The Pursuit Of Effective ED Automation
By Ken Congdon, editor in chief, Health IT Outcomes
The Emergency Department (ED) is the life's blood of most hospitals. It's where the vast majority of orders originate and a key source of hospital revenue. With this in mind, it's no wonder why many hospitals have targeted the ED as a focal point for digitization and automation. The need to improve efficiency in the ED has only increased in recent years as the number of patient visits continues to rise and medical staffs are forced to treat more people with fewer resources. EHRs are thought by many to be the tool that will optimize ED efficiency. However, implementing an enterprise EHR solution in the ED may not result in a more streamlined department. In fact, in many cases, this move can have the exact opposite effect.
Unique Challenges Require Custom Tools
A potential drawback of using an enterprise EHR in the ED is that they are not designed for the emergency medicine environment. Life in the ER moves very fast and ED clinicians won't tolerate a technology solution that will slow them down. Some enterprise EHR systems can have this unintended effect because they are not designed from the clinicians' perspective.
"Many enterprise EHR systems have attempted to take existing technology and modify it to address ED processes rather than building a program from an ED clinician's point of view," says Dr. Steven Rube, family practice physician an executive VP/CMO of EmpowER Systems. "This often results in very dogmatic programs that require clinicians to complete one predetermined step before they can enter the next piece of information, and so on. The ED clinical workflow doesn't work this way. There are several scenarios that can alter the way information is entered in an ED environment and an EHR program for the ED needs to provide contingencies that address these scenarios."
According to Rube, prescriptive enterprise EHR platforms can significantly impede ED productivity, which has had a negative impact on the adoption of EHRs by ED physicians. "Many enterprise EHRs have less than a 25% physician adoption rate," adds Rube.
Rube also states that another unique trait of the ED is that it acts as a miniature hospital within the hospital. When patients enter the ED, they are either subsequently released or admitted to the hospital. According to him, an EHR system in the ED needs to be patient centric as opposed to technology centric, meaning that the software should track the patient throughout the ED ? providing detailed information on wait times, vitals, medications administered, etc.
Siloed ED Patient Data Offers Limited Value
Specialized EHR software platforms exist that address the specific requirements of the ED. Select hospitals have leveraged these technologies to successfully streamline their day-to-day operations. The only problem is, in most cases, the information these systems collect remains siloed in the ED ? it doesn't follow the patient, even if they are admitted to the same hospital. This can pose some patient safety issues and flies in the face of recent HIE (health information exchange) initiatives.
The key seems to be to adopt a specialized EHR platform for the ED and ensure this data is integrated with the hospital's enterprise EHR platform. According to Dr. Rube, this integration should go beyond an exchange of HL7 messages between systems, but should also incorporate the integration of data entered into physician master tables. "If an allergy is added to the patient's allergy list in the ED, it should be visible in the allergy table when they are admitted to the hospital an inpatient and vice versa," says Rube.
This type of sophisticated integration can be performed by internal experts or consultants. In addition, Rube's company, EmpowER Systems (which designs ED-specific EHR systems and other technology solutions aimed at the ED) recently entered into a partnership with enterprise EHR vendor Keane to integrate the two platforms to work together seamlessly. Perhaps this is a sign of things to come in regards to EHR and HIE.
Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at ken.congdon@jamesonpublishing.com.