New system brings all hospital databases to ED

How would you like to have the following questions answered instantly:

• Which patients are in the ED now?

• Which patients were seen this week with an elevated glucose level?

• How many patients with acute MIs were taken care of in the ED last year, and who were they?

A unique information system has been developed by ED physicians that allows users to access all existing patient information.

"It’s an extremely dynamic way of answering any question you have about one patient or group of patients in a big hurry," explains Craig Feied, MD, FACEP, FAAEM, director of informatics for Washington (DC) Hospital Center, one of the EDs where the system is being used. Feied is co-developer of the system. (See story on quick access to patient information, p. 105.)

The system is unique because it connects multiple departments into a single database. "We took all the existing data floating around the hospital and brought it together in one place," he says. That includes the hospital mainframe, lab and X-ray computers, the EKG system, radiology, quality improvement, the Pyxis medication dispensing system, and the billing system. Users can look at clinical, demographic, and billing data side by side on the same screen.

This is very different from traditional information systems used by EDs, Feied stresses. "Usually EDs either build a tracking system or they build what they think of as an electronic chart, which is built around a paper chart concept."

No training or inservicing is needed to use the system, he says. "We trained people by putting a machine out with a sign that says Beta Test, and showing them one or two little things, and encouraging them to play with it. Within a week, everybody knew how to do everything."

The following are are some key components of the system:

1. Revenues increase.

"The system allowed us to find more than a million dollars of lost billing because it allows us to look at groups of patients instead of one patient at a time," says Feied.

The system brings billing and collection information into the light, so it lets you see what has been done wrong in the past. "This allows us to recapture billings we were previously losing," he says.

For example, often patients over 65 were labeled as uninsured/self pay when they had Medicare but were too ill to speak, he notes.

"Those cases were never being correctly billed or collected. Our system made it possible for us to recognize all patients over 65 were being registered as self-pay, and we can see what their previous insurance was. The problem solved itself overnight just by showing the clerks what was happening," Feied explains.

2. Quality improvement efforts are smoother.

The system streamlines the ED’s quality improvement process, which regularly reviews groups of charts. "We query a certain group of patients we need — for example the acute MIs. Then we can pull those specific charts as opposed to a manual process where we literally look through 150 charts," says Therese Pearrell, RN, MSN, director of the ED at Washington Hospital Center.

3. The response time for callbacks is shorter.

"As a director I get callbacks for patients who may have questions," says Pearrell. "Or a physician may call to find out where their patient went to. The system gives us demographic information as well as the patient’s diagnosis or discharge. It’s very time-consuming to respond to many calls that come into the ED, so this is very helpful."

For example, an HMO may want to know the disposition of eight patients who were all seen in the last five hours. "This way, you can pull up all the HMO’s patients and can immediately tell whether they were discharged or admitted and where they went," she explains. "In the past, we’d have to find the patient’s chart, and the manual log may not have been up-to-date."

4. Nurses are prompted to give discharge instructions.

The system reminds nurses to give specific discharge instructions and documents that patients received that information. Also, the instructions are printed out for the patient.

"This way, we don’t have forms all over the place for the multiple discharge instruction we give patients. This saves a lot of space, which we often are pressed for," says Pearrell.