According to a recent KLAS survey on emergency department information systems (EDIS), 38 percent of hospitals surveyed are already looking to invest in their second or even third EDIS. Seems high? Not if you consider that for many hospitals, the ED is the first point of entry for a majority of their patients, so it better deliver. The same survey also says that though only 25 percent of hospitals currently have an EDIS, 40 percent plan to implement one in the next two years. The wealth of new or improved products on the market means that CIOs shopping for a system have choices, and many more questions to ask.
“There's no magic bullet for me,” says Jason Hess, research director at KLAS Enterprises, Orem, Utah. “By and large the argument comes down to IT vs clinical.” Best of breed EDIS (typically developed by clinicians) generally garner high satisfaction rates. And yet, according to KLAS, the greater majority of second generation EDIS purchases are sole source enterprise solutions that easily integrate back to a hospital's main HIS. Why? Connectivity, it seems, is key.
Connectivity through effective interfaces to internal and, increasingly, external applications rate high on everyone's wish list for an EDIS, but Hess says functionality is also important. “We look at key modules,” he says. “The first is patient registration, typically captured in the patient ADT (admission/discharge/transfer) system for the hospital and sent over an interface to the EDIS.”
Triage or tracking through an electronic whiteboard is next, Hess says, and allows clinicians to see in real time where the patient is, if labs are back and make room assignments. Next up? Clinical documentation. “Are physicians really documenting electronically in real time at the bedside?” he asks. “Many physicians say if the solution takes 17 mouse clicks, we don't use it when we're busy.” And what ED isn't busy?
Hess says the ordering module of an EDIS is the last key piece, which means tests like CT scans or labs, with results incorporated in the main EMR, and the ability to view PACS images right in the EDIS. If it's not interfaced, he says, nurses may have to print the order and re-key it into the clinical system. “I've seen that a lot,” he says. “Yes, the physician is ordering into the EDIS, but if it's not integrated to the rest of the clinical (systems), it's double the work.”
Though best-of-breed systems are easier to use, Hess says, “With no interface there will be no adoption.”
Best of breed
But if a hospital chooses to go best of breed, are the daunting interfaces a roadblock to implementation? Not for Eastern Connecticut Health Network (ECHN) in Vernon, Conn. ECHN went live last March, and though its primary HIS system is Meditech (Westwood, Mass.) the organization chose Chicago-based Allscripts for the EDIS. “I'm not going to throw away my whole HIS just to get an ED system, yet I needed an ED system with all the management features that Allscripts offered,” says Charles Covin, CIO at ECHN. Allscripts EDIS came from the acquisition of physician-developed Nine Rivers Technology, Raleigh, N.C., and is number one in KLAS.
Why not stay with Meditech as a sole source solution? Covin says at the time Eastern was looking, execs didn't feel the Meditech ED system had the advanced functionality they needed.
“We realized there's no way you can fully interface everything from two foreign vendors,” Covin says. “But there is a core functionality that is important to fully integrate.” ECHN negotiated that interface even before bringing in the system, using Iatric Systems, Boxford, Mass. “It was a very complex interface, which had never been done before between Meditech and Allscripts,” he says. He says ECHN felt it could establish a strong working relationship with Allscripts and Iatric to get the project to work — and that was a key factor in the decision.
Documentation is a shared process. Lab orders placed in the Allscripts EDIS go back to the Meditech system for service, which then sends the results back to Allscripts. “Our intention here was not to have anyone use two systems,” says Covin. Registration is done in Meditech, the registration appears in Allscripts and at that point the patient is on the tracking board. The ED nurses and physicians do all their work in Allscripts and that's interfaced back to the appropriate Meditech module. User departments work in their Meditech module, and the results interface back to Allscripts. At the same time, the results go to the Meditech system too, so when the final ED report comes over, everything now resides in the Meditech system.
“Attending physicians only look at Meditech for a complete record,” Covin says. “And they didn't have to learn a new system. Almost nobody has to know two systems.”
The final ED report is sent to the physican's office in a number of different ways. “If physicians have an EMR, and we've developed an interface for it, we send it directly to their EMR,” Covin says.
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