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Urgent Care: CIOs Struggle with the ED Integration Issue

November 28, 2010
by Mark Hagland
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Will Standalone Systems Hold up Under Meaningful Use

EXECUTIVE SUMMARY

The current landscape around meaningful use requirements under the HITECH Act is forcing CIOs and their colleagues to confront a stark choice between two strategies-one being maintaining a best-of-breed emergency department (ED) clinical information system, and interfacing it to their core inpatient electronic medical record system; and the other being to pursue a uniform core-clinical strategy, even if that means ripping and replacing a best-of-breed ED system with an ED module from the core-clinical vendor. The debate over this choice reflects the broader clinical IS challenges facing CIOs and other healthcare IT leaders today.

Chuck Podesta, senior vice president and CIO at the 562-bed Fletcher Allen Healthcare in Burlington, Vt., has faced what many CIOs might consider a potential “nightmare” scenario: he's ripped out a popular best-of-breed emergency department (ED) information system and installed the ED IS module from his core clinical EMR vendor (the Verona, Wis.-based Epic Systems Corp.). Facing a “Sophie's Choice”-esque conundrum of a potential emergency physician mass revolt, versus interfacing hell in perpetuity, Podesta swallowed hard and sat down with the physician leaders of his ED, who, in his words, “really stepped up to the plate,” and agreed to make the change to the core clinical-based ED module.

WE HAD WORKED VERY HARD WITH THEM AS PART OF THE EPIC GO-LIVE PROCESS, AND IN FACT WENT LIVE IN THE ED 72 HOURS IN ADVANCE OF THE REST OF THE HOSPITAL, TO HELP SMOOTH THE TRANSITION.-CHUCK PODESTA

And even though the hospital's 30 ED physicians' “productivity tanked, as we had expected,” by the time the Epic system went live in June 2009, “We had worked very hard with them as part of the Epic go-live process, and in fact went live in the ED 72 hours in advance of the rest of the hospital,” to help smooth the transition, Podesta reports. What's more, he says, what emerged was the realization that an absolutely key factor involved in ED physicians' loss of productivity (which was adding an hour or more onto their already very long workdays, in the busy, 60,000-visit ED) was the length of time needed to document in the new system. “How we finally got over that hump was by bringing on the Dragon [NaturallySpeaking] speech recognition product from [the Burlington, Mass.-based] Nuance [Communications Inc.], which bolts on very nicely to the Epic ASAP ED product, and which works very nicely with the templates in the Epic system, and takes about a half-hour to learn,” he notes.

With that technology addition, Podesta was able to overcome an intense ED physician satisfaction challenge, and move forward to streamline the ED-to-inpatient documentation and clinical workflow continuum through the implementation of a single core clinical vendor across both the ED and inpatient spheres.

POINT OF TENSION

Chuck Podesta
Chuck Podesta

The question facing Chuck Podesta and his colleagues at Fletcher Allen is one being replicated across the country, as CIOs, clinician leaders, and clinical informaticists nationwide are confronting the best-of-breed-versus-core-clinical-vendor choice in its most dramatic, concentrated form, at a time of heightened tensions. With the data collection and reporting requirements for meaningful use coming out of the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, the stakes around that question are higher than ever. What's more, since so many hospital organizations around the country implemented best-of-breed ED clinical information systems before they implemented full EMRs, but are now rushing to implement EMR and computerized physician order entry (CPOE) to comply with meaningful use, their leaders face a stark choice between potentially alienating their ED physicians and living in interfacing hell for the foreseeable future.

Scott MacLean
Scott MacLean

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Comments

The issues are complex in this area, and the choices can be wrenching. For CIOs who decide not to pull a best-of-breed ED system, there are new options in interface management and automated interface documentation that can reduce implementation and maintenance effort. (Full disclosure: I work for an interface management software company.)

This best-practice suggestion from our blog may be of help:
http://caristix.com/Blog/2010/11/hl7-interface-specifications-easy-to-do...

Sovita Chander
Caristix

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