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Control, Alt, Delete: Retooling Processes for Successful EDIS Delivery

Control, Alt, Delete: Retooling Processes for Successful EDIS Delivery. Chief Medical Information Officer Caritas Christi Health Care System Attending Emergency Physician St. Elizabeth’s Medical Center Boston, MA Co-chair, Emergency Care Special Interest Group Health Level 7

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Control, Alt, Delete: Retooling Processes for Successful EDIS Delivery

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  1. Control, Alt, Delete:Retooling Processes for Successful EDIS Delivery Chief Medical Information Officer Caritas Christi Health Care System Attending Emergency Physician St. Elizabeth’s Medical Center Boston, MA Co-chair, Emergency Care Special Interest Group Health Level 7 Immediate Past Chair Section of Emergency Medical Informatics American College of Emergency Medicine Todd Rothenhaus, MD FACEP

  2. A Boston Medical Center • Level 1 Trauma Center • 127,000 annual visits • 38 full time attendings and NPs • >200 rotating house staff per year • >150 full time RN staff • 5 geographically separate locations

  3. The Emergency Department • People • Architecture • Communication

  4. Health Care “Deliverables” • Medications • Procedures • Education

  5. ED IT Adopters • “Well Tuned” Emergency Department • Disaster Area • Begging HIS to computerize • CPOE Victim • Reluctant Adopter • Homegrown Developer

  6. Basic ED workflow

  7. Basic ED workflows • Most “variable” workflows • Triage • Discharge • Patient Entry • 1 versus 2 step triage • Meet/greet • Full versus variable/minimal triage • 5 level triage (CDS) • Triage directly to a room • Bedside registration • Radiology and labs prior to evaluation

  8. Triage Workflow • Patients brought directly to the treatment area should get a different kind of triage than patients who wait • Meet or greet • Regular triage • Bedside triage • “Uncouple” triage and RN care

  9. ED Communication Workflow • Roll out EDIS to supporting departments • Registration • Admitting • Housekeeping • Radiology • Pharmacy

  10. EDIS Data and Reports • Legacy data • System generated reports • Data mining the back end

  11. Welch S, Augustine J, Camargo CA Jr, Reese C. Emergency department performance measures and benchmarking summit. Acad Emerg Med. 2006 Oct;13(10):1074-80.

  12. How EDIS data is captured • “Active” tracking vs. “passive” tracking • What events are being associated with each timestamp • Consider users ability to “game” the system

  13. How (not) to Lie with EDIS Statistics • The best • Overall LOS • Time to Room • Time to Registration • The worst • Time to be seen by MD • Disposition to departure

  14. Profiling and benchmarking • Physician statistics • Patients per hour • RN statistics • Patient-hours

  15. Summary • Small changes in workflow can substantially perturb ED operations • Implementations take much longer to recover from than you think • Consider triage and disposition workflows carefully – do not overload triage • Roll out EDIS to supporting departments • EDIS data has substantial limitations

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