In 2004, Great Plains invested in ED-specific technology to improve care management and continuity, clinician collaboration and physician alignment. It deployed a best-of-breed ED information system, or EDIS, that included patient tracking and nurse and physician documentation. An important functionality requirement was its ability to integrate with our inpatient electronic health record and other applications to enable seamless data exchange. Costs for the EDIS, training, support and implementation services for hospital personnel are proprietary to our organization.
To implement the system and integrate the EDIS to the hospital information system, Great Plains established a six-member implementation team composed of the chief information officer, ED medical director, ED director and three IT employees. We applaud our ED physician leaders for leading Great Plains to automate healthcare delivery and provided training support to enhance clinicians' computer skills.
Over the past seven years, Great Plains has realized significant quality, safety and patient experience improvements from its EDIS. Instant access to accurate and up-to-date data including allergies and lab results has decreased errors and duplicate tests, once common with paper-based documents regularly misplaced or inaccessible as patients transitioned from one level of care to another. Physicians and nurses report higher job satisfaction, crediting the EDIS for more informed decisions and time with patients.
The EDIS has enabled Great Plains to strengthen relationships with referring community doctors. The facility configured the system to prevent ED physicians and nurses from leaving their shift without signing their records. As soon as documents are signed, the EDIS automatically faxes a patient's complete ED chart to his or her primary-care physician. As a result, the PCP now has the relevant documentation in hand before the patient arrives for follow-up care, resulting in an 80% decline in calls asking for ED records.
The EDIS has allowed Great Plains to retain its status as the healthcare destination of choice for residents in west central Nebraska. Many opt to drive 60 miles to Great Plains rather than a competing facility 40 miles away because of our advanced EHR and extensive services. We strive to make the ED the “front door” for our far-flung patient community to access those services, and the EDIS helps us achieve this strategic goal.
The EDIS is also playing a significant role in helping Great Plains qualify for stimulus funding. Great Plains currently meets or exceeds several of 14 core measures comprising Stage 1. Under those measures, facilities must perform at least one test of their EHR's capability to exchange data with a health information exchange. While this HIE requirement could be a major challenge to hospitals, the EDIS has made possible our joining the Nebraska Health Information Initiative (NeHII). Great Plains transmits all ED results and radiology and transcription reports to NeHII, making it the first system to successfully transmit data to the Web-based statewide data exchange. Authorized facilities and physicians in Nebraska, Iowa and Missouri are exchanging this and other critical data on 1.8 million patients. As NeHII expands, we plan to transmit a daily download of syndromic surveillance data via the EDIS.
Also, the EDIS leaves Great Plains well-positioned to comply with two other Stage 1 measures that are considered public-health criteria but require some type of health information exchange capability. Under those measures, hospitals must perform at least one test of their ERH's capability to submit syndromic surveillance data and reportable lab results to public health agencies unless those organizations cannot receive the information electronically.
The EDIS helped Great Plains:
- Save $215,000 annually in transcription costs.
- Retain the same number of clinicians at 28 FTEs per adjusted occupied bed including five board-certified ED physicians and three physician assistants and advanced practice registered nurses, despite annual ED visit volume rising 25% since 2004.
- Realize its goal of maintaining ED turnaround time between the time a patient arrives and is treated within two hours—an impressive wait time given that GPRMC did not increase staff and currently averages 300 to 400 more patients monthly, a significant increase since 2004.
Great Plains is committed to evolving its EDIS as a critical-care delivery and health information exchange tool. By reducing its paper dependency and instigating secure data exchange, the rural health provider's investment paved the way for rending higher quality and cost-effective care across its enterprise and beyond geographically connecting statewide and regional medical facilities.
Jim Anderson is chief information officer at Great Plains Regional Medical Center, North Platte, Neb.