Vendor perspectives

ADVANCE asked six technology vendors - FormFast, MEDHOST, Picis, Polycom, T-System and Welch Allyn - to summarize the current state of their respective ED development efforts. Their responses appear in the following subsections, along with previews of future initiatives.

FormFast - Consider the patient who arrives in the ED with the sudden onset of pain from a kidney stone. In agonizing pain, the patient struggles to think clearly. Yet, procedures must be followed before he can "enter the system" for care. Health care delivery must be accurate. But it must also be delivered quickly - especially in an ED situation.

The improvements in safety and service for the ED patient of today are not the results of any one technology, but rather a convergence of technologies, according to FormFast. Taken together, they help reduce wait time, ensure fast and accurate communication with appropriate points of contact in the care continuum and contribute to the efficacy and outcomes of the ED visit. Moreover, these advances help hospitals comply with HIPAA and other regulations.

When a patient arrives in the ED, the admissions clerk can verify demographic information, scan insurance cards for coverage and co-pay requirements, retrieve data on past ED visits and request records from any past hospital admissions all with a few keystrokes. "Gone are the multi-part typed face sheets of years past. The ED admissions clerk can now print on demand all necessary chart forms, permissions and information sheets along with the patient wristband and labels," FormFast stated. Electronic signatures speed the process and lessen the demands on a patient with an emergent condition. A barcode can also be attached to these items - which will help with the transition to the EMR and record archiving, the company noted.

Rapid data retrieval helps make pertinent records available to the ED physician, ensuring that allergies, medications and existing history are accessible. Patients who come to the ED - even those who are ambulatory upon arrival - are usually in a state of compromised health (in pain, for example) that may make them poor historians. Access to the pertinent medical history helps ensure that caregivers get accurate information.

Should the patient require admission, forms-on-demand software allows the nurse on the division that will receive the patient to have timely access to ED records, and the ability to print out forms needed for the inpatient admission and to access standing orders. Workflow software ensures that appropriate communications also takes place (i.e., the software sends a copy of the ED sheet to the patient's physician, along with requests to pharmacy and other support services).

After inpatient admission, or after ED treatment alone, discharge orders and prescriptions are printed for the patient and added to the medical record. This ensures that patients and caregivers have accurate, timely information for their reference.

FormFast provides software required for barcodes, print-on-demand chart forms and workflow.

MEDHOST - The company said it works closely with each of its customers to learn how it can enhance its ED information system to better meet workflow efficiency and patient safety needs. MEDHOST stated that its most significant development within the past year has been to expand its Administrative ToolKit application, which allows facilities to customize clinical content and processes to further tailor the system to meet specific needs.

The company noted new and timely customizations in the aftermath of Hurricane Katrina. For example, Texas hospitals were able to quickly customize the system to enable tracking and management of Katrina victims.

Other MEDHOST customers reported positive results in the following areas:

reduction of patient wait time to less than 15 minutes from entering the ED to seeing a physician;

increased revenue driven by improved charge capture (e.g., $20 million incremental revenue increase in one year at a Texas health system);

one-day conversion from dictation and manual systems to complete automation, including electronic documentation and order entry at a 90,000-visit Texas ED;

100-percent compliance with physician order entry;

increase in net revenues by $50 per patient with better charge capture; and

greater than 99.8 percent system uptime.

MEDHOST said that it has invested heavily over the last 12-18 months in expanding its customer-focused operation in both associates and technology. The company stated that it will focus on "...making solutions faster, and easier to use and learn; expanding our capabilities in enterprise management; delivering more revenue capture and cost savings by extending revenue management products; and creating more synergy between and with other software and hardware products through cutting-edge integration."

Picis - The company said it is the first and only vendor to embed the Broselow-Luten Color Coding Kids system into its ED information system. "Using these color codes, Ibex PulseCheck provides a visual indicator of where a child fits on the Broselow color continuum for consistent decision-making around correct medications, fluids and equipment for pediatric patients," Picis reported.

The company also noted that Ibexpen, a new digital pen input device, enables clinicians to create an electronic patient record in Ibex PulseCheck while using pen and paper to document clinical data at the bedside.

Other developments include a new bio-surveillance tool, a discrete data interface to CIS, and a unique Rapid Clinical Record that pulls a patient's history and clinical data from the Meditech HIS into Ibex PulseCheck for fast, easy access, according to Picis.

Picis described Ibex PulseCheck as "a full department management system that promotes safety and efficiency in emergency care."

Picis said that a Pennsylvania hospital handling 40,000 visits per year used biosurveillance to detect the outbreak of influenza and prepare resources needed for proper care. The hospital achieved full return on investment (ROI) within six months (doubled charges from $800,000 to $1.6 million). In addition, the hospital eliminated five full-time equivalents in coding/dictation; reduced denials for reimbursement and shortened the billing cycle; and decreased average patient length of stay from 3.6 to 2.1 hours.

A Chicago hospital handling 40,000 visits per year eliminated a $1 million deficit within a year, increased facility charges by $1.7 million and increased professional charges by 25 percent ($630,000). The hospital reduced time in acute care by 56 minutes, in main treatment by 79 minutes and for fast-track patients by 40 minutes.

A southern Illinois hospital handling 63,000 visits per year increased facility charges by 26 percent, decreased "door-to-doctor" time from 52 to 21 minutes, and decreased "people leaving without being seen" from 100 to 10 per month, Picis reported.

The company pointed out that it continually strives to make patient care faster, easier and safer in the ED environment. In the next 12-24 months, Picis said it will "...continue advances in interoperability, our Ibexpen technology and our Ibex Biosurveillance module, while also paying attention to customer requests in all of our applications."

Polycom - The company launched its Mobile Responder unit in 2006. "Designed specifically for first responders, emergency management, police and firefighters, the unit provides real-time communication that goes beyond simple video," according to Diane Fokas, health care territory manager for Polycom.

"In minutes, the unit can be assembled, connected to a wireless network and used to send critical medical information from an ambulance to a hospital," Fokas said. "Emergency room staff can prepare properly for patient arrivals and can receive critical, up-to-the minute, diagnostic information. If the hospital utilizes EMRs or EHRs, vital statistics can be monitored in expectation of the patient."

In addition to the Mobile Responder, the Practitioner Cart can be used in many ED environments for both medical consults as well as interpretive services, Fokas noted. The "pole cart" setup enables the product to co-exist within a hospital's current ED environment. The cart can be used by ED clinicians and then easily stored, Fokas added.

With Polycom's video communication technology, consults can be completed directly from a community hospital's ED and communicated to a teaching hospital that specializes in a specific practice, saving valuable diagnosis and transport time for the patient, Fokas explained. For example, Fokas said Polycom has worked with several hospitals to provide immediate diagnosis of stroke patients through Tele-Stroke programs.

In another installation, a community hospital in southwestern Ontario (Canada) regularly seeks diagnostic specialties from a neurological teaching hospital in London (England). "This program has allowed patients to receive the Tissue Plasminogen Activator (tPA) drug within the three-hour limit and has changed the medical outcome for countless patients," Fokas stated.

Because of the newness of the Mobile Responder, customer feedback will be essential and key to understanding what enhancements need to be made over the next 12-24 months, according to Polycom. "As circumstances change in emergency care, the Mobile Responder will be prepared to adjust accordingly," Fokas explained.

Fokas said Polycom has seen increasing use of the Practitioner Cart in the ED environment and will look for opportunities to further develop the product to suit the needs of emergency room staff.

T System - In October 2005, the company released version 2.4 of T SystemEV, "a highly usable and scalable ED information system that can smoothly implement in a single facility or a multi-facility scenario."

According to the company, T SystemEV was designed by an experienced team of clinicians and software developers to give users access to the most clinically relevant documentation components based on the patient's chief complaint. "Its ergonomic design keeps the amount of free text and layered windows to a minimum, helping to expedite complete information capture in a fast-paced ED environment. In-depth reporting tools and security features are built into the system to provide administrators and IT with resources to monitor the use of the system," T System stated.

Version 2.4 enhancements include an improved lab/results interface, which allows users to edit lab text, view lab/order status on the tracking screen and incorporate results into the record. Other enhancements: an easier-to-use faxing tool, additional administrative reports, improved security/records locking and updated professional coding support.

T SystemEV version 2.4 "...is designed to improve the capture of clinically relevant and legally required information about a patient's visit through its careful layout; the physician and nurse documentation modules are organized according to the patient's chief complaint," the company stated. "Additionally, T SystemEV dramatically reduces lost charts, allows immediate access to past patient records, and allows the clinician to document at the patient's bedside, all of which directly contribute to better patient care in the ED."

Other tools that result in ED workflow improvements include patient tracking, HIS interfacing, order status/results, print-on-demand prescriptions/discharge instructions, work or school release forms, coding summaries and electronic signatures.

T-System said it is currently developing T SystemEV 2.6 version for release in the third quarter of 2006. Anticipated features include a computerized physician order entry component, the Core Clinical Data Module and enhanced tracking board views, the company noted.

Welch Allyn - The company said the introduction of the new Propaq LT patient vital signs monitor was the most significant development in its ED technology in the past 12 months. According to Welch Allyn, "The monitor is the first in the world that can serve as an ambulatory monitor, bedside monitor and transport monitor in one device."

The Propaq LT, which began shipping to customers in December 2005, weighs approximately 2 pounds while providing 3-5 lead ECG, NIBP, SpO2 and respiration monitoring. "[It] can be attached to the smallest fluids poles, hung on a transport gurney bedrail and easily connected to an off-the-shelf large flat-panel display," the company stated. "Because the monitor is intended for ambulatory use, it allows ED clinicians to rule out MI patients in attached chest pain clinics or observation units. It also can be used wirelessly in hallways, in CT and throughout the ED when census escalates."

The company also recently introduced its Connectivity Server. The server allows Welch Allyn's central monitoring system and devices such as the Propaq LT to interface via HL7 with ED clinical information systems and electronic medical records.

In the next 12-24 months, Welch Allyn said it will continue to work on more motion-tolerant vital signs parameters including SpO2, NIBP and ECG. "This is vital to EDs as they care for shock trauma patients, infants and pediatrics, palsy patients, etc. - all of whom can exhibit unusual amounts of motion artifact," the company explained. "Later this year we will be adding motion-tolerant Masimo SpO2 to Propaq LT as well as our own motion-tolerant NIBP capability called Smartcuf, based on signal averaging oscillometry technology. The NIBP algorithm uses elements of the heart rate determined from ECG to derive its readings."

The company also said it plans to provide patient monitors and wireless systems that can be quickly deployed throughout the ED - or even into the hospital parking lot - to flex hospital resources in the event of a large-scale medical emergency or disaster.

Moving ahead

Assuming, after due diligence, that you're planning on moving ahead with ED technology initiatives, NBHD's Wagner offered the following recommendations in three key areas:

Marketing. Get the word out about technology benefits and project dates. Everyone should know what is coming, and when.

Training. Start with one-on-one and small-group sessions. Then plan on having IT staff available to be immediately available, side-by-side with users, when going live. Since many applications will be used all day/everyday, training support should end quickly, as users have to become proficient quickly.

Downtime. Once the technology is part of how users deliver care in the ED, downtime becomes critical. Map out planned downtime before you go live and establish your policies and procedures for unplanned downtime.

Mr. Irving is editor of ADVANCE.

ADVANCE acknowledges the contributions of the individuals and companies mentioned in this article.