The ambulance backs up to the emergency department, and a critically injured patient is wheeled in. Doctors and nurses scramble about, barking orders and grabbing equipment and charts, while a dry-erase board in the center of the chaotic room keeps track of each patient’s status.
Today’s ER? Not likely, say hospital officials and healthcare IT vendors who scoff at the notion that the NBC-TV show imitates life. In fact, you’d be as likely to find a dry-erase board in a hospital’s emergency department as you’d see George Clooney return to the show to bolster his paycheck.
Spurred by a 2006 Institute of Medicine report titled “Hospital-Based Emergency Care: At the Breaking Point,” more hospitals are employing technology in their emergency departments. Programs like Picis’ EDPulseCheck and MEDHOST’s EDIS track each patient in the ED, coordinate doctors and nurses, schedule medical treatments and facilitate bookkeeping. Other programs, like PortBlue’s recently released CommandAware Hospital Incident Response System, allow hospitals to better organize their EDs to handle crises ranging from hurricanes to bioterrorism attacks to pile-ups on the freeway.
“The emergency department is not the (hospital’s) back door – it’s the front door, an entry point for 40 to 60 percent of a hospital’s patients,” points out Todd Cozzens, CEO of Wakefield, Mass.-based Picis, which has been offering EDPulseCheck for approximately seven years. “It’s the most visible portal to the community.”
And that portal is only now being spruced up.
According to the IOM report, the number of people visiting EDs for emergency care rose by 23.6 million between 1993 to 2003, while the number of hospitals fell by 703 during that span (the number of emergency departments decreased by 425 and the number of hospital beds dropped by 198,000). This has led to overcrowded emergency departments, overworked hospital staff and fragmented care, and the report describes “an especially urgent need to apply information technology to the delivery of emergency care.”
According to Cozzens, roughly 30 percent of all North American emergency departments have some sort of technology, while less than 15 percent are outfitted to a point that they would be considered IT-dependent. But those figures, he says, are changing rapidly as hospitals move to automate their EDs.
Today’s ED programs track patient progress on a monitor, diagramming beds, patients and staff much like a restaurant might chart tables, customers and waiters/waitresses. Touchscreens and hand-held devices allow doctors and nurses to call up critical information on patients and treatments, prescribe medicines and schedule surgical procedures. Automated – read, paperless – systems move the patient through the ED to discharge or a hospital room, create an electronic health record and establish an audit-free billing record.
Quite a change from the ED of, say, just a few years ago.
“Automation was a novel idea back then,” says Patricia Daiker, a registered nurse and director of marketing for Dallas-based MEDHOST, which has been offering its EDIS system since 1999. “Nowadays, you have a more savvy healthcare market.”
MEDHOST CEO Craig Herrod says his company, like so many others offering ED technology, has seen strong growth in recent years. The challenges faced by emergency departments in the wake of the Sept. 11, 2001, terrorist attacks and Hurricane Katrina spurred some of that growth, when paper-based emergency departments had trouble coping with the sudden influx of patients and medical issues.
“Our goal is to shave seconds, minutes, from each (ED) encounter,” he says.
Mount Sinai Medical Center in New York City deployed Picis’ EDPulseCheck three years ago, and has seen a 50 percent decrease in the amount of time it takes to move a patient through the department. In addition, the hospital has seen an increase in revenues of some $7.5 million, as well as improved documentation and billing and a drastic decrease in lost or incorrect data.
“We used paper. We charted in paper – virtually longhand,” says Dr. Kevin Baumlin, director of informatics and assistant professor at Mount Sinai’s Department of Emergency Medicine.
“We didn’t just try to automate what we did,” Baumlin says. “We tried to improve on what we did.”
Joining the mix is Los Angeles-based PortBlue, a vendor of custom-based modules that is venturing into subscription-based services with the launch late last year of CommandAware, a HIPAA-compliant hospital incident management system. PortBlue is one of several vendors to launch products in the wake of Katrina, which challenged already-overworked emergency departments from Florida to Texas.
“This will be a very important issue for hospitals in 2007,” says Paul Dimitruk, PortBlue’s CEO.
PortBlue has launched CommandAware in hospitals in Florida and Washington and is working with large hospitals in other parts of the country.
“It takes the place of the … conventional three-ring binder,” he says. “It’s accessible, it’s up to date, and it’s on the right person’s shelf when it’s needed.”
What lies ahead in ED technology? Herrod and Daiker say MEDHOST is working on improved databases for pharmacies to better identify drug interactions and instances when generic drugs may be used instead of more expensive medications. In addition, they’re developing risk management and clinical decision support tools to help ED doctors with the so-called “John Ritter Syndrome” – a case that presents as one diagnosis, but which could contain tiny, all-but-unnoticeable signs of being something more dangerous. For instance, a doctor might see all the signs of a migraine headache, but when inputting data to an ED system an alert might indicate the possibility of a stroke.
Cozzens, meanwhile, says Picis is continually working to make the system easy to use, since ED personnel rarely have the time to take on a complicated piece of technology when lives are at stake. He’d like to see more decision support and risk management tools, as well as data warehousing and analysis tools that might help EDs in different hospitals identify the onset of an epidemic or health emergency early enough to avert a crisis.
“What’s absolutely key in the ED is that everything is easy to use,” he says.
