eP-Doc in the ED – The Faster Leaner HIEFermin Barrueto Jr., MD, FAAEM, FACEP, FACMTRegional Director, Dept of EM, UCHSClinical Assoc Prof, UofMD, Dept of EM

Pilot Study

4 Emergency Physicians

3 months Paper T vs 3 months Forerun

Integrated with Voice Recognition – Dragon

ePen utilized but not main mode of data input

Trial had minimum integration of ADT interface only

ED Environment

Patients/Hour

Jan Feb March May June July1.20

1.30

1.40

1.50

1.60

1.70

1.80

1.90

2.00

1.68

1.49

1.65 1.64

1.551.541.53

1.50

1.54

1.33

1.64

1.45

1.78

1.90

1.85

1.79

1.92

1.78

1.62

1.57

1.46

1.56

1.62

1.56

ABCD

Study

RVU/Hr

Jan Feb March May June July6.00

6.50

7.00

7.50

8.00

8.50

7.98

6.76

7.15

7.81

7.43

7.60

6.796.70

7.43

6.15

7.54

6.82

7.69

7.998.09

7.94

8.28

7.72

8.24

7.44

7.08

7.45

7.88

8.05

ABCD

Study

RVU/Pt

Jan Feb March May June July4

4.2

4.4

4.6

4.8

5

5.2

5.4

4.72

4.55

4.35

4.754.78

4.95

4.42 4.44

4.77

4.61 4.61

4.71

4.29

4.21

4.37

4.44

4.34.34

4.48

4.73

4.85

4.77

4.88

5.17

ABCD

Study

Overall Results

Medical Staff Satisfaction

Forerun vs MeditechForerun Meditech P-Doc

Needs Dragon VR Yes Yes

Needs Integration Yes No

Integrate Radiology

Yes – Nighthawk also

Partly – no Nighthawk

Clinical Decision Support

Yes No

Load Time of Chart

1.6 – 3.0 secs Unknown - CPOE

Productivity Proven Unknown

ePen Yes No

ARRA Certified Yes Yes

Build Required No Yes

Cost Analysis

Meditech Estimated Risk10% reduction in productivity (0.2 pts/hr) +

Dragon

= $1.44 Million

+ Cost of “Building” (unknown time)

No cost for Pdoc program

Hospital Benefits

20% decrease in facility charge denials

Medical Staff Satisfaction

Improved Patient Safety (CDS)

ARRA Meaningful Use Certified

Improved Peer Review (CDS)

Improved Risk Management (CDS)

Improved Core Measure/HAI (CDS)

Conclusion

UCEMP LLC willing to share the monetary risk to avoid the Meditech risk

Hospital will avoid Meditech risk and gain an EMR

Hospital has agreed – contract signed, implement 7/12

Meditech v6 CPOE

ePhys Documentation with Forerun

Physician buy-in, enthusiasm for implementationOne physician recruit stated he would only accept position if we had this EMR

Vision

Regionalization of Emergency MedicineUMEMN is 10 EDs on 10 different platforms

EDs can communicate Syndromic survelliance – better than hospital

Develop Best Practice Guidelines - avoid Readmits

Improve Peer Review/QA/Core Measures - quality

Improve Risk Profile – decrease medical malpractice

Improve Revenue – proved in pilot