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

Preventing Errors

To prove her point, she cites recent studies showing that between 50 percent and 60 percent of hospital admissions can come through the ED. Improved patient care also is evident in the area of risk management, she says. According to Figueroa, the use of an EDIS is critical in preventing medication errors due to allergies or contraindications with drugs patients may already be taking. Medication/conflict checking and legibility of prescriptions are two more issues resolved through automation, she says.

In addition, hospitals often write off the costs associated with undocumented expenditures for services and supplies, Figueroa notes. But an EDIS with a point-of-care order entry component can capture information related to all equipment and supplies used, in addition to all charges incurred.

Given today's economy and rising health care costs, return on investment also is a major concern, says Mark Crockett, M.D. A practicing emergency medicine physician, Crockett is the co-founder, president and CEO of Rosemont, IL-based ibex Healthdata Systems Inc., another major EDIS vendor.

Referring to the experiences of his own company's clients, Crockett says, "We've had places where ROI was three months. For others, a year. Typically it's three to six months."

EDIS vendors are split into two camps: those who believe a single, comprehensive system offers a total solution with seamless integration; and those who feel modules offer more system design flexibility, easier integration and lower up-front costs.

Basic Differences

Sprague says that in many hospitals, the modular approach is winning. "People I have talked to are installing modules to ease their way into a complete system," she explains, noting that once each piece purchased from a single vendor is in place, the ED will then have a complete and comprehensive system. When installing modules, most start off with patient tracking, then add a charting module, she says.

Another basic difference between vendors is the platform on which their EDIS is designed. While most are still client/server-based, some are totally Web-based. There are even some vendors, according to Sprague, who are building hybrids--"putting Web-based front ends on older legacy systems." But here again, she identifies a trend. "I definitely think it's going toward the Web-based technology. "Web-based products are easier to manipulate, and with security the way it is today, a lot of these tools are already in place."

Crockett concurs. "A lot of people are writing Web-based software," he notes. "Hospitals are dying to get out of the client/ server environment because the cost of upgrading is higher."

Easily distributed over an intranet using a single server, ibex PulseCheck[R] is a totally Web-based EDIS that creates a complete electronic medical record from triage to disposition, Crockett says. Because it uses ultrathin client architecture, it is platform independent, he says, adding that a Web browser is built right into the operating system, making this EDIS easy to install and run in any size hospital.