Economics of an Emergency Department

From contract to go-live: the transformation and implementation of a big-bang EDIS installation for three hospitals.

By Gene Grochala; Patricia Cavanaugh, RN, MSN; and Barbara Grande, RN, BS.

Capital Health recently went through a transformation — merging two hospitals, opening a newly constructed hospital, renovating and upgrading existing facilities, adding new technology, transitioning one location from an acute care hospital to a satellite emergency department (ED) and adding new medical services — to become a truly regional healthcare system. One fundamental requirement for any new technology was full integration with existing hospital systems so that patient data could be stored in a central record and shared across the health-care system.

As part of the technology transformation, Wellsoft Emergency Department Information System (EDIS) was deployed in Capital Health’s emergency departments to provide an enterprise-wide ED electronic medical record (EMR), automate and streamline ED workflows and support Meaningful Use.

Managing care for more than 80,000 ED patients each year in four emergency departments (Capital Health Regional Medical Center, Capital Health Medical Center–Hopewell, Capital Health Pediatric Emergency Services and a satellite ED at Capital Health Mercer), Capital Health is accredited by The Joint Commission as The Joint Commission Primary Stroke Center and is one of 10 designated trauma centers in New Jersey.

A big-bang approach was our only option. The goal was to have all ED staff, in all locations, start to use the new system at the same time. By having a specific go-live date that coordinated with the opening of the new hospital, all planners and users clearly knew the goal and understood when they should expect changes.

To introduce a new system, we used a “super user/train-the-trainer” approach so that all individuals were trained on the new ED system before go-live. A multi-disciplinary team that included doctors, key ED clinical and administrative staff, IT, hospital departmental staff, etc. selected Wellsoft EDIS. In addition to feature and integration requirements, having a vendor partner who could ensure that the new system would be live in multiple EDs by the date of the new hospital opening was critical.

On Nov. 6, 2011, the third Capital Health location went live with Wellsoft EDIS, 3 weeks after a simultaneous go-live at the first two locations and only 6 months after contract signing. Using a “big bang” approach, staff in each ED began us-ing Wellsoft EDIS for patient tracking, electronic clinical documentation, CPOE, results, professional and facility charge capture, auto-faxing, image capture and a range of HL7 interfaces

Each of our executives had specific roles.

CIO TO CIO:

1. Focus on Patient Quality and System Efficiency

Overall, our hospital transformation project is about supporting patient care. The focus in the ED is to improve workflow efficiencies to provide higher quality care. Our IT projects are for the sake of the patient, not for the sake of IT. All implementations are driven by measurable outcomes for the patient (improvements, economics, etc.) and integration for system efficiency.

2. Have the Right Partner

We believe in a “best of breed” approach, but demand a high degree of integration. Having a vendor who can deliver products as promised in a high-quality way equals success. Knowing the vendor’s reputation for keeping promises and providing support, as well as their understanding of their product and the needs of the hospital, ensure that we have a true partner before, during and after implementation. One measure of a successful partnership for us is not having to go back to the contract when questions arise.

 CNO TO CNO:

1. Involve the Clinical Teams

With a big-bang approach, we had many processes and workflows to review. For our EDIS project, Wellsoft project and clinical implementation managers worked with representatives from various departments, including triage, registration, urgent care/sub-acute care, pediatric, adult, lab, radiology and cardiology orders and results, pharmacy orders, admissions, and billing, to tightly weave the EDIS into ED workflows. All reviewed existing workflows and identify areas for change and improvement.

2. Train, Train, Train

Successful implementations require more than just software; it requires capable users, which means training is key. A hands-on blended learning approach, tailored to hospital needs and based on the ED workflow, is recommended for not only the nursing staff but all clinical and administrative staff in the ED. If possible, make the training required. We used a train-the-trainer approach where “super users” can continue to provide guidance well after go-live. For our Wellsoft EDIS implementations, super user training was completed 4 weeks before go-live. End-user training was completed 3 days before go-live. We have 24 super users and trained over 200 clinical and administrative staff. Our super users and Wellsoft staff provided hands-on assistance 24 hours a day during each EDIS go-live, which lasted 5 days.

Project Lead To Project Lead:

1. Communicate

Having a communication plan makes it easier to keep team members and stakeholders up to speed, track the progress of the project, maintain enthusiasm and provide means for feedback. We kept our steering committee, project committee, ancillary project team members and future users up to date with periodic project newsletters, e-mails, and faxes. We found that the more we communicated, the more our staff felt involved, which helped minimize grumblings and concerns as the go-live date approached. Now that the go-lives are complete, we publish ED productivity results to key stakeholders.

2. Learn from Experience

Many have asked if I would support a big-bang go-live across a health system again. The answer is maybe. Our go-live dates for the EDIS project were driven by the opening of our new hospital. Bringing up three hospitals on a new system at the same time was a challenge. Implementing the system in one ED at a time would have been less stressful for our IT organization and less stressful for our super users. If the date could have been pushed out, we also could have completed some additional workflow improvements. Capital Health now has a means to measure productivity in each of their EDs using the integrated reporting feature. Productivity is easily measured at each step of the patient’s visit, allowing for a door-to-disposition view and a proactive way to identify workflow bottlenecks. In addition, Capital Health anticipates positive economic impacts in terms of cost savings (moving from paper to electronic documentation) and time savings for clinicians (with automated order entry and results tracking. In addition, Capital Health will use Wellsoft EDIS to help boost the bottom line with appropriate billing from the automatic capture of appropriate ED charges that otherwise might be lost.

Posted in Client Stories.