Three phases of EDIS: installation of a comprehensive emergency department information system enables a Virginia IDN to revitalize its ED services - What works: EDIS

Health Management Technology, March, 2003

In real estate, location is key. In emergency services, it's speed and quality.

In the late 1990s, Carillon Health System in Roanoke, VA, was a healthcare organization with many opportunities for improvement. Emergency department wait times were negatively impacting patient satisfaction, staff morale and overall ED revenue.

PROBLEM

Carillon is a $1 billion healthcare organization that services more than 1 million people in western Virginia. It employs almost 10,000 people at 10 owned or managed hospitals, physician practices and primary care centers.

The emergency departments at Carilion's hospitals needed a healthy dose of technology. In previous years, patients labeled as "LWBS"--left without being seen--had approached 3 percent. In addition to LWBS patients, patients who were seen experienced turnaround times (TATs) of up to six hours. Carillon Senior Vice President and CIO Greg Walton estimated that every hour of reduced turnaround time is the equivalent of adding 3.42 ED beds. Conversely, extended TATs were the equivalent of depleting ED bed capacity.

Because the EDs used paper systems and dry erase boards, it was difficult to efficiently track patients throughout their ED visits. Because paper charts were used, only one clinician at a time could access a patient's medical record. Without an automated solution, tracking practice variations among the hospitals' emergency department physicians was not easily accomplished. This made it difficult to develop best practice approaches for specific patient complaints.

Lack of automation contributed to the potential for lost revenues. The LWBS patients translated to a potential $1 million loss, based on an average of $400 per ED visit. Estimates are that 10 percent of all LWBS patients ultimately are admitted to a hospital, and at $10,000 per admission, the potential for loss totaled more than $2.6 million. When lack of information technology can contribute up to $3.5 million in lost revenue per year, it's time to automate.

SOLUTION

Carilion's emergency services department and information services department worked together during a six-month selection process to identify the type of solution required.

ED and IT staff determined that they needed a comprehensive and integrated clinical management system that would be available throughout the emergency department and also at the enterprise level for admitted patients. Six vendors were invited to submit proposals, and four finalists were selected from this list. After on-site demonstrations with the finalists and site visits to other hospitals, we selected the Integrated Clinical Management System (ICMS) from Wellsoft Corp. in Somerset, NJ. We felt the Wellsoft system offered the most comprehensive system with strong user-friendliness, allowing us to extend our existing IT infrastructure investments.

Carillon targeted five hospitals with a combined total of almost 140,000 annual ED encounters for the EDIS installation: Bedford Memorial Hospital (12,000 visits), Carillon Franklin Memorial Hospital (19,000 visits), Carillon Roanoke Memorial Hospital (39,000 visits), Carillon Roanoke Community Hospital (40,000 visits), and Carillon New River Valley Medical Center (29,000 visits). These facilities include a Level 1 trauma center, a women and children's facility, and several community hospitals.

IMPLEMENTATION

ICMS is a three-module or three-phase system: 1) patient tracking; 2) nursing and physician documentation; 3) computerized physician order entry (CPOE) and results reporting.

Carilion's implementation plan specified that two facilities for each module would be installed with assistance of Wellsoft's professional staff. Beginning with the third facility, Carillon IT staff assumed responsibility for all subsequent installations, allowing Carillon to grow internal experience with EDIS installation. Go-live began in December 2000, with the remaining four EDs coming online within five months.

Phase 1, patient tracking, includes triage, patient tracking, discharge instructions, online prescription writing and work/school excuse generation. This required an ADT interface from the Siemens Invision system to the Wellsoft emergency department information system (EDIS). This interface included storing and retrieval of Carilion's enterprise master patient index (EMPI) that links the EDIS to the hospital information system, clinical diagnostic systems (lab and radiology PACS), physician practice management systems and document imaging system. This ultimately helps to construct a paperless ED. This phase also completes the patient's final disposition with electronic, comprehensive discharge instructions, electronic prescriptions and work/school excuses.

Phase 2, clinical documentation, includes nursing assessment, social history, progress notes, physician history and physical exam templates, all driven in pop-up window selections, with ICD-9 codes automatically displayed upon selection of diagnoses, and CPT and APC codes provided as part of the patient record. This required an interface of the electronic ED medical record into the enterprise's document imaging solution and completed our transition from a paper ED record to an electronic record.