News & Events :: Media Mentions

Technology to the Rescue

Emergency medicine practitioners summon information technology to improve patient care and bolster revenue.

By Bill Briggs, Senior Editor
Health Data Management Magazine, January 2002

Suppose you walk up to the desk clerk of an Atlanta hotel and say you’d like a single room with a king-size bed. The clerk responds, “I’ll see if we have any available.” He steps from behind the desk, takes the elevator to the top floor, then proceeds to open each door until he finds an unoccupied room meeting your request.

This scenario is absurd, of course, because no hotel could survive such an inefficient system of tracking empty rooms. It’s no less absurd in an emergency care setting when a triage nurse must physically check each exam room or cubicle to see what’s available, says Phillip L. Coule, M.D., director of emergency medical services at the Medical College of Georgia in Augusta.

Until August, when patients arrived at the Medical College’s emergency department, the triage nurse had no idea what was going on in back, Coule explains. “There could be five rooms open or none,” he says. “Now, when a patient comes up to the window, the triage nurse can see the status of every room via computer with just the click of a mouse.”

Inefficiency long has plagued emergency care settings, but information technology is helping streamline processes while improving outcomes and increasing revenue. Technological advances—incorporating hand-held devices, wireless networks, the Internet and regional information systems that track emergency room space availability—are contributing to greater efficiency in emergency medicine.

These advances in information technology help emergency medicine facilities more easily perform such tasks as patient documentation, patient and room tracking, charge capture, and clinical decision support, while improving access to patient medical records.

Emergency medicine is unique in terms of the speed, intensity and singular nature of its patient encounters, says Hal Gilreath, senior manager at PricewaterhouseCoopers, a New York-based consulting firm. “Providers are more mobile and patients are more critical,” Gilreath explains. “In addition, care is very episodic. The ER usually is not going to see the same patient more than once.”

The need for emergency medicine practitioners to perform quick analyses and get patients stable for transfer or release hasn’t changed since the inception of such care, Gilreath says. The quality of care, however, has improved, he adds. Hospital closures, a rise in the number of uninsured in the United States and other external pressures have created enormous strain on the emergency care sector, says Thomas C. Kravis, M.D., a consultant for the Chicago-based consulting firm Arthur Andersen.

“Because of the increasing number of patients, emergency care departments are overloaded,” Kravis says.

Overcrowding a concern
Overcrowded emergency departments and the consequent need to divert patients to more distant facilities can have disastrous results when time is precious.

At the Medical College of Georgia, information technology offered a solution, says Coule, the emergency medical services director. Since implementing an electronic patient registration and documentation system from New Wave Software Inc., Cincinnati, the medical college can better control overcrowding, Coule says.

“When the department is not very busy, the speed at which a patient gets into a room is faster,” he says. “When the department is full, the information system speeds up putting a patient in a room because we can tell immediately when one opens.”

Emergency medicine facilities nationwide wrestle with the overcrowding issue. A serious consequence of overcrowding is ambulances—and patients—being diverted to more distant emergency departments because no room is available. This can cause critical delays in care as ambulances look for available emergency department space.

Web-based information systems, however, are the solution for some communities, such as Phoenix. The Phoenix Fire Department—which employs 1,500 firefighters, half of whom are paramedics—is connected to a Web-based dispatch system that tracks emergency department patient volumes at 28 hospitals.

If an area hospital’s emergency department is full, the hospital can change its online status to “closed” using a computer linked to the information system, from Milwaukee-based Infinity Healthcare Inc. The application, called EMSystem, enables all member institutions to report their emergency department’s status in real time, says Mike Generalli, a paramedic captain for the Phoenix Fire Department. “Within 60 seconds, everyone knows the hospital went ‘closed,’ ” Generalli says.

A hospital’s status information is monitored at the fire department’s “alarm” room via a PC logged onto Infinity Healthcare’s password-protected Web site. From there the information is relayed electronically to mobile data terminals in ambulances and broadcast on the vehicles’ two-way radios.

That’s a far cry from the old method, which was telephone-based. A hospital would call the Phoenix Fire Department and other emergency services organizations to change its emergency department status. That would trigger the fire department to make six to eight phone calls to other health agencies and organizations.

In addition to monitoring emergency department patient loads, the Web-based system is enhancing cooperation among the participating institutions, Generalli says. Monthly meetings of the organizations’ representatives during the two years the network has been running have yielded ideas about how to make emergency care easier for all parties, he adds.

Costs for participating in the Web-based network are an initial $9,500 per hospital in a given region, plus an annual subscription rate of $850 for each participating organization.

Catching on
Web-based networks designed to track an emergency department’s status are catching on around the country, but the concept isn’t new, says Kravis, the Arthur Andersen consultant. “These systems were developed five to 10 years ago,” he says, “and now they are increasing.”

Technology has improved on the early automated systems, which were not Web-based. Costs also have dropped, making Web-based systems more attractive to public entities that often fund them, Kravis adds.

County emergency medical services agencies often spearhead such initiatives, as do local government agencies such as public health departments.

Patient data
In addition to Web-based tracking of emergency departments, some hospitals are using emergency medicine information systems to quickly search for a patient’s medical history, Kravis says.

Locating relevant registration data speeds the administration process and reduces interruptions to the care process. And having clinical data in hand also helps avoid redundant tests and procedures on “frequent fliers,” individuals who repeatedly visit emergency rooms, Kravis says.

Many hospitals have this kind of emergency department data available only for patients they have treated. Efficiency and savings on a grander scale could occur if patient information was available through a central database on a regional or metropolitan area basis, some observers say.

Such a program is under way in central California, spearheaded by the Oakland-based California Emergency Physicians Medical Group.

The group employs some 700 emergency medicine clinicians—including physicians, physician assistants and nurse practitioners—assigned to 66 hospital emergency departments and ambulatory care centers ranging from Sacramento to San Diego. The medical group’s client organizations deliver about 15% of California’s emergency care, says Ted Kloth, M.D., vice president of business development.

The group is offering the 1.5 million patients treated each year at its members’ emergency care facilities an online personal health record. The records are stored in a patient data registry called PersonalMD, from PersonalMD, Pleasanton, Calif. Personal health record.

Patients who sign up for PersonalMD service get an identification card and a personal identification number. Patients load their medical records with pertinent facts and can grant access to emergency personnel.

The patient’s record is stored in PersonalMD’s database and can be accessed via the Internet or by fax, Kloth says. “Emergency patients usually don’t have records on file where they are being treated,” he says. Plus, emergency department patients often aren’t coherent and may not be able to tell clinicians essential details of their medical history, says Kloth, who also is on the emergency staff at Walnut Creek, Calif.-based John Muir Medical Center.

“But if the patient has a card that can access an EKG or medication information, imagine how that can save money and time by avoiding repeated tests or giving the wrong medication,” he says.

California Emergency Physicians Medical Group is involved in developing other means for streamlining the emergency care process, albeit indirectly, through MedAmerica, its subsidiary management services and technological support company. MedAmerica provides support services solely for California Emergency Physicians Medical Group.

One of MedAmerica’s products is a patient tracking and documentation information system that helps participating California Emergency Physicians Medical Group organizations’ emergency personnel document services, monitor the patient’s location within a hospital and produce after-care instructions for the patient, says Steve Saunders, MedAmerica’s CIO.

The client/server-based application is installed in partnership with participating hospitals and requires interfaces with admission-discharge-transfer and laboratory information systems, Saunders says. The application is designed to improve emergency department efficiency.

Mining data
On a broader scale, MedAmerica developed a data warehouse that enables the California Emergency Physicians Medical Group to examine and enhance clinical practices at its client facilities. The data warehouse contains information on all patient encounters and helps the organization develop best practices and boost efficiency, Saunders says.

Clinicians can review practices via a password-protected intranet, which also serves as a conduit for clinical discussion forums, explains Wesley A. Curry, M.D., president of the medical group.

Tapping into existing banks of data is a goal of many emergency departments, including the Medical College of Georgia. Extracting data from its emergency department is especially important for the teaching institution, says Coule, the emergency medical services director, who also is an assistant professor.

“We need to know the productivity of our residents so we can coach them, and encourage them to move things along if necessary,” he says.

Before automation, Coule had to dig through treatment records that were typed into a paper-based log. “It was cumbersome, after-the-fact and very labor intensive,” he adds. Tracking patients with chest pains, for example, was also painful for administrators, Coule says, noting that the complaint could have been written as “chest pain,” “CP,” “chest pressure” or some other variation. Now, clinicians use drop-down lists to enter patient complaints, standardizing the naming process.

The technology in place at the Medical College of Georgia already is making a difference, Coule says.

“If we are more efficient, we’ll see more patients and get them out of the ER faster,” he says. “The use of information technology in the emergency department is probably going to alleviate the overcrowding problem.”

Sidebar: Hand-held, wireless coming into play

Many provider organizations are trying to make drug interaction data accessible to clinicians via the nearest computer. But for mobile emergency department physicians and nurses, that’s not always close enough. The California Emergency Physicians Medical Group believes it has a solution, in the form of personal digital assistants, says Ted Kloth, M.D., vice president of business development at the Oakland-based emergency medicine staffing and management services company.

The medical group’s goal was to enable access to drug information without being tied to computers, or even the Internet. “We found that hand-held devices have tremendous ability to provide information at the clinicians’ fingertips,” Kloth says. “It takes longer to log on to the Internet.”

About 600 clinicians, working at 66 emergency care facilities in California, signed up for the service. Hand-held devices from Palm Inc., Santa Clara, Calif., were made available to all who wanted them.

The devices contain drug prescription and interaction information from ePocrates.com, San Carlos, Calif. Kloth believes fast access to the information has reduced the California Emergency Physicians Medical Group’s exposure to legal liability from medication-related errors.

“It helps them keep up,” he says. “Clinicians can’t read everything, so we provide a ‘peripheral brain’ in the Palm.”

Hand-held devices soon could be attractive options for many emergency care facilities, says Hal Gilreath, senior manager at PricewaterhouseCoopers, a New York-based consulting firm. “Point-of-care technology is maturing enough to see more mainstream adoption in the next year or so,” he contends. The key to such advances is a simple, intuitive interface with other information systems in a hospital, he says. That will enable clinicians to input and access data. But the technology must be easy to use, Gilreath cautions.

“The applications must have drop-down lists to minimize handwriting, and screen sequencing” that will enable clinicians to move logically from one screen to another to limit waiting time. “And they have to support workflow,” he adds.

Bedside orders
Adding wireless networking functions will assist in meeting the information access needs of emergency departments without interrupting workflow, some observers say. At the Medical College of Georgia, Augusta, emergency physicians began reaping the benefits of wireless hand-held devices in late November.

“I can sit at the patient’s bedside and order lab tests, interventions, medication, X-rays—all with the tap of a button,” says Phillip L. Coule, M.D., assistant professor at the Medical College of Georgia and director of emergency medical services. “It will all be set in motion, and then I can go see the next patient.”

Before the devices were available, the process started with Coule tracking down the patient’s paper chart, then manually entering the orders and peeling and sticking coded diagnosis and treatment stickers onto the chart.

The wireless system comes from New Wave Technologies Inc., Cincinnati, and the hand-held devices are iPAQs, from Compaq Computer Corp., Houston.

Such advances in information technology will enable provider organizations to meet expanding demand for emergency medical services, contends Wesley A. Curry, M.D., president of California Emergency Physicians Medical Group. “More than 100 million patients visit emergency rooms every year,” Curry says. “That will increase due to our mobile population, the lack of health insurance and the lack of access to care.”

As wireless applications and hand-held devices reach their technological potential, physicians will have access to patient records and treatment information anywhere, Curry contends. And the advent of personal health records added into the mix makes it possible to tie health care information together.

“Then it doesn’t matter whose ER treats the patient,” he adds.