As the healthcare environment continues to become more competitive and complex, hospitals and health systems are discovering that in order to succeed they must consistently deliver high quality patient care, while managing costs. Pivotal to that success is the Emergency Department (ED), which often serves as the key entry point for patients entering the hospital. Since it impacts a hospital’s reputation and represents a substantial portion of revenue through admissions, it is critical to have a fully optimized ED. Additionally, improving ED throughput has been established as a key quality initiative by many industry leaders including The Joint Commission, The Advisory Board and the Institute for Healthcare Improvement.
Whereas many years ago, it was sufficient for Emergency Departments to utilize paper charts and a whiteboard for patient tracking, the times have changed— and so has technology. Emergency Department Information Systems (EDIS), also commonly called Emergency Department EHRs, were developed in the 1990s to replace paper-based and manual systems.
According to the American College of Emergency Physician’s (ACEP) Policy on Health Information Technology, an Emergency Department Information System is an extended EHR system designed specifically to manage data and simplify processes in support of Emergency Department patient care and operations.
The Emergency Department environment is immensely different than that of ambulatory and inpatient environments. While ambulatory and inpatient settings focus on longitudinal care, emergency care settings are episodic and generally more complex. Patients arrive in the ED under unpredictable circumstances, and typically require immediate and urgent medical care. Both speed and accuracy are critical throughout the ED encounter – from check-in and triage, to documentation and order processing, to communication with other hospital staff, all the way through to discharge. Numerous operational steps must be taken under severe time constraints and sometimes overcrowded conditions.
Due to these differences, simply utilizing the same EHR technology as ambulatory and inpatient isn’t advised and is like trying to fit a square peg into a round hole. For example, many have found their hospital-wide HIS or enterprise EHR system doesn’t offer the advanced features, functionality or customizations necessary for Emergency Departments. And with the number of ED patients continuing to grow year after year, many hospitals have realized the growing need to provide better care by streamlining processes, workflow and throughput through the utilization of an Emergency Department Information System (or an ED-specific EHR).
Some of the key features of Emergency Department Information Systems include:
- Patient Tracking is a must-have for automating workflow within the emergency department by coordinating and accelerating the flow of patients. The patient tracking board is typically color-coded and should be easy to read at-a-glance so clinicians can better track pertinent patient information including the status and location of the patient throughout the encounter. Ideally, the information should be dynamic and in real-time (users shouldn’t have to refresh the screen for updated information). It should also be tailored by the vendor to tightly integrate into the ED workflow utilizing best practices. Some EDIS vendors also offer unique screens such as triage or fast-track display which can be configured to display only the data you want to see.
- Clinical Documentation is more challenging in a fast-paced Emergency Department environment where it needs to be done with greater speed and precision. This means physicians and nurses need an intuitive, easy-to-learn, lightning fast and accurate charting system that minimizes clicks. Charts from previous visits automatically available to support patient care decisions, the ability for multiple people to document at the same time, instantaneous keystroke recognition with autosave, being able to use a variety of templates and mechanisms (voice, touchscreen, handwriting), and the ability to free text at any given point are just a few of the functionalities available to maximize utilization and minimize EHR fatigue and burnout.
- Order Management includes CPOE (Computerized provider order entry) for procedures, tests, medications, IVs and consults, as well as viewing of the results. Pivotal elements of order management include: the ability to specify and customize orders and order sets, integrated Clinical Decision Support, support for routine and critical values, auto-documentation and time stamp of results information and results reviews, as well as instant submission of orders to lab and/or radiology for completion.
- Reimbursement that is accurate and timely is essential to ensuring hospitals don’t lose revenue for allowable ED charges. To optimize revenue, a system needs to provide: complete and accurate charge capture for E&M Level of Service, CPT and Service Codes; integrated charge capture that automatically captures start/stop times and charges for pushes, injections and hydration procedures; and immediate regulatory and procedure changes for facility and physician coding (so as to eliminate coding-related denials).
- Risk Management/Clinical Decision Support (CDS) are reminders, alerts and decision support tools that help clinicians decide whether to accept possible existing risks or modify the current treatment plan for the patient. Drug/drug and drug/allergy alerts, medication reconciliation alerts, drug dosing calculator alerts based on minimum/maximum doses, mandatory data capture, and state mandates all fall under the umbrella of Clinical Decision Support. Ideally, it should be highly configurable (for example to allow for differences at each site), and should have easy on/off functionality for alerts.
- Data Management/Analytics allows administrators and hospitals to calculate, track and ultimately improve performance. Data collection should be built right into the workflow with data points (structured and unstructured) automatically captured in the background. It should include not just clinical data, but financial and operational data as well.
- Discharge Planning includes discharge instructions, final diagnoses, patient education, follow-up management, etc. It should expedite the discharge process and provide opportunity for the clinicians to review/confirm all information and orders prior to the patient’s release from the ED.
- Integration, although listed last here, is certainly not the least important. It’s critical to have an EDIS built on scalable and flexible architecture that allows it to integrate well with EHR and HIS platforms, HIEs, as well as lab, radiology, pharmacy, PACs, cardiology, billing and other ancillary systems. It should also provide a single point of access for clinical information.
Benefits and Anticipated Outcomes
There are many benefits to investing in an Emergency Department Information system. Some of the most common ones include:
- Productivity and Efficiency Improvements: Through automated processes, there are increased efficiencies in patient throughput and clinician productivity. By utilizing various EDIS components, many hospitals experience reduced waiting times, elopements, and triage times, as well as decreased overall length of stay (LOS).
- Enhanced Quality of Care, Patient Safety and Satisfaction: Hospitals without an EDIS generally have longer wait times which can result in lower patient satisfaction and worse patient outcomes. With an EDIS in place, when workflow is optimized and the right information is made available to help clinicians more effectively make decisions, then generally patient care, satisfaction and outcomes improve.
- Increased Revenue: This could take into account improved charge capture, tracking of infusion start/stop times, and/or real-time tools offering E&M professional coding capabilities – all of which can help improve revenue. A decrease in medical errors and liabilities is an added benefit since they would have a negative impact on revenue.
- Time Savings: For order entry, documentation, ePrescribing, discharge instructions, etc. A decrease in clinician turnover time at the end of the shift could also translate to less overtime payout.
Want to compare Emergency Department Information System vendors? Check out the latest 2019 Best in KLAS: Software and Services Report for Emergency Departments to see how vendors stack up.
If you want to understand if an Emergency Department Information System would be right for your hospital, or are interested in seeing a demo of the #1 rated Emergency Department Information System by Wellsoft, click here.
Did you know? Wellsoft EDIS is still offered as a standalone solution, but is also now part of the larger enterprise hospital solution from Medsphere.
