Transcript Informatics in the Emergency Department??

Informatics in the
Emergency Department
Katrina Hurley, MD
September 6, 2007
Objectives
• Clinical perspective
• Complexity of information in
emergency care
• Electronic patient data in Canadian
Emergency Departments
• Local tools/technology
• Opportunities
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You’re taking a walk downtown…
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A man clutches his chest and collapses
Witness calls 9-1-1 on cell phone
You start CPR
Ambulance arrives within 3 minutes
Cardiac arrest
Advanced life support and transport
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Man collapses on
sidewalk
Witness calls
9-1-1 via cell phone
Enhanced 9-1-1
EHS Communication Centre
Ambulance
dispatched
Computer Assisted Dispatch
Automated Vehicle Locator
Paramedics
assess, treat and
transport
Electronic Patient Care
Record (portable computer)
Arrival: Resuscitation Room
• Patient has no identification
• Flurry of activity
– Actions to stabilize, diagnose and treat
• “Registration”
– Generate paper chart
– Facilitate tests
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Registration
STAR (Hospital-wide)
EDIS
Chart review
Medical Records
Horizon Patient Folder
Lab tests
Laboratory Information
System (LIS)
X-rays
QuadRIS
PACS
Continued care…
• Patient is having a heart attack
• Transferred to cardiology for therapy
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Unanswered questions
• Who is the patient?
– What is the patient’s medical history?
– What medications does he take?
– Who is his next of kin?
• What happens after he leaves the ED?
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Patient outcomes
• Link EDIS data with Vital Statistics data
that is provided monthly on a diskette:
– Identifies patients who DIE within 30 days of
visiting the ED
• EDIS can track patients who bounce back
to the ED after a visit:
– Used for performance evaluation and
feedback
• Informal feedback
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Quality assurance
• How long did it take for the ambulance to
get dispatched?
• How long before the ambulance arrived?
• Was appropriate medical care provided?
• How long did the patient stay in the ED
before definitive treatment?
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Need for data
• Assess system performance
• Assess patient outcomes
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Use of EDIS in Canada
• 2005 survey with 65% response rate
• 39% had an EDIS
• 9/13 jurisdictions access death data
• 8/13 can access admission data
• 2/13 collect comprehensive data
– NO national database
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Overcrowding
• Why does it happen?
• How can we predict it?
• Can we use liaise with EDIS to create a
warning system?
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Performance evaluation
• Can we use EDIS to liaise with other
hospital information systems in the
province to determine patient outcomes?
• Can we give out-come based feedback to
clinicians to improve their performance?
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Disaster planning
• Activate disaster plan.
• Available as a paper/MS Word document.
• Could we create an electronic disaster
activation system that interfaced with EDIS
to enhance patient flow and
communication in a disaster?
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Information flow & management
• Information flow in emergency care is
complex:
– Interfaces with numerous information systems
• Redundancies and inefficiencies
– E.g. Pre-hospital ePCR must be printed
• Lots of data captured on paper or pdf
– Electronically inaccessible
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Questions???