I'm ex-military," says L. Albert Villarin, Jr., M.D., emergency department director of medical informatics at Albert Einstein in Philadelphia, in explaining how important it is for emergency department information systems to provide clinicians with up-to-date, reliable patient data at the point of care.
"And I look at it (the hospital's ED information system) as my heads-up display in my aircraft, or my situational awareness. The more information you have at your fingertips, the more fluid you can be." Given how fluid patient care is in hospital EDs — Villarin points out that the only things scheduled in EDs are laboratory tests — keeping track of what's going on should be a high priority.
Of course, the history of EDs began long before automation, and has until recently been one of gradual struggle toward greater efficiency and more optimal patient care. But accelerating ED visit volume, increased costs in this very expensive clinical area, a growing emphasis on patient safety, reimbursement pressures from payers, and growing consumer awareness are all focusing a major spotlight on EDs and compelling hospital leaders toward automation.
Movement on dual fronts
Industry experts say two things are happening. First, the number of hospitals implementing ED information systems (EDIS) is growing rapidly. Though no more than probably 400 hospital EDs have "a completely integrated EDIS that includes computerized physician order entry (CPOE), physician documentation, and nursing documentation, and is fully interoperable" with the rest of the hospital enterprise, the majority of hospital EDs are moving down that path, says Mark Crockett, M.D., a practicing emergency physician at 82-bed Morris (Ill.) Hospital.
Equally important, says Crockett, who is also president of the Emergency Care Division of Wakefield, Mass.-based Picis, is that, "The definition of an EDIS is growing to not only involve patient and data tracking and data capture and analysis, but also nursing and physician documentation, CPOE, and charge capture as integral components."
A key advance, Villarin says, is that the systems that track patients and patient care flow, results reporting and even clinicians, must become passive, meaning that to be successful they won't require active human intervention. Villarin and his colleagues at Albert Einstein are implementing technology from Mission Viejo, Calif.-based Patient Care Tracking Systems (PCTS).
Cory Wagner, a director of product development at PCTS, notes that as hospital ED leaders have become successful with basic patient-movement tracking tools, they have turned to innovations such as badge-ing clinicians, and analyzing patient flow to optimize it. This is where tracking tools will really benefit everyone, Wagner says.
Sharp hones ED processes
At the five-hospital Sharp HealthCare system in San Diego, Donna Miranda, R.N., M.S.N., the organization's manager of clinical systems, says that when she and her colleagues were planning their system-wide EDIS implementation with CliniComp, also in San Diego, it was clear that they needed first to be able to track patients, and then better manage their flow through the care process.
That flow is much better post-implementation, Miranda reports, and, she adds, "We've been able to decrease our lengths of stay in the ED, and that has increased patient satisfaction, because we're not asking the same questions multiple times. Also, we don't have to continually track the physicians down to tell them when patients are ready to be seen; they take responsibility for looking at the tracking screen themselves. So, it's a satisfier for clinicians as well."
It comes down to commonsense advances, she says, such as not having to shift a patient out of a critical care bed and then move that patient back. And, she adds, because of the data available for multidisciplinary data analysis, ED clinician staffing and bed management can be better predicted and optimized.
Mark Hagland is a contributing writer based in Chicago.