ED Information Technology: What`s It Mean for EMS?

     There's a dirty little secret about that patient-care report you worked so hard to craft so carefully: A lot of times, the one person who most should be reading it isn't.

     "The interesting thing that happens with the report," observes Brian Keaton, MD, president of the American College of Emergency Physicians, "is that everybody reads it but the doctor. A sick patient may be transported before the paperwork is ever created. Then I manage that patient in the ED and move them on to the next stage of care before EMS is even done writing the report. That report eventually becomes an addendum to the patient's chart, and the first time I see it is doing a run review. Wouldn't it be nice if we had that information available from the outset?"

     Yes, it would. And the day is coming when every patient entering a medical system--not only via EMS, but through hospitals, clinics and various other gateways--will have electronic health records that follow them seamlessly wherever their journey takes them, giving every clinician involved in their care along the way a clear and complete picture of their medical history, earlier treatments, test results, allergies and more. The eventual goal is a national health information network composed of interlocking regional health information organizations (RHIOs) that can, by sharing such data, expedite and improve the care their patients receive.

     "We're really just now beginning to explore the opportunities for exchanging data," says Keaton. "There's a nationwide push for health information exchange--when health information is kept proprietary, it really holds the customer hostage. We have huge opportunities, and people recognize those."

     There are two dimensions to this quest. The first is establishing the infrastructure and links by which data is created and moved about--the pipelines, if you will. The second is defining the data and who should have access to it, then developing the policies and procedures to securely manage it in a way that maximizes patient benefit. Technologically, things are moving along well enough on the first count. The latter, however, entails a human--i.e., political--element that, as those in EMS well know, can be endlessly vexing.

     But even as issues are hashed out at state, regional and national levels, many hospitals, recognizing an imperative to improve their own operations, are forging ahead individually, seeking better efficiency in the way they manage and process patients, particularly from the ED.

     "The EDs are the front door of the hospital," says Craig Herrod, president/CEO of MEDHOST, a vendor of emergency department information systems (EDIS). "And every hospital is looking for ways to speed up throughput, increase customer satisfaction, retain staff and not lose their shirts."

     In MEDHOST's case, that's led to an explosion of growth: In the last year, the company signed more contracts than in the previous 24 years combined, and saw increases of 50% in its revenue growth and 58% in its employee base.

     An individual EDIS may not enable the full range of external linkages a hospital will eventually need--horizontally across its community and vertically within its region, state, etc.--but it can improve operations internally in short order, which can benefit EMS by reducing things like ambulance diversion.

     Meanwhile, the links will come in time, and the good news is that it really isn't EMS's battle to fight. This is one of those rare occasions where we can let the healthcare big dogs fight it out, and still realize the benefits. "EMS is going to have to pattern a lot of what it does after what its hospitals are doing," says Keaton. "We have about 200 nascent RHIO efforts in the United States, and they're bearing the majority of the work of linking hospitals with pharmacies and individual providers. As these organizations create and develop, it would be wise for EMS to be at that table. They need to represent their interests as the structures are being put together. It's important for the EMS community to be aware of what's going on, and be a participant in any health information exchange initiative."
-JE