IT in the ED: the nature of emergency department medicine means specific and comprehensive IT needs for clinicians - Emergency Department Information Systems

Health Management Technology, Feb, 2002 by Richard R. Rogoski

The fast-paced environment of a hospital emergency room often leads to information overload. Yet those who regularly deal with a quick turnaround of patients, split-second decision making and detailed discharge instructions know that most information systems installed in other parts of the hospital can't meet the specific needs of the emergency department (ED).

Last summer, The Kennedy Group (TKG) in Chicago surveyed more than 400 hospital CIOs concerning the biggest challenges facing their EDs. According to Catherine Sprague, senior associate at The Kennedy Group, 76 percent of respondents listed patient tracking as a major problem. Patient turnaround time came in second, garnering almost 62 percent of the vote.

However, what Sprague also discovered was that only 24 percent of respondents said they already had an emergency department information system (EDIS) in place. Seventy-one percent said they were planning on installing one within the next five years, but 5 percent said they had no interest in installing such a system.

If some hospitals are reluctant to incorporate a separate EDIS, two major factors stand out, says Sprague: getting people to input data and the ability of the EDIS to interface with other hospital systems.

Points That Persuade

On the first point, Sprague notes that many of the newer systems incorporate voice recognition software and says, "Handhelds get people to consistently input data--especially at the bedside."

Lisa Figueroa, M.D., agrees. As an emergency medicine physician and the chief medical officer for Cary, NC-based A4 Health Systems, a major EDIS vendor, Figueroa says doctors and nurses no longer have to waste time looking for a patient's chart. In fact, she estimates that between 30 percent and 40 percent of an ED physician's time can be spent on non-patient care due to inefficiency or lack of automation.

In EDs where patient information still is gathered on paper charts attached to clipboards, these clipboards are "put into a rack, depending on acuity, and gotten to in the order they were put there," she says. But an EDIS allows the staff to select any patient at any time and do all the necessary documentation, which, in turn, is accessible to anyone else who needs that information.

"A doctor with a wireless handheld can see all the information at the bedside and can place all orders at point of care," Figueroa says. "That gives the physician more time to see more patients." Also, a system that enables full and legible documentation allows for complete coding, she adds.

As for the nagging question of integration, Sprague states, "Every product I've looked at uses standard interfaces for integration," adding that most are HL7 (Health Level 7) compliant.

Not surprising, the majority of TKG survey respondents who said they already have an EDIS have interfaced it with one or more systems, she says, and the most common interface is with laboratory systems.

Currently there are about 16 major EDIS vendors in the U.S. While each may highlight certain features of their system, Sprague says most rely on a set of core components: patient tracking; charting (including different views for triage, physicians and nurses); patient logs; discharge planning and instructions; prescription writing; and procedure/ diagnosis coding.

Admissions Through ED

Because patient tracking has proven to be a major concern, vendors often stress whether their system uses active or passive tracking. With active tracking, a patient's location or status is determined on the basis of information that is manually entered into the system. Passive tracking often uses an infrared sensor worn by the patient. But Sprague notes, "There seems to be controversy over active versus passive tracking. People I have talked to say there are still problems with infrared sensors--like walls getting in the way."

The importance of patient tracking is not just confined to a single hospital's emergency department. Sprague cites the case of Carilion Health Systems in Roanoke, VA which recently went from a paper-based system in some of its hospitals to a system-wide EDIS. Carilion selected the Integrated Clinical Management Systems product from New Jersey-based Wellsoft, from a field of 14 systems they considered, and they used a three-phase implementation plan to rollout the product. Because every ED in the health care system became interconnected, Carilion was able to track drug, child and spouse abusers as they periodically visited different hospital ERs.

The Carillon case also gives credence to another of Sprague's observations: Larger hospitals with more ED visits per month, and those with multiple facilities, are more likely to invest in an EDIS. Figueroa concurs, saying her company focuses its sales efforts on medium to large-sized hospitals. But she also says an EDIS will make any ED more efficient and can improve any hospital's bottom line.

Figueroa explains that while an ER used to be perceived as a financial drain on a hospital, it's no longer considered as such. "Hospitals spend a lot of money focusing on patient satisfaction," she says. "Hospitals have been renovating ER waiting rooms. They're now looking at the ED as the gateway to admissions."