Federal law (EMTALA) requires ED to provide care to everyone.
Emergency careAnti-dumping LawScreened, Stabilized, TreatedRole is evolvingLast resort24/7/365
Emergency Department
124 million ED visits in 2008 (NHAMCS).10% of all ambulatory care visits.41 ED visits for every 100 Americans.2007 IOM report showed crowded ED crisis2003 US GAO report showed insufficient
inpatient capacityB/w 1995-2008, ED visits increased 28%.Number of uninsured decrease from 17 to
15%Non urgent health problems
Emergency Department Statistics
No simple definitionUrgency is best determined by level of
immediacy by triage staff. Immediate (4%), Emergent(12%),
Urgent(39%), Semi-urgent(21%), non-urgent(8%), Unknown (16%).
2/3 rd of all ED visits outside normal business hours (8a.m.-5 p.m., M-F).
Non-urgent health problems
Triage status is based on the following classification: Immediate/emergent – Patient should be seen
immediately or within 15 minutesUrgent – Patient should be seen within 15-60 minutesSemi-urgent – Patient should be seen within 61-120
minutesNon-urgent – Patient should be seen between 121
minutes and 24 hoursUnknown – No mention of immediacy in the medical
record; hospital does not perform triage; or the patient was dead on arrival.
Source: CDC/NCHS. National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department
Triage Status
Rapidly assess, treat, educate and discharge patients
Time delays crucial concern to patient careNeed to reduce response time in treating
patientsProviders concerned using EMR slows down
patient care
ED Challenges
Strategy or strategies presented concisely with appropriate relevance
Who: ED physiciansWhat: Implement EMR on iPadWhere: Emergency Department
Who, What, Where
Improved physician-patient interaction Improved workflow with iPadsStructural benefits of iPads
http://www.youtube.com/watch?feature=player_embedded&v=DUJ3rojx7HU
Benefits
Improved physician-patient interaction Physician can maintain effective communication
with patients via face-to-face interaction iPads enhance patient education
physician can show images, videos, X-ray scans, test results, medical references and dictionaries
Improved patient satisfaction Patients see physicians making use of latest
technology for treatment Patients have face-to-face time with physician
Benefits
Improved Workflow with iPads Improve access to patient and clinical
information in patient room iPads reduce redundancy – don’t need to log
in and out, adjust screen position, push cart in and out in each room
Mobility – physicians constantly moving, need access to information on the go
Benefits
Improved Workflow with iPads iPads make the workflow faster – touchscreens,
more efficient for orders entry Future customization of EMR
Customize EHR to physicians’ worflow Future application development Integration with other clinical applications
Closer towards an ideal clinical workflow More efficient Put in orders and meds Get tests results back expeditiously Discharge patients more quickly
Benefits
Structural Benefits of iPads Touch screens enable ease of use
Easier to navigate than using mouse, clicking , scrolling Use is intuitive Ability to hold and manipulate item helps encourage use Removes barriers between user and device
Similarity to paper Lightweight Write on it Carry around like clipboard chart Like using smart paper Tactile experience replicates familiarity of paper interface
iPads improve infection control Screens can be wiped down easily No keyboard so no dust collection, No fan to spread germs
Benefits
Application development – iPad app using Citrix receiver to virtualize EMR
Incorporate phone directory and paging system from device
Documentation review, lab study review, order entry, review of imaging studies
Other Benefits
Application development – iPad app using Citrix receiver to virtualize EMR
Incorporate phone directory and paging system from device
Documentation review, lab study review, order entry, review of imaging studies
Examples
Remote Access EMR Systems Allscripts – client for iPad eClinicalWorks – client iClickDoc Eclipsys – remote access to Sunrise Hospitla EHR Epic – Canto/Haiku GE Centricity – remote access client for iPad
Native iPad EMR Applications Dr. Chrono - advanced medical speech to text function,
paperless medical billing, iPad patient check-in and custom clinical notes.
Nimble - medical art, refill requests, evidence based decision support, patient scheduling, patient data graphing and more.
iPad EHR Clients & Apps
Remote Access EMR Systems Allscripts – client for iPad eClinicalWorks – client iClickDoc Eclipsys – remote access to Sunrise Hospitla EHR Epic – Canto/Haiku GE Centricity – remote access client for iPad
Native iPad EMR Applications Dr. Chrono - advanced medical speech to text function,
paperless medical billing, iPad patient check-in and custom clinical notes.
Nimble - medical art, refill requests, evidence based decision support, patient scheduling, patient data graphing and more.
iPad EHR Clients & Apps
1. The Atlas of Emergency Medicine - iPhone / iPad app by Usatine Mediahttp://www.youtube.com/watch?v=_Ey8HSXsuf4- the app described in the demo has a very
broad and comprehensive outline which can provide physicians with medical advice at their fingertips.
- the app provides both text and images for easier use during research on medical procedures.
2. palmEM http://www.palmer-ww.com/
iPad App Examples
- palmEM app similar to Usatine app in principle.
3. Sparrow EDIS by Montrue Technologieshttp://medcitynews.com/2012/05/ipad-app-uses-voice-technology-to-improve-er-patient-experience/- Utilizes Nuance™ voice recognition- Ground Control feature allows for other
patient health information to be displayed on iPad.
iPad App Examples
Personnel impact Physician resistance
Protection of dataOther ethical concerns
Mitigation of Potential Problems
Personnel impactProtection of dataOther ethical concerns
PortabilityCitrix client – requires multiple logins
Mitigation of Potential Problems
http://www.acep.org/content.aspx?id=25936http://hschange.org/CONTENT/1204/1204.pdf
References: