ROI in the ED: installation of EDIS helps Georgia hospital handle population boom.

The city of Conyers, Ga., bustles with rapid growth. Housing subdivisions, heavy construction equipment lining the roads and a massive shopping mall point toward a significant population boom in this city located 25 miles southeast of Atlanta.

A far less obvious, but still very telling, symptom of Conyers' growing pains is the dramatic increase in visits to Rockdale Hospital, the area's primary emergency care provider. The hospital anticipates 35,000 emergency department (ED) visits by the end of 2003--up from 20,000 in 1997.

Rockdale Hospital's emergency department had implemented virtually every technique it knew to increase efficiency--including bedside registration and a bed-control policy--short of automating the department. It soon became clear that automation would most effectively handle the sharp increase in patient load.

The hospital embarked on a one-year exploration of emergency department information system (EDIS) vendors, evaluated 10 and then brought in a handful to demonstrate their systems. During the process, Rockdale Hospital staff went on a site visit to Trinitas Hospital in Elizabeth, N.J., where EmergisoftED had been implemented for nearly one year. The system's ease of use allowed Rockdale nurses to navigate through it with little or no instruction.

Rockdale Hospital selected the EmergisoftED system to automate its emergency department because clinical and IT staff felt it was an intuitive, user-friendly and comprehensive system. Implementation took about 80 days, and EmergisoftED successfully interfaced with the hospital's main McKesson information system.

Immediate Impact

While true ROI for Rockdale's EDIS will not be measured until at least a full year after its April 2003 go-live, the hospital is already realizing significant savings. Just a few months after the application went live, the ED is saving $4 per unit of service. Factored into the estimated 35,000 emergency department visits this year, that figure will yield initial efficiencies from EmergisoftED at $140,000. The hospital is confident that long term ROI will be significantly higher, particularly when it ear weigh the combined results of greater revenue capture, more cost savings, elimination of illegible patient charts and overall improved workflows.

Although long-term ROI is a key consideration for Rockdale as it reviews the efficiency of its EDIS on an ongoing basis, several immediate clinical and administrative benefits were realized. As with all electronic medical records (EMRs), EmergisoftED helped the hospital to eliminate grease boards for tracking patients, and all information entered into the system by triage or ED nurses could automatically be copied into nurse and physician charting, saving staff time and improving information accuracy.

Since the day the system was implemented, the ED has not received calls from pharmacies asking a nurse to pull a chart to confirm what a physician had ordered; illegible prescriptions are a thing of the past at Rockdale. Also, the charge nurse no longer has to tie up ED nurses on the phone to determine where specific patients are; he or she can simply pull up the tracking screen on any computer terminal in the ED.

Following the EDIS go-live, the emergency department has not misplaced a single patient record. Because patient information is automated, no one can walk off with or misplace a patient record. This not only benefits the hospital in its HIPAA compliance, but it also eliminates revenue the hospital may lose because payers cannot be hilled for a patient whose record is missing.

Since the system automatically identifies and time- and date-stamps each nurse's or doctor's access of a patient record, the system's management reports now provide specific detail on every patient encounter, tracking workflow inefficiencies to specific points in the ED and even to specific clinicians. This helps to eliminate bottlenecks in the emergency treatment process.

In addition, evaluation of clinician performance has improved. Prior to installing the EDIS, the clinical directors had to manually evaluate more than 2,000 patient records every month in order to review, rate and counsel clinicians. Today, that information is made available in a single report with the touch of a button, freeing administrators to spend time enhancing workflow and patient care, rather than flipping through paper charts.

Also, patient documentation functions have helped to improve Rockdale's ability to capture the required interventions for the proper level of service coding, providing the supporting detail needed to bill Level 4 and Level 5 interventions, rather than the down-coding that occurred in the past because part of the patient documentation was illegible to clinicians, coders and billers.

Lessons Learned

While implementing EmergisoftED and integrating it into Rockdale's healthcare information system occurred faster and more smoothly than hospital IT and clinical staff anticipated, there were several lessons that came from moving into the EMR environment. For example, marketing the system internally to everyone--particularly attending physicians--would have resulted in a much shorter learning curve, because attending physicians needed to get accustomed to the system's verbiage, codes, abbreviations and workflow. Rockdale conducted a marathon day of introducing as many people to the system as possible, but there was no "phasing-in process" for using the EDIS. When the system went live, everyone was using it; paper records and pre-EMR processes were immediately things of the past.

The hospital also recognized that it was right to expedite selection and implementation of an EDIS; waiting even one year would have been too late, putting the hospital under significant pressure.

It is apparent to Rockdale Hospital that growth within its service area is unlikely to slow down, but with a fully automated emergency department, ED providers and administrators are confident they can handle whatever challenges may lay ahead.

SOURCE

Key Neal Clinical Nursing Director, Emergency Services Rockdale Hospital & Health System Conyers, Ga.

PRODUCT/COMPANY

EmergisoftED Emergisoft Corp. Dallas www.emergisoft.com