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
MD MBA
ApolloMD

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  131. With havin so much content do you ever run into any problems of plagorism or copyright violation? My site has a lot of unique content I’ve either written myself or outsourced but it looks like a lot of it is popping it up all over the web without my permission. Do you know any ways to help prevent content from being ripped off? I’d really appreciate it.

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  142. Hey I know this is off topic but I was wondering if you knew of any widgets I could add to my blog that automatically tweet my newest twitter updates. I’ve been looking for a plug-in like this for quite some time and was hoping maybe you would have some experience with something like this. Please let me know if you run into anything. I truly enjoy reading your blog and I look forward to your new updates.

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  144. I was curious if you ever considered changing the structure of your blog? Its very well written; I love what youve got to say. But maybe you could a little more in the way of content so people could connect with it better. Youve got an awful lot of text for only having one or two images. Maybe you could space it out better?

  145. Hey would you mind sharing which blog platform you’re working with? I’m looking to start my own blog soon but I’m having a difficult time choosing between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design seems different then most blogs and I’m looking for something completely unique. P.S Apologies for being off-topic but I had to ask!

  146. Does your blog have a contact page? I’m having problems locating it but, I’d like to send you an e-mail. I’ve got some suggestions for your blog you might be interested in hearing. Either way, great site and I look forward to seeing it develop over time.

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  148. Please let me know if you’re looking for a article author for your blog. You have some really good articles and I believe I would be a good asset. If you ever want to take some of the load off, I’d absolutely love to write some content for your blog in exchange for a link back to mine. Please shoot me an email if interested. Regards!

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  151. With havin so much written content do you ever run into any issues of plagorism or copyright infringement? My blog has a lot of exclusive content I’ve either created myself or outsourced but it looks like a lot of it is popping it up all over the internet without my authorization. Do you know any ways to help reduce content from being ripped off? I’d really appreciate it.

  152. Hello there! I know this is kinda off topic but I’d figured I’d ask. Would you be interested in trading links or maybe guest writing a blog post or vice-versa? My site goes over a lot of the same topics as yours and I believe we could greatly benefit from each other. If you are interested feel free to send me an e-mail. I look forward to hearing from you! Great blog by the way!

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  160. My coder is trying to convince me to move to .net from PHP. I have always disliked the idea because of the expenses. But he’s tryiong none the less. I’ve been using Movable-type on various websites for about a year and am concerned about switching to another platform. I have heard good things about blogengine.net. Is there a way I can import all my wordpress content into it? Any kind of help would be really appreciated!

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  164. Have you ever thought about adding a little bit more than just your articles? I mean, what you say is important and everything. However think about if you added some great photos or videos to give your posts more, “pop”! Your content is excellent but with images and clips, this blog could definitely be one of the most beneficial in its niche. Good blog!

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  269. Have you ever considered creating an e-book or guest authoring on other websites? I have a blog based upon on the same ideas you discuss and would really like to have you share some stories/information. I know my subscribers would appreciate your work. If you are even remotely interested, feel free to shoot me an e mail.

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  281. I’m really loving the theme/design of your weblog. Do you ever run into any web browser compatibility issues? A handful of my blog visitors have complained about my blog not working correctly in Explorer but looks great in Safari. Do you have any advice to help fix this problem?

  282. I was wondering if you ever considered changing the structure of your site? Its very well written; I love what youve got to say. But maybe you could a little more in the way of content so people could connect with it better. Youve got an awful lot of text for only having one or 2 images. Maybe you could space it out better?

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  284. Excellent blog! Do you have any helpful hints for aspiring writers? I’m planning to start my own website soon but I’m a little lost on everything. Would you advise starting with a free platform like WordPress or go for a paid option? There are so many choices out there that I’m completely confused .. Any tips? Thanks a lot!

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  289. Hello! This is kind of off topic but I need some advice from an established blog. Is it very difficult to set up your own blog? I’m not very techincal but I can figure things out pretty quick. I’m thinking about creating my own but I’m not sure where to start. Do you have any tips or suggestions? Thanks

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  293. Hey I know this is off topic but I was wondering if you knew of any widgets I could add to my blog that automatically tweet my newest twitter updates. I’ve been looking for a plug-in like this for quite some time and was hoping maybe you would have some experience with something like this. Please let me know if you run into anything. I truly enjoy reading your blog and I look forward to your new updates.

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  295. I know this if off topic but I’m looking into starting my own weblog and was curious what all is needed to get setup? I’m assuming having a blog like yours would cost a pretty penny? I’m not very web smart so I’m not 100% sure. Any suggestions or advice would be greatly appreciated. Thank you

  296. Hi! I know this is kinda off topic however , I’d figured I’d ask. Would you be interested in trading links or maybe guest writing a blog post or vice-versa? My blog addresses a lot of the same topics as yours and I feel we could greatly benefit from each other. If you are interested feel free to send me an e-mail. I look forward to hearing from you! Great blog by the way!

  297. Awesome blog! Do you have any recommendations for aspiring writers? I’m planning to start my own blog soon but I’m a little lost on everything. Would you recommend starting with a free platform like WordPress or go for a paid option? There are so many options out there that I’m completely overwhelmed .. Any suggestions? Thanks a lot!

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  312. Have you ever considered creating an ebook or guest authoring on other websites? I have a blog based upon on the same ideas you discuss and would love to have you share some stories/information. I know my audience would enjoy your work. If you are even remotely interested, feel free to shoot me an e mail.

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  325. With havin so much content do you ever run into any problems of plagorism or copyright infringement? My website has a lot of unique content I’ve either created myself or outsourced but it looks like a lot of it is popping it up all over the internet without my permission. Do you know any methods to help stop content from being stolen? I’d really appreciate it.

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  332. Today, I went to the beach front with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is entirely off topic but I had to tell someone!

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  337. Amazing blog! Do you have any helpful hints for aspiring writers? I’m hoping to start my own blog soon but I’m a little lost on everything. Would you recommend starting with a free platform like WordPress or go for a paid option? There are so many options out there that I’m totally confused .. Any suggestions? Kudos!

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  346. Have you ever considered writing an e-book or guest authoring on other websites? I have a blog centered on the same ideas you discuss and would really like to have you share some stories/information. I know my readers would appreciate your work. If you are even remotely interested, feel free to send me an email.

  347. My programmer is trying to convince me to move to .net from PHP. I have always disliked the idea because of the costs. But he’s tryiong none the less. I’ve been using WordPress on a number of websites for about a year and am concerned about switching to another platform. I have heard very good things about blogengine.net. Is there a way I can transfer all my wordpress content into it? Any help would be greatly appreciated!

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  349. First off I would like to say great blog! I had a quick question in which I’d like to ask if you don’t mind. I was interested to know how you center yourself and clear your mind prior to writing. I’ve had a hard time clearing my mind in getting my ideas out. I truly do enjoy writing however it just seems like the first 10 to 15 minutes are wasted simply just trying to figure out how to begin. Any recommendations or hints? Appreciate it!

  350. Hello just wanted to give you a brief heads up and let you know a few of the images aren’t loading correctly. I’m not sure why but I think its a linking issue. I’ve tried it in two different web browsers and both show the same outcome.

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  353. Hi! This is kind of off topic but I need some guidance from an established blog. Is it tough to set up your own blog? I’m not very techincal but I can figure things out pretty quick. I’m thinking about making my own but I’m not sure where to begin. Do you have any points or suggestions? Many thanks

  354. I know this if off topic but I’m looking into starting my own blog and was curious what all is required to get set up? I’m assuming having a blog like yours would cost a pretty penny? I’m not very web savvy so I’m not 100% sure. Any tips or advice would be greatly appreciated. Cheers

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  357. Today, I went to the beach with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She placed the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is entirely off topic but I had to tell someone!

  358. Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your point. You clearly know what youre talking about, why throw away your intelligence on just posting videos to your blog when you could be giving us something enlightening to read?

  359. First off I would like to say excellent blog! I had a quick question which I’d like to ask if you do not mind. I was curious to find out how you center yourself and clear your mind prior to writing. I’ve had a hard time clearing my thoughts in getting my thoughts out. I do take pleasure in writing however it just seems like the first 10 to 15 minutes are usually lost simply just trying to figure out how to begin. Any ideas or tips? Thanks!

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  364. Hello there! This is kind of off topic but I need some advice from an established blog. Is it very hard to set up your own blog? I’m not very techincal but I can figure things out pretty quick. I’m thinking about creating my own but I’m not sure where to start. Do you have any points or suggestions? Appreciate it

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