Re-engineering the Emergency Department in the Wireless Age

As one of the central issues of this election year, the viability of our traditional models of healthcare delivery is increasingly being questioned. With the strain of more than 136 million annual visits spread across a declining number of facilities (5,100 in 1991 to 4,500 in 2007) , Emergency Departments across the country are searching for a rebirth. As access to primary care and hospital options decline, healthcare delivery facilities are consolidating to contain cost and maintain quality. With hospitals increasingly dependent on maximizing inpatient occupancy, preventing leakage, and improving their quality of care (as measured by HCAHPS, etc), cultivating an emotional attachment to patients has never been more critical. As the ‘front door’ to the hospital, EDs are the primary access point for most patients and are responsible for 60-70% of all admissions. Modern day emergency departments face a number of challenges:

  • Limitless Clinical Scope: EDs treat cardiac arrests, heart attacks, and life-threatening infections, while simultaneously having to cater to low acuity patients with strains, sprains and sore throats.
  • Increasing Volumes Have Outpaced Technological Improvements: Despite the use of advanced patient tracking software, standardized clinical pathways, and electronic medical records to triage patients more efficiently, facilities continue to struggle with prolonged wait times, unsatisfactory patient outcomes, and poor patient perceptions.
  • Patient Engagement is Difficult to Achieve: Recent literature suggests that over 50% of patients discharged from Emergency Departments did not understand their discharge instructions. Even more troubling, is that the majority of those patients did not realize that they did not understand their discharge instructions .
  • Increasing Scrutiny on Cost: With the average cost of an emergency department visit at close to 4.6 times the cost of a physician office visit , insurers and administrators alike are looking closely at using technology to reduce the cost and increase the efficiency of care.

Emergency Departments are re-engineering themselves to promote lasting patient engagement and appeal to the smart consumption of healthcare. A number of entrepreneurs are racing to serve this need using technology as the primary catalyst. The advent of comparative shopping across hospital outcomes data, patient satisfaction scores, and patient feedback has already fueled patient choice. Patients are looking for team-based care that leverages disparate information sources and provides rapid, cohesive treatment. The adoption of real-time, integrated electronic medical records like EPIC and Cerner tie together various primary care, sub-specialty, and hospital visits with the potential to eliminate redundancy and streamline care. With up to 72% of patients wanting to book appointments for healthcare online, new services like InQuickER, iTriage, and ER Express empower patients to directly schedule times with providers offering convenience, efficiency, and choice. Beyond scheduling, the ER Express platform uses a program called ER Passport to allow sick patients to be fast-tracked to local emergency departments from surrounding offices and urgent cares with minimal wait times. Several examples of new ways that patients are connecting to EDs include:

  • A patient on his way to the ED logs into his iPad and uses a hold my place in line service. He expects the ED to know who he is and be ready for him thereby decreasing his actual time in the ED. InQuickER delivers this web-based service at more than 100 hospitals.
  • A patient uses an iPhone app to self-diagnose her issues via a self-directed symptom-checker, which also recommends the nearest provider. More than 6 million patients have downloaded iTriage’s symptom-checker app. Recently the RWJ Foundation granted $100,000 to two Johns Hopkins medical students to launch SymCat symptom checker which leverages statistical data from the CDC.
  • A family physician office uses a website that transmits an electronic referral to the nearest hospital when her patient’s acuity level warrants ED evaluation, replacing the usual phone call/fax that often results in miscommunication. This referral not only notifies the ED, but gives the hospital’s case manager a heads-up that this patient was recently an inpatient and is a potential 30-day re-admission. WellStar Cobb Hospital in Atlanta uses the ER Passport program with its community physicians to strengthen the continuum of care, bolster community physician relations, and manage their 30-day re-admission metric.
  • While sitting in an exam room, a patient uses an SMS-text-based program to rate her overall satisfaction. A charge nurse monitors an electronic dashboard that highlights spikes in dissatisfaction, and deploys a service recovery process to explain to the patient why it is taking so long, for example, for labs to be resulted. Later, at home, she receives an email inviting her to browse an online library of discharge instructions videos, recorded by Emergency Medicine Board-Certified physicians, complementing the verbal and written instructions she received a discharge. An Atlanta-area health system is set to pilot these two programs fall 2012 as part of ER Express.

EDs are being redesigned to streamline the patient encounter, cater to educated healthcare consumers, and usher in a new level of patient engagement. These products help further segment the marketplace and a more satisfactory patient experience. Several emergency departments are using novel after-care strategies including live phone follow-up calls after discharge and standardized, cloud-based video discharge instructions. Preliminary data suggests that the use of these new technologies is paying significant dividends regarding patient perceptions and overall patient satisfaction. As that translates to increased hospital market share, the widespread use of these technologies to overcome fragmentation in the current healthcare paradigm is inevitable.

Yogin Patel

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