About five years ago, Centegra Health System, a three-hospital system in northwest Chicago, implemented McKesson Paragon as the organization's electronic health record. This included using the EHR in the provider's emergency departments.
But this caused various issues in the emergency department within just a few weeks of go-live because the EHR was not efficient for use in EDs, said Daniel Campagna, MD, emergency department medical director and IT director of emergency services at Centegra Health System.
"These inefficiencies caused our processes to slow to a crawl," he recalled. "Speed means everything in emergency care, and due to the system not being aligned with the flow of the emergency department, it caused all of our quality metrics to greatly suffer. The inefficiencies of Paragon forced us to go back to a partial paper process because our clinicians just couldn't use it."
Centegra Health quickly realized it needed an EHR developed specifically for the ED – one that could meet the demands of the department's unique environment. The health system currently sees an average of approximately 70,000 patients annually in the emergency department across all three hospitals, and to best treat them in a timely manner, physicians and nurses must be as efficient as possible.
Centegra turned to T-System, a vendor of emergency department information systems, specifically T-System EV, an emergency department electronic health record. Because it was developed for the emergency department, the EHR takes into account the unique aspects of patient care in the department.
"T-System is geared toward rapid documentation and computerized physician order entry, and it gives nurses the ability to efficiently and effectively care for patients," Campagna said. "Again, speed is the name of the game in the emergency department, so any documentation solution not built for the department slows down processes and adds risk to what we do."
The emergency EHR has an innovative way of documenting the patient record where it uses circles and backslashes to generate a story of the history and physical exam, Campagna explained.
"It is incredible how the system offers efficient documentation while also providing a complete picture of the care the patient received in the emergency department," he said. "Our physicians, nurses, PAs and techs use the system for patient care."
The emergency EHR is linked with the hospital's inpatient EHR from McKesson and interfaces with a PACS system and laboratory system, importing imaging studies and lab results.
As a result of using the new emergency EHR technology, the health system has seen a 64 percent reduction since 2016 in its door-to-doc times, from an average 67 minutes to 29.7 minutes.
"Because T-System functions perfectly within the flow of the emergency department, our clinicians can document care quicker, and in turn are able to spend more time talking with and caring for patients, instead of spending a lot of time in front of the computer screen documenting care," Campagna said.
"The documentation method allows our clinicians to more efficiently care for patients, which reduces the overall wait times, allowing patients to go from entering the ED to seeing a physician faster," he added. "And we've seen anecdotal evidence of patients being more satisfied with their care because they are seen by a physician faster."
Combining advanced technology with improved triage processes has truly made the largest differences in reducing the time it takes patients to see physicians, he added.
What's more, Centegra Health has achieved a reduction in its left-without-being-seen rate from 2.1 percent in 2016 to 1.1 percent in 2018. The left-without-being-seen rate is a percentage of the patients who register in the emergency department but leave on their own volition prior to a medical screening exam from a qualified provider.
Sometimes they leave because their pain subsides or they begin to feel better, but often patients leave because the wait to see a physician is too long. Door-to-physician times and inefficiencies are huge drivers in the left-without-being-seen rate.
"Once we installed T-System EV, we saw a reduction in the left-without-being-seen rate because we could treat patients faster," Campagna said. "This metric is also tied to how clinicians are able to spend more time with patients and less time needing to document. Again, speed and efficiency are the largest and most crucial elements in the ED, and by being more efficient, we can see patients faster."
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