At North Broward Hospital District (NBHD) in Fort Lauderdale, Fla., one of the five largest public health care systems in the U.S., emergency department (ED) technologies have a major impact on quality of care. According to Joseph J. Wagner, MPA, FHIMSS, vice president and CIO at NBHD, which encompasses more than 30 health care facilities, "The [ED] systems are robust and reliable and the technology is state-of-the-art."

Wagner commented, "Technologies introduced into the EDs have really made a difference for doctors, clinicians and patients."

One such application, in use for about a year, creates discharge prescriptions and generates a legible printed copy for the patient.

In another area, ED physicians have immediate access to digital images via NBHD's PACS, which has been live for about 9 months. "This eliminates the delay of film processing and allows ubiquitous access to images anywhere in the hospital," Wagner noted. "Faster access to patient data for the physician also reduces wait times, speeds treatment and improves safety."

NBHD's EDs have been wireless for several years, Wagner added, enabling data access through the use of mobile carts and tablet PCs.

And a new product - a pendant-based, voice-activated communication system implemented in October 2005 - further leverages NBHD's wireless network. Wagner explained: "Everyone who wears a pendant can talk immediately to anyone else wearing a pendant. The devices can be used to page physicians, clinicians, etc. When a person responds to the page, the call goes directly to the pendant that made the call - not to some other phone. The clinician does not have to track down the person who sent the page.

"You can also call for help wherever you are. For example, if you require security, you do not have to locate a physical telephone. You can broadcast requests to the appropriate ED group to ask for emergency assistance. And since only those in the group will hear the request, you don't have the entire department running to help."

Wagner added that Cerner's FirstNet ED product is utilized in all of NBHD's EDs. "We utilize Cerner FirstNet, Powerchart and the clinical data warehouse to triage, document, place orders, track patients and provide physician order entry in a wireless environment. Since its inception, we have not been able to keep up with requests to supply more electronic information. This is a very good sign. One of the biggest hurdles to implementing an EMR is getting the clinical personnel to support the technology and to have it really work for them," he explained.

Behind the scenes

With its four EDs (including one trauma level I and one level II), NBHD strives to improve patient care and safety while increasing staff efficiency wherever possible. Detailed planning helps the organization achieve its objectives.

"The strategic decisions regarding IT and applications are reviewed and approved by a committee chaired by a board member," Wagner said, "with all of the organization's executive staff represented."

He added, "The proper governance structure must be in place for any project that involves so many hospital disciplines. You must have representation from every group that will be impacted. You have to be certain that all affected parties are serious about the project. IT cannot design, build and implement these technologies in a vacuum."

Caregiver perspective

Naturally, the use of ED technology differs from facility to facility. And even within a given health care organization, usage differs by clinical role. Jennifer Cordia, RN, provided ADVANCE with the perspective of the ED nurse director at Sisters of Mercy Health System in Chesterfield, Mo.

Cordia noted that single sign-on technology has had a significant impact on ED operations within the past 12 months at Sisters of Mercy. "Single sign-on technology allows ED co-workers to access software with increased speed," said Cordia. "Co-workers are not logging in and out many times during their shift. Individual access is accomplished in a timely manner as the ED co-worker handles an increasing volume of patients."

Cordia indicated that technology vendors have an acceptable level of understanding of ED issues; however, vendors need to recognize that ED workers may have little or no computer background or skill. "It is important that [staff] understand not only the application of the product, but the operations of it as well," she explained. "If the product adds time and what is perceived as additional work, the product will not be accepted and will not be utilized."