Emergency Department Information System Overview
For a lot of patients, the entrance to the hospital is not located at the lobby, but through the emergency department’s swinging doors. As the first stop in any patient’s journey, it is quite obvious that a hospital’s emergency department or ED needs to be fully optimized to provide the best initial medical care possible for emergent situations.
Automating clinical processes and documentation in EDs has always been a challenge for hospitals. In contrast to an inpatient or ambulatory setting where the focus is on longitudinal care, a typical ED scenario is episodic in nature, concentrating on individual encounters and immensely complex clinical workflows1. Speed is key, and accuracy is vital, whether it be in triaging patients, capturing clinical data, communicating with clinicians and hospital staff, or processing admissions and discharges.
Hospital emergency departments have, traditionally, managed to get by with providing emergent care to patients through manual processes and tools, e.g., communicating with each other either verbally, through paper charts, or employing the use of whiteboards for patient tracking purposes. But with the ever-increasing number of ED patient visits annually, hospital administrators have now realized the proportionately growing need to provide better emergent care by streamlining processes, workflows, and documentation within the organization — a need that, widely believed, can be addressed with the use of clinical information systems, such as an electronic health records (EHR) system.
EHRs have provided substantial benefits to hospitals that have successfully implemented them in both inpatient and outpatient settings. However, use of these EHRs in the ED has proven challenging, even to the most tech-oriented clinical staff. The emergency department environment is exceptional, the whole gamut of disease relentlessly arriving without schedule on the doorstep of overburdened emergency clinicians. Workflows are complex and vary from patient to patient, and the pace is hectic. Clearly the EHRs that these hospitals are using hospital-wide is not cut-out for the ED, and as such, the realization of the need for a more specific solution — an EDIS.
As defined in the EDIS Functional Profile (2007) document by the HL7 Emergency Care Special Interest Group, an Emergency Department Information System is “an extended EHR system used to manage data in support of Emergency Department patient care and operations.2” Whereas the primary purpose of the EDIS is similar to a basic EHR in that it aims to support and document in a patient record the direct care of the patient, there are core functionalities that are focused on in an EDIS.
Key Features of an Emergency Department Information System
One essential feature of an EDIS is an adaptive patient registration module. Whether the patient is entered into the system during triage, or if full registration is impractical and quick entry at bedside is required, the EDIS should allow users to quickly and, more importantly, accurately, capture information needed to uniquely identify the patient for patient care to proceed unhindered.
Patient tracking is critical to automating workflows within the emergency department, more so than in any other hospital department. A patient list without decision support will not work in the ED. The system should be able to track the patient’s clinical course (patient status, order status, etc.) as well as the patient’s location within the hospital through all phases of the ED encounter.
Related to patient tracking is clinical workflow / task management. A robust tracking tool should also allow for all tasks for a specific patient to be communicated to each and every member of the team involved in the care of that patient.
Another essential EDIS function is clinical assessment and documentation. While all EHRs provide a way to document any clinical encounter, the challenge in an emergent situation is to be able to do this quickly, accurately, and completely. Intuitive user interface design, leveraging on previous documentation, ability for users to abandon and resume documentation quickly without loss of data, and support for multiple authorships, are just some of the functionalities that the EDIS requires for its clinical documentation module.
Computerized provider order entry, or CPOE, while not uniquely essential for the just the EDIS, is managed in a slightly different way in the ED. Specificity and customizability of orders for the ED, as well as integrated decision support, are paramount for success.
Another crucial feature for an EDIS is results viewing. Real-time access to results, long before the paper report is sent to the ED, could significantly impact the life and death struggle of the patient.
Disposition management functionality of an EDIS would allow for faster and more efficient inpatient admission or ED discharge of the patient. The system should provide opportunities for clinical users to review and validate any and all outstanding orders, documentation, or reports related to the ED encounter prior to release of the patient from the ED.
Lastly, an EDIS should have a robust administration module that could assist hospital administrators in managing the emergency department by having access to predefined and ad-hoc reports that are focused on quality data and performance measures, rather than the actual number of available reports within the system.
What’s next? How do hospitals determine which EDIS to implement?
The decision on acquiring a hospital EDIS is only the initial step towards improving patient care. The next step, obviously, is to determine what solution is best for the organization. The choice is tough for hospital CIOs and CMIOs alike, and it boils down to either acquiring a “best-of-breed” system, or to use the EDIS module of the hospital’s existing clinical information system3. There are pros and cons to both choices and it is up to the hospital administrators to discuss and work with the solution providers to determine what is best suited for their hospital, keeping in mind that the ultimate goal of automation should always be for the welfare of the patient.4
Do you want to understand how an EDIS fits into your hospital? MedProjects can work with your hospital to analyze your emergency department needs and build a business case for your decision.
If you are interested in learning more about MedProjects Healthcare IT Consulting Services or our EDIS offering, kindly contact us. You can also see additional information on our Health IT Services page.
Written by Godofredo “Doc Jun” Inciong II MD, MSHI
References
1EDIS: Primer for Emergency Physicians, Nurses, and IT Professionals. Rothenhaus et al. 2009.
2EDIS Functional Profile – Registration Release 1 (Version 1.4) – Emergency Care Special Interest Group – HL7. 2007.
3Information systems improve hospital emergency departments. Raths, David. 100 Companies. Volume 18, Issue 3. 2009.
4Quality and Safety Implications of Emergency Department Information Systems. Farley et al. 2014.