Here’s a little anecdote which deserves some attention. In the kind of nightmare scenario that keeps C-suite folks up at night, a hospital in Indiana saw wait times in its emergency department soar to double what they were once it installed an EMR.
Columbus Regional Hospital, which sits about an hour south of Indianapolis, installed a new EMR in June. Prior to installing the system, average ED wait times hovered at about two hours and 25 minutes for fast tracked, less-severely-ill patients, while acute-care patients waited an average of two hours and 32 minutes.
But things got ugly quickly once the EMR went live, reports iHealthBeat. During the first week of the EMR transition, fast-track patients waited four hours and 41 minutes for ED care, while acute care patients waited four hours and 13 minutes. This happened despite the fact that the hospital had brought in extra nurses to ease ED overcrowding.
Over the past two months, wait times have come down to similar, but slightly higher, levels than they were at before the EMR was put into place.
I suspect the problem occurred because the hospital simply got caught flat-footed. Adding extra nurses is a good first step, but unless the news sources I’ve accessed have failed me, the institution didn’t do much to anticipate where the snags would be.
So what exactly happened here? Of course we don’t know, but it’s easy to make a few guesses.
One possibility, of course, is that the EMR was installed poorly or unready, though I’d guess this was less likely given the pressure on IT departments to get it right.
Did the hospital do enough to train doctors and nurses on the system before the pressure was on? It seems fairly likely that it did not.
The real cause of Columbus Regional’s problems, however, is probably that the hospital bought a cruddy EMR and superimposed it on a not-too-efficient ED operation. (Those original wait times sound pretty heinous — acute patients waiting more than two hours? — much less the post-EMR figures).
It seems to me that this hospital’s ED processes must have had one foot on a banana peel already when the EMR was launched. Sadly, even the best EMRs can’t fix problems they aren’t designed to address.
It is probably true the ED did not attempt to optimize workflow prior to Go Live. However, all available hospital information systems are disruptive to ED workflow. The ED is a unique environment that requires ED specific software.
Wonder how their billings worked before and after?
I can tell you this. They are a great hospital and the staff, Nursing and IT, are second to none in giving care to the patients. I wish them well and am confident in their abilities to get this worked out.
I’m with Brian’s comment. Being an ED doc, I can tell you all HIS ED “modules” are just parts bins from the inpatient program duct taped together and shoved into the ED. While any ED conversion has workflow issues, this is a normal story for this vendor and other HIS, it just so happens this one hit the news. Other sites suppress the press to prevent patient loss to competitors.
Since I’m a firm believer in EHR for ED’s, I’m particularly concerned about a massive failure like this. Some possibilities have been mentioned as to what might have gone wrong. Poor product, poor bucket full of pieces that didn’t link well together, no accommodation of actual work flow, etc.
Let me offer a scenario for your comment. I’m PLANNING and EHR for an ED that is still all paper based. Obviously, I spend a pile of time observing each and every role in the ED, on different shifts, and including Xray techs, lab techs, EKG, etc. I observe soup to nuts some selected patients, following each person who handles the patients in turn.
Now – if this is possible, I use a trial account with a tablet and play scribe to each practitioner as they do their thing, entering in test accounts with fake patient names preassigned everything the doctors, etc. are noting in their paper records. I do everything the way they are doing it – the same order, as I follow them around. I try this with the different ED EHR products that we are considering, and review the results later on with the medical team and an EHR vendor rep. We go through what went right and wrong, and what can and can’t be changed. Then we spec out and pick a product.
Is this pure fantasy? Can it actually be done, and have any of you done it?
thats actually how we developed ours. http://www.epowerdoc.com
[…] be fair, I’ve heard of many an EMR installation which created temporary havoc and pumped up wait times in the ED for a while. But the level of paralysis I’m reading about hear seems to be setting some kind of […]