In 2007, PHYSICIANS at Exempla St. Josephs Hospital in Denver requested that the hospital install a new emergency department information system so they could have a more organized view of current data for their patients. But they also insisted that the new application be integrated with other clinical applications at the hospital and its referring clinics so they could refer to past information to make better care decisions.Many hospitals have an EDIS, which automates clinical documentation and provides dashboard views of information for all patients in their emergency department. Because not all ED patients are admitted to the hospital, providers often use the separate system to manage data for these patients.Clinicians at many hospitals, however, are no longer satisfied with a standalone EDIS that cant send or receive data from other clinical applications, especially electronic health records. They want to integrate their EDIS with other systems to improve care quality and workflow coordination.So a growing number of hospitals, including Exempla St. Josephs, are selecting a new EDIS, in part, based on how well it can integrate with other applications.There are hundreds of examples of how having an integrated system can help care quality in the ED, says Myra Mengwasser, a director at Noblis Inc., a Falls Church, Va.-based not-for-profit research and consulting firm. It could offer more information so that clinicians dont have to reorder tests or re-enter information, which could reduce wait times.The ideal system would be that when a patient comes into an ED, that ED would have access to all their previous encounters at the hospital or their other physician practices. That will require a significant investment in I.T.Creative LinksSome hospitals also are linking their EDIS to their picture archiving and communication system to accelerate radiology report turnarounds. And others are linking them with bed management, respiratory therapy and medication management applications, says Barbara Cox, senior principal at Noblis.About 10 years ago, it was common for vendors to sell an ED system as a niche application and then require hospitals to deal with integrating it, Cox says. But now hospitals are changing their processes and demanding an ED system that already can tightly integrate with various clinical applications.As the main referring hospital for a few dozen primary care clinics owned by Kaiser Permanente, Exempla St. Josephs has incorporated many practices from the giant Oakland, Calif.-based organization as its own. For example, it has a separate referral process for Kaiser patients, which represent 60% of its total patient load.Kaiser-employed physicians who staff the hospitals ED wanted the departments new information system to be well-integrated with Kaisers electronic health records system as well as the hospitals clinical systems, says Justin Chang, M.D., an ED physician.We were well-versed in Kaisers ambulatory electronic records system, so we used our experiences with that when we looked at ED systems, Chang says. It was important for us to get these two huge systems working together to improve patient care.Now ED physicians and nurses at Exempla St. Josephs can access Kaisers EHR, from Epic Systems Corp., Verona, Wis., via a Web portal while they view data in the hospitals new ED system, from Picis, Wakefield, Mass.Physicians at Kaisers Denver area referral center, which facilitates referrals for all the organizations members, also can access and place orders in the hospitals EDIS while they are in the delivery systems EHR.The hospital also linked the ED application to its hospital information system, from Medical Information Technology Inc., Westwood, Mass. Further, it plans to enhance the connection with Kaisers EHR to enable data from the EDIS to flow directly into the records system after the patient has been discharged. And it will integrate the EDIS with its Pyxis medication dispensing cabinets from Cardinal Health Inc., Dublin, Ohio.At Their FingertipsPhysicians and nurses have so much information at their fingertips now, Chang says. To be able to see whats going on with the patient from multiple systems is crucial. If you can give clinicians tools to more efficiently do their job, its inevitable that you will see improvement.Exempla St. Josephs Hospital, however, had to jump through several administrative hoops before deploying the EDIS.Although it already had longstanding relationships with Kaiser, the payer/provider organization had never enabled the hospital to access its systems. And I.T. staff at both organizations failed to develop a mutually agreeable joint model for sharing ED data when they took on the task a few years ago, says Chang, the ED physician.So the ED physicians spent months working with Exempla St. Josephs and Kaiser executives to get permission to build interfaces and enable joint access capabilities among systems at the separate organizations.The Kaiser executives ultimately agreed to an integration initiative with certain limitations, which Exempla executives agreed to fully fund.We had to bridge both worlds for this, Chang says. To get Kaiser physicians to access the Kaiser EHR at Exempla was a hoop to jump through.To get non-Kaiser nurses to access it was another hoop.While executives supported a joint project, the plan they agreed to allow ED physicians to create only a partial integration between Exemplas EDIS and Kaisers outpatient EHR. Hospital clinicians now click on a portal in the EDIS to access the Kaiser system, which then is presented on a read-only separate screen via customized PCs that have two monitors. Kaiser physicians at the referral center also access the Exempla EDIS via a Web portal.Kaiser, which provided staff to train Exempla nurses on its systems for the project, now has agreed to fund part of another initiative to fully integrate the two systems, Chang says.
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