News & Events :: Media Mentions

Technology in the ED

Emergency Departments adopt technology to improve care, bottom line.

By Caroline Broder
www.iHealthbeat.org, August 21, 2003

Emergency departments are typically the last area of a hospital to adopt technology. Walk into any emergency department, and you're likely to see the same old white grease boards that EDs have used to track patients for years.

A recent study by researchers at Boston's Brigham and Women's Hospital confirmed the situation. The study, published in the August issue of Academic Emergency Medicine, revealed that emergency departments in academic teaching hospitals had scattershot technology implementation. The study found that 18% of the 149 responding EDs had implemented computerized physician order entry systems, and only 7% had medication error checking systems in place.

"What we have found is that a lot of hospitals are reluctant to make this investment. A lot of them don't see the ED as their prime focus," said Bruce Siegel, director of the Robert Wood Johnson Foundation's Urgent Matters National Program Office, which helps hospitals ease ED crowding. The program gave a $275,000 grant to the Regional Medical Center at Memphis to use bar codes and wireless devices to track patients in the ED. The hospital is working with FedEx to develop the technology.

Siegel, who also is a research professor at the George Washington University in Washington, D.C., said that many hospitals don't make the investment because most EDs have contract physicians on staff. When a hospital is looking at places to implement technology, it usually makes the investment in an inpatient area to please the hospital's regular staff clinicians.

Technology has potential in EDs But neglecting the ED's technology needs could be a mistake. A study from the California HealthCare Foundation found that the emergency department could be a potential source of revenue through inpatient admissions to the hospital. Today, the ED may as well be the front door for many hospitals. In many cases, it is the first interaction a patient has with a hospital, says Ken Howard, executive vice president of acute care for A4 Health Systems, a health care software vendor.

"There's a lot more people right now going to the emergency department for primary care," he said.

Still, he estimates that less than 10% of hospital EDs have some sort of automation and less than 50 U.S. hospital emergency rooms are totally paperless.

One hospital ED that did go paperless is Mount Carmel St. Ann's, an Ohio community hospital that is part of the Mount Carmel Health System. In July 2001, the Westerville hospital began using a comprehensive electronic system from A4 Health Systems. The system has helped the hospital save half a million dollars and increased charge capture, according to Sonja Howard, a registered nurse and system administrator for the ED. Another benefit: The ED doesn't lose patient charts like it used to, and medical records are more complete, Howard said.

John Muir Medical Center in Walnut Creek, Calif., also uses A4's technology in the emergency department. The hospital went live with a patient tracking system and physician order entry in March 2002, and has since improved patient throughput in the ER, eliminated lost charts and decreased its billing time.

"Everybody knows where every patient is," said Julie Crouse, the hospital's ED director. "...Nurses can triage patients faster."

Anaheim Memorial Medical Center is another California hospital looking to remove patient bottlenecks in the ED with technology. The ED can better manage these backups using infrared devices that clip to a patient's hospital gown, staff uniforms and equipment. Sensors installed at various points in the ED then read the signal.

Elsewhere, the California Emergency Physicians Medical Group started a program to offer its members handheld computers with access to clinical guidelines and the ePocrates prescription drug database. About 600 California ED physicians are now using the handhelds, according to Dr. Wesley Curry, president of CEP.

Physician support, integration key to success
Before installing technology in the emergency department, it's important to secure physician or nurse buy-in. At Mount Carmel St. Ann's, the ED's contracted physician group was on board from the beginning and helped pick the system. Today, the ED has about 95% usage of the system, Sonja Howard said.

At John Muir Medical Center, nurses gave feedback about the system before it went live and had a hand in choosing how the technology would integrate with their workflow. However, the ED physicians weren't initially as enthusiastic and had a "really hard time adapting," Crouse said.

Another strategy for success is to roll out with what A4's Howard calls the "big-bang" approach, instead of gradually phasing in a technology. That way, physicians can't complain that the previous phase didn't go well.

"If your physicians aren't behind it, you can kiss it goodbye," Howard said.

Both Mount Carmel St. Ann's and John Muir Medical Center went live with the technology all at once. While both hospitals said this was the best approach, it was not a pain-free experience for John Muir's ED.

"The first weekend was hell," admits Crouse. "We came to a dead-stop; it was a very difficult two to three weeks."

A4 stepped in to help, and staff eventually learned the system. Since then, physicians have told Crouse they wouldn't go back to using paper. The hospital plans to add clinical decision support at point-of-care within the next month.

Another piece of advice: Hospitals should integrate ED systems with other hospital systems, says Nancy Burghart-Hall, CIO for MedAmerica, the California Emergency Physicians Medical Group's medical practice support company.

"If you're not fully integrated across all units of the hospital, automating just the emergency department doesn't do that much for you," Burghart-Hall said.

Most hospitals have several IT projects competing for dollars, leaving EDs as the last place to get funds for technology, she said. While very few hospitals have succeeded in automating the emergency department, A4's Howard said he has seen an uptake in hospitals looking to wire the ED.

"People are now seeing the emergency department as a source of revenue," Howard said.