In 2006, the military completed worldwide deployment of its outpatient documentation solution, AHLTA. In 2007, the military began deployment of its inpatient documentation solution, Essentris®. Adoption of electronic health records has arguably been an area of contention in emergency departments because time spent electronically documenting care is time spent away from providing patient care.
During a recent interview with Navy Cmdr. Peter J. Park, MD, we inquired about the Essentris Emergency Department Module, one of the key projects making a difference in the way our service members' health care is documented in the emergency department. Park is Navy Medicine's deputy director for Clinical Informatics and the program manager for the EssED program. He is also an attending physician in the Department of Emergency Medicine at the Naval Medical Center San Diego.
How did you first get involved with the
Park: In the spring of 2008, I was placed in charge of a new project that was responsible for developing an integrated emergency department module within Essentris®, the military's inpatient documentation solution used in stateside facilities. I initially established some aggressive implementation timelines, because we really needed a completely new, tightly integrated emergency department module with notes, tracking boards, flow sheets, interfaces, etc. I discussed our options with leadership, and we determined the best option was to go back to the drawing board with the developer. We created a multi-phased approach focused on creating a suite of tools to help our staff deliver the care that our patients required.
How many phases comprise the project?
Park: The original plan called for four phases and only focused on the core emergency department staff, but later we expanded the plan to nine phases, allowing us to address critical elements such as reporting functions and, ultimately, Theater capabilities.
Where are you today in the phased implementation?
Park: In June 2008, we implemented Phase I, which set up a system to start registering patients at NMCSD so our staff and developers could learn how to document care in Essentris®. It provided a foundation for our development team to build upon. Two months later, we went live with Phase II, which focused on automating patient data documentation. This saw us introduce the "ICE", or the (I) Interface between the (C) Composite Health Care System and (E) Essentris®, which I helped to co-develop. Phase III rolled out in October 2008, focusing on nursing staff requirements. This phase included fielded nursing notes, flow sheets, workflows and integrated dashboards.
Finally, in December 2008, we implemented the provider piece as part of Phase IV, which integrated all our prior efforts. The following year, we released Phase IVa with a new engine called the Melder. This allowed us to pre-populate new emergency department encounters for returning patients with significant patient information from prior encounters.
Today, our primary goal is to focus on implementing our next three phases.
What will the remaining phases include?
Park: Phase IVb will bring integrated aftercare patient instructions to the emergency department and help us improve communication with our beneficiaries. Phase IVc will introduce Computerized Provider Order Entry and allow us to place orders into Essentris® instead of writing them on paper. The templates in Phase IVd are intended to speed the encounter documentation process. After that, we'll work on the coding and billing requirements, targeting the needs of our non-emergency department staff (e.g., consultants) and reporting functions that will allow us to track data in real-time on our wounded, ill and injured patients who come to the emergency department from Theater.
What sites have received EssED
Park: Currently, it's online at NMCSD, Madigan Army Medical Center, Travis Air Force Base and the Naval Hospital Bremerton. Ultimately, EssED will be deployed to all 50 Military Health System Military Treatment Facilities that have an emergency department. NMCSD has served as our software development and test site, due to its proximity to the vendor's headquarters. We chose three beta sites—one per service—to cover the breadth of our facilities (e.g., trauma centers, tertiary care hospitals and community hospital settings).
What is the ICE project and what made it special for you?
Park: Think about all the data associated with a visit. Our staff had to retype all the patient demographic information (e.g., marital status, sex, date of birth, address) into Essentris® even though it was already archived in CHCS. This was a huge productivity and data quality issue for the emergency department, so I teamed up with a software engineer, Anthony Feaster, who worked at NMCSD in the Information Management and Information Technologies Department. We wrote a series of CHCS routines initially implemented in San Diego. They activate every time you register a patient in CHCS and automatically create a package of the patient demographic and clinical data, which is then sent to the local Essentris® servers. Then the Essentris® servers use that data to automatically generate and populate an emergency department or inpatient chart for the patient.
Overall, what has been the general impact, or potential impact, of the ICE upon patient care?
Park: With Phases I and IVa, we introduced the ICE module and launched a novel tool to automatically pull up data on returning patients. ICE saves invaluable time for our emergency department nursing staff and providers alike, in a setting where every minute saved can mean the difference between life and death. Ultimately, this process completely eliminated the need to manually register patients in Essentris® and retype information that is already available.
We are currently working with another vendor to add it into the CHCS baseline code and complete additional testing. So far, ICE 2.0 is up and running at NMCSD, MAMC, Travis and Bremerton.
What do you think EssED will mean for the MHS?
Park: The emergency department community created a novel collaboration across Service lines in conjunction with the Service Chief Medical Information Officers and DHIMS. This unique environment has enabled one functional community to leverage an agile distributed development model to apply best practices and create a TriService standardized module in Essentris®. Most of the issues we overcame aren't unique to the emergency department. So with minimal modification, our solutions are extensible to other care settings.
In 2007, providers in the emergency department at NMCSD documented care on paper charts. Staff wasted countless hours each day rewriting demographics and patient information into medical charts. Medical teams lost more time searching multiple systems for patients' past medical/surgical history and clinical information. Three years later, it's a different story.
For more information, visit DHIMS Communications at DHIMSCOMMTEAM@tma.osd.mil or via fax 703-379-0604.
SOURCE: CliniComp, Intl.