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The EHR allows the ED to track all patient encounters in real time, documenting activities, such as when patients arrive, when they are first visited by a nurse or physician, when orders are placed and results returned and the time the visit concludes, with either an admission into the hospital or a discharge.

The EDIS also helps determine and coordinate adequate staffing needs. The technology’s analytical capabilities can compare historical information and census data to determine appropriate staffing levels to meet and predict periods of high volume. It can also alert staff if capacity is exceeding the available number of beds. Workflow efficiency is another critical element to improv- ing patient care. Workflow processes can get backed up when there is no clear, immediate way to notify physicians that lab and test results have come back. With an EDIS, lab results are immediately uploaded into the patient’s record. Automated alerts can also notify clinicians when orders need to be filled, when lab values are abnormal, when patients need to be transferred to a different department or when ambulance patients need to be registered – all of which decrease overall turnaround time.

The technology further helps EDs meet meaningful-use standards by automating and printing discharge instruction forms. EDs can also make discharge instructions available via email to the patient. Prescriptions can be written electroni- cally, reducing errors and drug interaction. Similarly, hospital transfer information can be part of the patient’s electronic record that follows them from the ED to the hospital or primary-care setting.

The automated system provides patient-information man- agement for a variety of ED procedures, including patient tracking, order entry, prescribing, data retrieval, charting and nursing functions. In addition, a facility-wide documentation system promotes patient safety outside of the ED by helping the staff identify people who have multiple visits (ED and primary care) and may need specialized help in managing their care. The right EDIS can also be used to identify patients who are using the ED inappropriately – for example, for non-emergent needs such as suture removal and follow-up care – and help navigate them to the right venue, such as a PCP or urgent clinic. With the advent of uniform data-collection systems and

ED-based surveillance systems, emergency medicine also has the potential to play a powerful role in measuring and improv- ing the health of the population. EDs can provide information on the healthcare needs of a diverse population and serve as a unique research lab for studying the functionality of the healthcare system.

This information can be used to identify, track and trend outbreaks of disease, for surveillance of bioterrorism or for collecting data for regular disease management such as diabetes, hypertension, myocardial infarction, pneumonia and congestive heart failure. Many of the systems are able

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to aggregate and collect the information needed to report quality measures to CMS and other healthcare organizations. The effective EDIS can help suggest care to the clinician to provide the highest quality care to the patient. An ED environment is very different from specialty clin- ics, primary-care sites or even the hospital floor, because ED physicians are typically treating patients with multiple conflicting complaints instead of a singular condition, such as a cough, cold or hypertension. As a result, when it comes to the medical record, there must be a means for address- ing these various conditions so that the information can be quickly and easily captured, coded and submitted for reim- bursement. Similarly, procedures common to the ED, such as restraints, sedations and intubations, are often missing from clinical EMRs.

A robust EDIS should generate reports on clinical, financial and operational efficiencies. The system should be equipped with real-time tracking or location technology to provide valuable information on throughput, length of stay, door-to- provider time, x-ray and diagnostic-turnaround time. In addi- tion, it should have the ability to integrate across the system by capturing the ED record and combining the information into the inpatient record, which includes imaging, diagnostic physician order entry and e-prescribing; it also provides a transition-of-care summary for the PCP.

Many vendors claim they provide a turn-key service, but what they might not reveal is how much time, money and add-ons you’ll need to invest in the product. Consider, for example, that many records that integrate data will pull in only certain pieces of information and leave other templates, such as the order sets, to be built by the client. Training costs need to be considered as well.

These are just some of the reasons why it’s critical to consider how much time is required for training, installation and deployment. The more specialized the system, such as a best-of-breed EDIS, the faster the implementation (on average three months compared to six or more months for an system-wide EMR) and the easier the flow between clinical, financial and operational components.

One of the most critical steps in implementing any EDIS is building collaboration across and between departments. This includes defining roles and responsibilities, fostering teamwork and helping staff and leadership manage their expectations. Likewise, it’s important to know the strengths and limitations of the technology, of what a record can and cannot do. Addressing those with department and team members will make the transition smoother and promote adaptation to the new processes.

Improving care quality across the continuum continues to be central to healthcare reform and a condition of provider funding. The ED is an integral partner in care delivery and, as such, relies on HIT to facilitate data integration and in- formation exchange within and beyond its organization as it advances toward new care models.

HMT HEALTH MANAGEMENT TECHNOLOGY December 2012 11

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