sandman.MD is a digital mobile solution for the complete documentation of all steps in anesthesia. From patient admission with anamnesis to planning and execution of anesthesia and discharge from the recovery room, all data can be recorded and events documented.

With the use of Sandman.MD, the typical deficits of handwritten anesthesia documentation such as

• incomplete documentation of measurement values and findings,
• complicated legibility,
• impaired further use of the data,
• time consuming delivery of the documentation,
• loss of paper documents and
• loss on benefit settlement

is effectively reduced.

With Sandman.MD's own communication method, measured values from anesthesia machines and patient monitors can be automatically and wirelessly recorded on the mobile workstation. It is not necessary to have a hospital LAN or WLAN in the surgery room.

The coupling to the iPad is done via small adapters, which are connected to the serial interface of the medical device via a corresponding cable. These adapters, the "Sandman-Interlinks", are able to establish their own local network via WLAN or Bluetooth. The iPads can log into this network and read the data respectively transfer it to the Sandman.MD anesthesia protocol.

Currently, Sandman.MD enables the integration of devices from Philips, Dräger, General Electric, Löwenstein medical as well as Nihon-Kohden and thus has international market leaders in its portfolio.

Sandman.MD is thus a worldwide unique system that enables the entire anesthesia workflow from patient admission through anesthesia execution to post-operative care of the patient with simultaneous mobile recording of anesthesia data without IT measures in the hospital.

In addition to integration into the world of OR equipment, integration into the IT infrastructure of the hospital or practice is essential.

For this purpose, a central component, the anesthesia server SAS.MD, is available, which optionally complements the functionality and application range of Sandman.MD.

The anesthesia server provides the following services:

• Premedication and anesthesia archive service
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  The patient data recorded on the iPad during premedication and during the course of surgery can be transferred to the SAS.MD and stored there. This data can be accessed from an iPad-Sandman.MD installation and downloaded to the iPad for further processing. This allows patient data to be deleted after processing on the iPad and to be available to other Sandman.MD users at a different time.
  This not only facilitates the exchange of data, but also significantly increases the privacy and data security features of Sandman.MD. If the iPad is lost, no more patient data is stored on the iPad, and if the iPad fails, all data is stored centrally.
  
• Configuration Service
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  Sandman.MD allows a number of user and house specific settings that can be configured locally via the iPad. Via the configuration service, these settings can be stored centrally and distributed from there to the Sandman.MD installations on all iPads.
  
• Interface Service
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  Patient data is usually collected and stored centrally in hospital information systems or patient data management systems. In order not to have to enter patient data twice and to transfer data generated by Sandman.MD to the central systems, a connection to such central systems is necessary.
  With the interface service, SAS.MD offers the possibility to connect to these systems via the medical standard data exchange format HL7. In addition, further application systems such as laboratory information systems or radiology systems can also be connected via this service. Thus the anesthetist has access to current data from other functional areas of the hospital, e.g. laboratory data from a perioperative blood gas analysis, online on the iPad during the operation.
  

By using the anesthesia server, all patient data on the anesthesia server are stored in an anesthesia case database. Irrespective of whether they are transferred to a central patient data management system. This means that the anesthetist has access at all times to the values from premedication and anesthesia documented in the past.

As part of premedication, the anesthetist can access the data of a patient's previous cases and view the protocols stored for this purpose. The premedication data of an old case can be transferred to the current treatment. This is an essential aid and facilitation for the anesthetist in his daily work and treatment.

In addition to data input via finger gestures and keyboard, photos can also be taken with the iPad during premedication and surgery. The photos are integrated into the premedication or anesthesia protocol.

The function is suitable, for example, for taking a doctor's letter or an information sheet signed by the patient. During the operation, special treatment situations, curves of non-integrated monitors or identification marks of blood reserves can be recorded.

Depending on the type, the photos can be viewed full-page on the iPad and output full-page with the protocol, so that an information sheet can also be read and printed in full size.

The photo functionality also serves to read patient data from patient labels, QR or bar codes.

All recorded data of premedication and anesthesia can be printed and saved as PDF protocols.

In addition to the presentation in structured numerical form, it is also possible to display the measured values, which are displayed in Sandman.MD in point diagrams, in the PDF protocol as point diagrams too.

Of course, photos can also be included in the report.

The structure of the protocols can be defined on the iPad. Containers are available for this purpose, each of which contains data from a specific area, e.g. patient identification, admission data or risks. These containers can be combined in any selection and sequence to form a protocol template. IT know-how is not required for this.

Several protocol templates can be defined, so that protocols are available as required, whether as a complete anesthesia protocol with photos, as an order protocol for the nurse or as anamnesis documentation.

Sandman.MD can contain all data defined by the Core Data Set (KDSA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anesthesiologists (BDA).

It is possible to document any number of anesthesia progression observations (AVB), of which three can be selected as KDSA-relevant postoperatively according to the currently valid version of the KDSA.

The entries are checked for validity by the plausibility criteria defined in the KDSA. If they are violated, the error messages defined by the KDSA are displayed.

The integration of the core data set for external quality assurance creates the prerequisites for internal and cross-institutional benchmarking for anesthesia performance. This forms the basis for a transparent comparison with other facilities, i.e. anesthesia clinics, anesthesia departments in care centres, outpatient facilities and anesthetists in private practice, and can help to draw suitable conclusions about the potential for action with which it is possible to increase the quality of patient care and at the same time reduce the associated costs.

Sandman.MD offers a wide range of data entry options. In addition to manual input via keyboard and wipe gestures or via photo, measured values can also be entered into the curve diagrams using the Apple Pencil.

Data can also be transferred from centrally available information systems. Where these are not available, patient master data can be read from patient labels or QR codes and automatically transferred to the data fields. To select a patient case to be treated, the case number can be entered manually or read from a barcode on the patient file.

Sandman.MD offers an interface based on the medical standard data exchange format HL7 via the anesthesia server so that patient master data does not have to be entered manually and maintained centrally in one place. This allows patient data to be transferred from central hospital information systems that also support this format.

Data and protocols can also be transferred back from Sandman.MD to the central system, depending on the respective HIS implementation.

The anamnesis survey follows general rules, but is still individually developed from house to house, also depending on the specialties. In order to meet these individual requirements, Sandman.MD has a hospital-specific configurable anamnesis area in addition to the predefined data areas available in premedication.

In this area, information can be defined in the form of entry forms with questions and predefined or free answer options. In this way, a coordinated data collection on the patient can be made available for every need and supporting the anamnesis.

Individual responses can be preset as standard responses. Any deviation from the standard is indicated.

In order to highlight important information that gives an indication of significant risks or the reason why a procedure was chosen, selected answer options can be marked with "CAVE" when defining the anamnesis forms, so that when this answer is selected, the corresponding question complex is automatically highlighted in color. "CAVE" flags can also be set manually at any time.

An overview page provides brief information about all entries.

The same functionality is also available for the postoperative area.

By using an iPad as a personal work tool, the highly mobile activity of the anesthetist is effectively supported. Whether for premedication, working in the operating room or transporting the patient, patient information and documented data is available and can be maintained continuously. A connection to a network is not necessary as the data can be stored on the iPad. The anesthetist's work is self-sufficient from existing infrastructures.

The iPad is used as a standard product, no specific configurations are made. This results in advantages for the purchase and availability of the devices, as well as for their usability, since, if desired, further applications can be installed that additionally support the anesthesiologist's work process.

Any current iPad, whether Standard, Mini or Pro, with all available screen diagonals can be used. If desired, sleeves to prevent breakage or disinfection are also available, as are holders for attaching the iPads.