Jon Morris, MD, FACEP, MBA WellStar Health Systems

1. Emergency Room Of The FutureLeveraging IT At WellStar Health System:Kennestone Emergency Department September 18, 2008 Jon Morris, MD, FACEP, MBA WellStar Health Systems

4. Agenda • Introduction • Kennestone Emergency Department • Metrics • More Metrics- Exit Phase • Even More Metrics- Non-ED Physicians • So far…

5. To Err Is Human • Patient Safety Issues: IOM report Nov. 1999 • > 44,000 – 96,000 deaths related to preventable medical errors/year • $17B - $29B cost • 2000 – Leapfrog Group

6. Example: 2007 Adverse Drug Events

7. The Need For Change “The definition of insanity is to continue to do the same thing over and over again and expect different results” Albert Einstein

8. Kennestone ED

9. Kennestone Emergency Department >102,000 Annual patient volume 40% of Kennestone admissions 24.38% admit rate (July 08) October 2007: ED Online

10. ED Flow “Before”

11. Paper ED Record

12. Completed ED Evaluation - Waiting For MD

13. October 2007: Kennestone ED Live Online Documentation and Order Entry • “Sole Source” strategy- McKesson • 18 month build • ED Tracking Board • Online Clinical Documentation (Horizon Emergency Care – HEC) • Online Order Entry (Horizon Expert Orders - HEO)

14. ED Flow “After”

15. ED Tracking Board WSKH ED Applications

16. Patients Waiting For MD

17. ED Patients: Status & Tasks

18. Documentation WSKH ED Applications

19. Online Documentation • Always Available • Real-time • Legible • Automated Date & Time • All Clinical Documentation In One Place • More Complete

20. ED MD Charting

21. Paper vs. HEC- MD Note

22. Order Entry WSKH ED Applications

23. Definition: CPOE • Provider Enters Orders • Clinical Decision Support • Easier to do the right thing • Harder to do the wrong thing • Immediate Order Transmission

24. Tools: I-Forms

25. Tools: Order Outlines

26. “Easier To Do The Right Thing:” Weight-based Dosing

27. “Easier To Do The Right Thing:” Weight-based Dosing

28. Leveraging CPOE: Automation

29. “Harder To Do The Wrong Thing”

30. Allergy Checking

31. Allergy Alert

32. CPOE: A Process • Multiple applications • Provider • Nursing • Pharmacy • Ancillary Services, i.e., Laboratory, Medical Imaging • Global process - multiple stakeholders • KLAS: 17.5% US Hospitals > 200 beds in 2007

33. CPOE- Financial Gains CPOE in Community Hospitals: • ADE cost • Renal dosing errors • Unnecessary / Redundant diagnostic studies • IV to PO conversion • $2.7M Reduction in Cost, 26 month payback* * Feb 08 MA CPOE Initiative Report

34. The Competition

35. Goals- WellStar Health System • Improve Care • Lower Costs • CPOE Using HEO • Two Years To First Facility Go-live • 100% Physician Adoption Two Years Post-live

36. Implementation WSKH ED

37. Challenges in Implementing HEC-HEO • Development • Training • Deployment • Adoption • Reporting

38. Implementing HEC-HEO

39. The Good-

40. The Bad-

41. And the Ugly Truth.

42. One solution… “In the middle of every difficulty lies opportunity” - Albert Einstein

43. A Better Way: Metrics

44. Throughput Analysis • Neglected value of ED applications • Acquire data from HEC & TB. • Quarantine invalid data • Report data compliance, i.e., reporting efficacy and accuracy. • Select and study throughput intervals. • Identify high-yield opportunities.

45. WS KH ED - Throughput Intervals • Arrival to Triage • Arrival to Bed • Arrival to EDMD Assigned • Arrival to EDMD At Bedside • Bed to EDMD at Bedside • EDMD at Bedside to EDMD Decision to Disposition • EDMD Decision to Disposition to RN Disposition • RN Disposition to Exit • LOS

46. ED Metrics

47. The Good: Reliable ED Metrics ERK - July 2008

48. The Bad: Delays in Seeing EDMD Admitted Patients: Patient Arrival to MD At Bedside: 61 minutes Patient in Bed to MD At Bedside: 42 minutes

49. The Ugly: Delays in Exit From ED July 2008 EDMD Decision to Admit to Exit from ED: Exit Phase = EDMD Decision to Admit → Patient Exit From ED 162 + 10 = 172 minutes 39-47% Average ED Patient LOS (Jan – July 2008)