ED Tracking: It Sounds So Simple, Doesn’t It?

By Yonatan Yohannes

In July’s edition of ACEP Now, an article titled “Seven Best Practices to Reduce ED Misuse” discusses policies implemented in Washington State to reduce the overall cost of Emergency Department care. These policies were pioneered by the Washington state ACEP Chapter (go ACEP!) as well as partner organizations. The “Seven Best Practices” in addition to other factors involved, such as savings from managed care health plans, saved the state almost $34 million for fiscal year 2013!

One of the policies that stood out was the implementation of a statewide electronic ED tracking system. This makes so much sense to have, that one really wonders why has it taken this long for it to come to fruition. Washington’s tracking system consists of an automatic notification sent to ED providers if a current visit is a patient’s 5^th or more ED visit in a 12-month period. The notification includes a summary of prior visits, care plans, and safety alerts (since we all know things can get a little rowdy in the ED sometimes). This specific system is designed to target frequent users and reduce repeated lab testing, imaging, avoidable admissions, and opioid prescriptions.

What if we could use a similar system for our overall patient population? What if a patient is not a frequent user, but has one or two prior outside ED visits over the last few months for the same problem? What if we could share not only ED information, but also discharge summaries, labs/imaging, social work summaries, etc.? Such systems do exist and are slowly being implemented across the country, whether on a statewide or district level (see Camden Coalition Health Information Exchange here, from Camden County, NJ [shout out to my home state!]).

The obvious risk to such a large collection of data that spans independent institutions is the concern for a potential security breach. However, with proper training and monitoring this risk can be minimized and we should not allow such a fear to deter us from providing the best and comprehensive care within our capabilities. The benefits of having such a system far outweigh the risks. It can streamline the care we provide – making it more efficient, effective, and therefore cheaper. Also, it allows us to identify those who utilize the ED the most and connect them with the resources they may desperately need such as primary care, social work, care management team, home visits, etc.

Thus far, the largest obstacle to implementing such a system has been cost (is anyone really surprised?). With a system that spans institutions of varying sizes, who is going to pay? Can we expect the institutions themselves to cough up the money? And if so, how do they divide the cost? It appears that most places who have such systems in place were developed with grants from the state and/or federal government. This is great news for the state of New York as we have $8 billion coming to us from Medicaid starting in 2015, with over $1 billion coming directly to Brooklyn (here).

This is critical soul searching time for Brooklyn. Will we search for new, innovative ways to develop our healthcare infrastructure? Perhaps invest in the development of our own “seven best practices” for reducing healthcare costs? Or will we fall back into our comfort zone and continue to finance the same systems and policies that have yielded zero or negative results over the last several years? Only time will tell. If you ask me, implementing a system to facilitate communication and teamwork among healthcare providers, such as a local health information exchange, would be a great starting point. One in which we can build upon in the years to come.

Check out the full article here.

References
Report to the Legislature. Emergency Department Utilization: Update on Assumed Savings from Best Practices Implementation. March 20, 2014