Emergency Man
Michael Bessette discovered during medical school that he was an
Health Data Management Magazine, 04/01/2010
Michael Bessette discovered during medical school that he was an "adrenaline junkie," and emergency medicine seemed like an appropriate specialty. A residency at Mount Sinai Medical Center in New York was followed by a stint in the Los Angeles area, but he eventually returned east and spent a number of years at Mount Sinai School of Medicine. Since July 2008, he has run the emergency department of 324-bed Liberty Health-Jersey City Medical Center, which sees more than 53,000 visits a year.
Bessette is an employee of Emergency Medical Associates, a contract ED company in New York, New Jersey and Pennsylvania. If an EMA client hospital doesn't already have an automated ED, the company throws in a basic standalone system for free. Physicians can enter orders on it, and it also has order sets, protocols and other quality improvement aids. The hospital can pay for a fancier version that interfaces with other hospital systems, and Jersey City opted to do so last August, at a cost of about $7 per chart. Now that the ED system, called EDIMS, talks to the McKesson ADT system, Bessette says it's "made a huge difference in the financial viability of the ED and the hospital as a whole."
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On Charge Capture
Our biggest problems were facility coding, infusions given, and supplies used. Because EDIMS can pull all of those out of the documentation, the charges are no longer lost. Once we started getting an appropriate level of coding, we projected an increase of $3 million in revenue in the first six months, but our estimates turned out to be conservative. It was more like $7 million.
On Quality Improvement
We have documentation templates for things we see frequently, like abdominal pains, febrile children or chest pain patients. The critical care committee wanted us to use a protocol for sepsis, and it was easy for us to create an order set. The important things are in bold, and optional things are not in bold. If we order hydration, it shows what the guidelines are for severe sepsis. And we can order other things "a la carte" off the regular order list if necessary. Now that we've interfaced the systems, we've also eliminated transcriptions, and transcription errors. Our incidences of medication errors and improper orders have dropped off significantly: we're now able to catch them when the order is entered.
On Emergency Department CPOE
In the ED, we write 95 percent of our orders when we first see the patient. Inpatient orders are protracted, and there may be individual orders triggered by different events. The main interface is the same, but the timing of order opportunities is different.
Michael Bessette, MD
Chair, department of emergency medicine
Liberty Health-Jersey City (N.J.) Medical Center
* MD, Sackler School of Medicine, University of Tel Aviv, Israel
* Formerly associate professor, Mount Sinai School of Medicine, New York
* Fellow, American College of Emergency Physicians
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