Microsoft PowerPoint - Sachs_The Role of

1560 Sherman Avenue Evanston, Illinois 60201 www.sg2.com

The Future of Emergency Care in the United States Health SystemThe Role of Technology on Future Emergency Care

Michael A. SachsChairman

[email protected]

June 25, 2004

AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Care Delivery ChallengesThe Path to Change

AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Emergency Care ChallengesThe Path to Change

4Confidential and Proprietary © 2004 Sg2

What’s Going to Happen

Sg2’s Focus

When It’s Going to Happen

What’s the Impact

?

… and the actionable strategies


Impact of Change™Database and Edge

Analysis

Impact of Change™Database and Edge

Analysis

Publicly Available

Utilization Data Sets

Publicly Available

Utilization Data Sets

Sg2 Team Covers the Industry

Demographic and Sociocultural Data

and Research

Demographic and Sociocultural Data

and ResearchClinical and Management Conferences

Clinical and Management Conferences

Clinical Advisors and

Clinical Experts at Member Hospitals

Clinical Advisors and

Clinical Experts at Member Hospitals

FDACMSFDACMS

Timing and Volume Impact of Evolving Minimally Invasive

Surgical Approaches

Benefit Design and Impact of

Consumer-Driven Health Plans

Annual Growth Rate for CT Angiography

ExampleExampleExample

Claims DatabaseClaims

Database


Impact of Change™ Model

Impact of Change™

Forecaster

2002 - 2012Technology

Inpatient Discharges and Days

Inpatient Discharges and Days

Outpatient Volumes

Outpatient Volumes

Payment

Sociocultural

Economy

Popu

latio

n

Outpatient Shift

Emergency Department

Visits

Emergency Department

Visits


Sg2’s Edge Core Topics

Clinical Enterprise of the FutureE-Care: TelemedicineEmergency DepartmentsIntensive Care UnitLab of the FutureMedical PrivacyMedical WorkforceOutpatient CarePharmacy of the FuturePhysician OrganizationsPoint of Care TechnologyProcedure CentersSelf-CareSpecialty HospitalsWiring Clinical Care

Commercial Health InsuranceConsumer Driven Health Plans Disease ManagementHealth Care Economic ForecastMedicaidMedicare PaymentPatient as PayerPayment for TechnologiesPayment Redesign

Cancer CareCardiovascular ServicesChronic DiseasesImaging ServicesInfectious DiseaseNeurosciencesOrthopedicsPediatricsSurgical ServicesWomen’s Health

Organization and DeliveryEconomics and PaymentClinical Services


ED is a Window on the Community

Consumerism

Sociocultural

Economy

Population

Competition

Medical Practice

Technology

Care Organization


EDs Serve Multiple Patient Types

Chronic Conditions

Trauma and Accidents

Acute Medical Insults

Primary Care(Non-emergency)

Types of ED Patients Current Major Emergency Care Issues

Inappropriate Utilization

Medical Errors

Delays in Treatment

High Costs


60,000

80,000

100,000

120,000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

ED Visits are Increasing

Sources: Division of Care Statistics, National Center for Health Statistics; CDC NHAMCS 2002 ED Summary, 2004; US Census

Emergency Department VisitsUS Market, 1992-2002

Visits(Thousands)

1992-200223% Total Growth

As Compared to 10% US Population Growth


25

30

35

40

45

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

ED Use Rates are Also Increasing

Sources: Division of Care Statistics, National Center for Health Statistics; CDC NHAMCS 2002 ED Summary, 2004

Emergency Department Use RatesUS Market, 1992-2002

Number of VisitsPer 100 Persons Per Year

1992-20029% Total Growth


1.01.01.21.31.31.41.4

1.71.81.92.02.12.3

2.62.72.7

3.14.0

6.730.6

DysrhythmiaNausea/vomiting

BronchitisPneumonia

GastrointentinalFever of unknown origin

AllergyCOPD

Skin infectionAsthma

Other lower respiratory infectionViral infection

Urinary tract infectionBack problem

HeadacheOtitis media

Chest painAbdominal pain

Other upper respiratory infectionInjury

EDs Treat a Broad Range of Problems

Emergency Department Visits by the Top 20 DiagnosesUS Market, 2002

(Millions)

Sources: CDC NHAMCS: 2002 data; Sg2 Analysis, 2004

Top 20 diagnoses represent 66% of total

ED visits.


4.43.1

2.74.3

3.33.8

2.02.92.9

3.13.7

2.93.7

2.83.0

2.04.7

4.32.22.3

DysrhythmiaNausea/vomiting

BronchitisPneumonia

GastrointestinalFever of unknown origin

AllergyCOPD

Skin infectionAsthma

Other lower respiratory infectionViral infection

Urinary tract infectionBack problem

HeadacheOtitis media

Chest painAbdominal pain

Other upper respiratory infectionInjury

Treatment for Complex Medical Problems Can Be Expedited

Emergency Department Average Hours Per Visit* by the Top 20 DiagnosesUS Market, 2002

(Hours)

* From arrival time to discharge timeSources: CDC NHAMCS: 2002 data; Sg2 Analysis, 2004 Average = 3.2

Technology Examples toReduce Treatment Time

CT angiography

Rapid diagnostics

Handheld/portable ultrasound

Functional MRI

Electronic medical record

Clinical decision support system


ED Utilization is Driven by the Elderly and Young adults

39.743.6

39.2

30.1

37.5

61.1

0

10

20

30

40

50

60

70

Under 15 15-24 25-44 45-64 65-74 Over 75

Visits per 100 Persons Per Year

Emergency Department Use RatesUS Market, 2002

Source: CDC NHAMCS 2002 ED Summary, 2004

Overall ED Use Rate 38.9


0

20

40

60

80

100

120

140

1970 1980 1990 2000 2010 2020 2030 2040 2050

Age 55-64 Age 65-84 Age 85+

Aging Will Increase Utilization and Acuity of Care

Population(Millions)

Elderly* and Upper Middle-age Population US Market, 1970 - 2050

Note: Data for 2010 – 2050 projections based on Census Bureau’s Interim Projection by Age, Sex, Race, and Hispanic Origin Source: U.S. Census Bureau*Elderly population consists of both the 65-84 and 85+ age cohorts

9.8% 11.3% 12.6% 12.4% 13.0% 16.3% 19.7%Elderly* as % ofTotal Population 20.4% 20.7%


Cardiovascular Disease Prevalence Will Increase

28

3331

36

2000 2010

Male Female

CVD prevalence grows by 18% as “Baby Boomers”

reach 65+ years.

Projected Population with CVD (millions) US Market, 2000–2010

Sources: American Heart Association, 2001 Heart and Stroke Update; U.S. Census Bureau


Neurological Disease Prevalence Will Increase

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Parkinson's Epilepsy Stroke Alzheimer's

2000 2005 2010

Number(Thousands)

Overall Disease Prevalence US Market, 2000 – 2010


Patients with Multiple Diseases Will Also Increase

141

125133

149157

164171

118

100110120130140150160170180

1995 2000 2005 2010 2015 2020 2025 2030

44.7%

46.2%47.0%

47.7%48.3%

48.8%49.2%

45.4%

Percent of the Population with a Chronic Condition

Growth in Chronic Disease, 1995-2030

Sources: Rand Corporation; Partnership for Solutions

Number of People with Chronic Conditions

Poor patient management of chronic diseases and poly-pharmacy issues

attribute to increased ED utilization.


Hospital Quality Initiatives Will Reduce ED Readmissions

Hospital Quality Initiative (HQI)

Source: CMS


Growing Health Care Costs Have Led to Insurance Changes

Sources: (GDP) Bureau of Economic Analysis, US Department of Commerce, 2004 (Employer Cost Data) Bureau of Labor and Statistics, US Department of Labor, 2004

Annual Percent Change

ED utilization by insured persons will continue to increase:Patients rejected from the managed care gatekeeper modelsAccessibility to treatmentReduced access to primary care physicians

Annual Employment Cost Trends1982 – 2003

0

5

10

15

20

25

1982 1985 1988 1991 1994 1997 2000 2003

Health Insurance

Total CompensationGDP


Patient Cost-Sharing Will Reduce Non-Emergent Care Volume

$6,656

$4,819

$2,875

$2,137

$2,412

$1,619

$508

$334

$0 $2,000 $4,000 $6,000 $8,000 $10,000

2003

2000

2003

2000 Employer ContributionWorker Contribution

Relative Share of Premium Cost:Employers vs. Workers, 2000 and 2003

$1752000

$2012001

$2512002

$2752003

Average Annual Deductibles for Single PPO Coverage: 2000 - 2003

+57%

Source: KFF/HRET Employer Health Benefits

Single

Family


Forecast of Emergency Department VisitsEmergent vs. Urgent* **

US Market, 2002-2012Visits (Thousands)

0

20000

40000

60000

80000

100000

120000

140000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

2002-2012 Total Growth

Overall 13%

Emergent 8%

Urgent 15%

* Visits with unknown or no triage status are proportionally distributed to urgent and emergent volumes** Emergent visit is defined as a visit in which the patient should be seen in less than 15 minutes. Urgent volume includes all other ED visits Sources: CDC NHAMCS: 2000-2002 data; IoC Analysis, 2004

Actual Forecast

ED Volume Will Increase–Urgent Care More Than Emergent


Demographic Growth the Largest Driver of Volume

11.8%

1.2%

7.7%

-0.4%

-4.9%

0.1%

Demographics Total Percent Change

Components Attributed to Emergency Department Volume Percent ChangesEmergent vs. Urgent*

US Market, 2002-2012 (Cumulative Changes)

Sociocultural Technology

PaymentConsumerism and Economic

* Emergent visit is defined as a visit in which the patient should be seen in less than 15 minutes. Urgent volume includes all other ED visits Sources: CDC NHAMCS: 2000-2002 data; IoC Analysis, 2004

Emergent Cases Urgent Cases

10.5%

8.6%

15.3%

-0.8%

-3.4%0.4%

Demographics Total Percent ChangeSociocultural Technology

PaymentConsumerism and Economic


41%

34%

10%

15%

Key Trends Will Impact Each Patient Type Differently

Polysaccharide vaccines for pneumococcal diseaseIncreased cost sharingIncreased uninsured population due to high premiumsReal time PCR Proton pump inhibitorsEconomic reboundAccess to technologyIncreasing societal dependence on ED

Primary Care(Non-emergency)

Emergency Department Volume Distribution by Type of PatientsUS Market, 2002

(Percent)

Medical therapies for osteoporosisIncreasing activityEmerging safety measures

Trauma and Accidents

Anti-inflammatory agents for COPD (next generation)Anti-IgE monoclonal antibodies for chronic asthmaDisease management

Chronic Conditions

Statins for atherosclerosisNoninvasive coronary angiography (CTA)Implantable cardioverter-defibrillators (ICDs)

Acute Medical Insults

100% = 110.2 million visits Highest Impact Technologies or Factors for Each Patient Type

Sources: CDC NHAMCS: 2000-2002 data; IoC Analysis, 2004


Pharmaceutical Advances Will Impact Emergency Care

-1800

-1600

-1400

-1200

-1000

-800

-600

-400

-200

0

200

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Cumulative Impact(Thousands)

Forecasted Technology Impact On ED Visits By Select Technology ClassUS Market, 2002 - 2012

Protein-based

Targeted drug therapies

Implantibles/Nanotechnology

Vaccines

Energy delivery (e.g., CRTs)

Minimally Invasive


ED Volumes Are Rising, But EDs are Declining–More Volume Per ED

4,652

4,037

1992 2002

A decline of 13%, due to hospitals closing their EDs

Number of Emergency DepartmentsUS Market, 1992-2001

Source: Hospital Statistics™, 2004


Molecular MedicineRedefining disease and treatments

ImagingReducing the unknown

ImplantablesKeeping parts working longer

Minimally Invasive SurgeryReducing patient trauma and shifting locations of care

Digital InformationAccess to care 24 x 7

Technology Changes Care Deliveries


Entering the Era of Targets

1. Disease is in the cell2. Precision in treatments3. Decentralization of care


v

New Care Delivery Models Will Emerge to Promote Efficiency

Anticipatory Processing

Parallel Processing

Future ED Care Delivery

Bedside/ Decentralized

Care

Medical IT

Operational Innovations

Traditional Triage

Serial Management

Current ED Care Delivery


Enterprise-wide

Operational Innovations

Advancements in Clinical

Technology

ED-Specific Technology and Care

Pattern Changes

Technology Will Impact the ED in Multiple Ways


Advancements in Clinical

Technology

Clinical Technologies will Change the ED Patient Mix and Reduce ED Utilization Mismatch

High Impact Technologies on ED Volume

Devices

ICDs

VADs

Chronic disease management

Medical therapies

Statins

Polysaccharide vaccines for pneumococcal disease


ICD Utilization Will Continue to Grow as Indications Expand-Expect More ED Visits

Sources: NHDS, 2001; IoC™ Database, 2003; JP Morgan MedTech Monitor, 2003; Sg2 Analysis, 2004

80,000 per year0-2,000 per year

Annual ICD market

Up to 9 years18 monthsBattery life1 day3-5 daysALOS< 0.5%2.5%Mortality

1 hour2-4 hoursProcedure time

Pectoral incisionMedian sternotomy or lateral thoracotomy

Implant site/Incision

≤ 40 cm3120-140 cm3Device size

Electrophysiologistor surgeon

Cardiac surgeonPhysician

20001980s

ICD InnovationsUS Market, 1980-2000

ICD Utilization for Approved Indications

0

20

40

60

80

100

120

CardiacArrest

VT/VF Non-tolerated

VT Tolerated High RiskPost-AMI

Number of patients with ICD implanted per year

(thousands)

The positive impact of ICDs on ED volume is mitigated by the new generation of “smart” pacemakers and ICDs, which include home monitoring systems that transmit detailed cardiac information to the physician offices.


LVADs Will Improve Patient Survivability and Will Generate Additional ED VisitsSurgical Technology Example: Left Ventricular Assist Devices (LVADs)

* Randomized Evaluation of Mechanical Assistance for Treatment of Congestive Heart FailureSource: NEJM, 2001; Dr. Eric Rose

rate per 100 patient days

DeathNeurologic DysfunctionBleedingLocalized InfectionSepsisThromboembolic EventArrhythmias:Cardiac ArrestArrhythmias:VA with cardioversionArrhythmias:SVA with cardioversionSyncopeNon-periop MIRenal FailureHepatic DysfunctionPsychiatric EpisodeLVAD Related RHFLVAD Periop BleedingDriveline or Pocket InfectionPump Inflow or Outflow InfectionDevice Thrombosis

0.2 0.1 0 0.1 0.2 0.3 0.4

LVASOMM

REMATCH* Study Results: Serious Adverse Events and Death, Rates Per 100 Patient Days

LVADs vs. Optimal Medical Management (OMM)

LVADsOMM

Rate per 100 Patient Days


Disease Management Will Prevent Patient Readmission and ED Use

0

100

200

300

400

500

600

700

800

Pre- Post-Disease Management

Four-Year Validation of CHFDisease Management Program

Sample Hospital, 2001

All Hospitalizations

CHF Hospitalizations

Hospitalizations

Source: UCLA Medical Center, 2002; Journal of the American Geriatric Society, 1990

1. Computer collects daily touch-tone answers

2. Algorithms trigger exception reports

3. Patients who have not called receive automated outbound reminder

Patient phones with weight and symptom report

Weight gain/loss or symptomatic

CHF nurse assesses patient

via telephone

Reviews adherence to

medications and diet

Readjusts medications, counsels and

educates, triages cases

Overview of CHF Tel-Assurance™ Process

-46%

-50%

Disease Management Example: Congestive Heart Failure


Statins Will Reduce Chest Pain Presentations to ED

Sources: CDC NHAMCS: 2002 data; JP Morgan Prescription Pad, 2003; Journal Gen Intern Med 2004; Sg2 Analysis, 2004

1,500

2,000

2,500

3,000

1999 2000 2001 2002 2003

Statin Prescription GrowthUS Market, 1999-2003

Prescriptions (thousands)

Future statin prescription growth will continue due to:

Personalized medicine and pharmacogenomics

Combined therapy with advanced cholesterol treatment, including synthetic HDL infusions and cholesterol vaccines

1999-2003 Total Growth

60%

Over 3 million people present to the ED with chest pain

ImpactStatins have been shown to reduce the incidence of coronary events by 35%, causing a significant impact on reducing ED visits

IssuesPoor statin adherence among patients treated for primary and secondary prevention of CHD due to copayment costs


Pneumococcal Vaccines Will Reduce ED Visits

Heptavalent pneumococcal conjugate vaccine (PCV-7) has been in widespreaduse since FDA approval in 2000.

More than 2.6 million patients presented to ED with otitis media and eustachiantube disorders in 2002

PCV-7 has been shown to be immunogenic for children under 2 years old. This age group was not protected by the traditional 23-valent vaccines

* Prior to vaccine approval (4/95 – 3/00) and after approval (4/00 – 3/02)Sources: CDC NHAMCS: 2002 Emergency Department Summary, March 2004; Pediatric News and Family Practice News, 2003; Sg2 Analysis, 2004

Herd immunity, decline in pneumococcal disease in older children and adults, has also been observed

Overall efficacy of all pneumococcal vaccines in preventing invasive disease is approximately 60%. ED visits of these patients will continue to decline


Enterprise-wide Operational Innovations

Operational Innovations Will Reduce Medical Errors and Wait Time at the ED

High Impact Technologies on ED Efficiency

Web-based health services

Electronic medical record (EMR)

Clinical decision support systems (CDSS)

Hospitalist and intensivist models

Remote ICU monitoring


Web-based Health Services Will Improve Access to Primary Care


Adoption of EMR Will Reduce Medical Errors

Hospitals are adopting EMR.

About 19% of health care providers have implemented a fully operational EMR system.

An additional 37% are currently in the process of implementing.

Impact of EMR in Emergency Care Settings

Paperless ED with EMR for triage, patient tracking, registration, order entry, nursing and physician documentation, discharge instructions and prescription writing

Reduction in medical errors with immediate access to patient records

National computerized information systems, as reported by IOM, required to significantly reduce medical errors and acceleration of EMR adoption/ implementation

Sources: HIMSS, 2004; IOM, 2003; Sg2 Analysis, 2004


Clinical Decision Support System Will Expedite and Promote Appropriate Care

Point of care “on demand” “just in time” information for

decision making

Scientific Evidence Clinician Experience

Information TechnologiesEthics and Values

Sources: Annals of Emergency Medicine, 2002; Sg2 Analysis, 2004

Impact of Evidence-Based Clinical Decision Support System in EmergencyCare Settings

Improved accuracy in clinical decision making with customized diagnosis and treatment based on evidence-based guidelines and up-to-date protocols

Increased staff productivity with operational efficiency through real-time, patient-specific decision support

Faster patient throughput


Intensivist and Hospitalist Models Will Streamline Hospital Efficiency

IntensivistsServe as the gatekeepers of the ICUs

Reduce hospital and ICU mortality

Improve hospital efficiency by reducing inappropriate ICU admissions and length of stay (hospital and ICU)

Reduce ED patient wait time and ED bottlenecks

Are in demand as hospitals are required to adopt full-time intensivist model to meet the Leapfrog ICU Physician Staffing standard. Only 10% of ICUs in the US meet this standard.

HospitalistsReduce admission times for medical patients admitted from the ED through a hospitalist triage and admission intervention system implemented by Johns Hopkins Bayview Medical Center

Reduce ED patient wait time and ED bottlenecks

The University of Pittsburgh offers a combined Internal Medicine/Emergency Medicine/Critical Care Medicine Training Program, preparing both intensivists and hospitalists to care for the critically ill and patient emergencies.

Sources: The Leapfrog Group, 2004; Journal of General Internal Medicine, 2004; Sg2 Analysis, 2004


16.0% N/CAverage LOS

26.7% 26.4% Mortality Rate

N/C

N/C

ICU

24.6% Variable costs/case

16.8% Outliers

Hospital

Estimated Impact of eICU®*

Advocate HealthCare intensivist monitors 50 patients using eICU®.

* Results of a 2-year study at Sentara Healthcare. As reported in Critical Care Medicine, 2004Sources: VISICU; Critical Care Medicine 2004; Sg2 Analysis

Remote Monitoring Will Improve ICU Throughput, Reduce ED Wait Time

Impact on Emergency Department

ED patient wait time and ED bottleneck reduction

Next-generation technology applicable to ED

Improved operational efficiency, especially during infectious disease outbreak


ED-Specific Technology and

Care Pattern Changes

Technologies Will Enable Changes Within the Emergency Department

High Impact Technologies and OperationalInnovations on ED Efficiency

Regionalization of care

Advanced imaging modalities

CT angiography

Rapid diagnostics

EMS technologies

ED information systems

Patient registration and tracking technologies

Lab automation

Effective triage models


Transforming ED from All Things to All People to Specialization – Regionalization of Care

5.0

7.0 6.6

8.46.87.0

14.0

7.6

12.1

10.0

LIMI PRAGUE DANAMI AIR-PAMI PRAGUE-2

Primary PCI Onsite Fibrinolysis

(1999)N=224

(2000)N=300

(2002)N=1572

(2002)N=138

(2002)N=850

* LIMI=Limburg Intervention/MI trial; PRAGUE=Primary Angioplasty After Transport of Patients From General Community Hospitals to Cath Units With/Without Emergency Thrombolysis Infusion Trials; DANAMI=Danish Multicenter Randomized Trial on Thrombolytic Therapy Versus Acute Coronary Angioplasty in AMI trial; AIR-PAMI=Air Primary Angioplasty in Myocardial Infarction TrialSource: Journal of the American College of Cardiology, 2004

Mortality Rates in Clinical Trials* Comparing Onsite Fibrinolysis vs. Transfer for PCI For STEMI Impact

Primary Percutaneous Coronary Intervention (PCI) has been proven to be more effective to treat ST-Segment Elevation Myocardial Infarction (STEMI).

Patient transfer strategies similar to regional trauma networks are needed.

Successful Networks Need

Centralized AMI facilities within reasonable distances

Integrated EMS

Experience in medical community with centralized AMI care networks

(Percent)


Advanced Imaging Modalities Strategically Located at the ED Will Accelerate Diagnosis

Handheld Ultrasound

16- or Higher-slice CT System

Digital Radiography System(Kodak Directview DR9000 at the trauma center of St. John Medical Center, Tulsa, Oklahoma)


CT Angiography Will Reduce Diagnostic Time for Chest Pain Choice of work-up depends on the clinical question:

Case A: assessment of functional impact of symptoms => stress testCase B: CAD likely & desire “road map” for intervention => angio or CTACase C: rapid exclusion of coronary obstructions => CTA

A

B

C

Former smokerChest painFamily history of CVDECG indicates a problem

EKGStress TestX-ray angiography

EKGX-ray angiographyCTA

EKGCTA


Rapid Diagnostics Will Reduce Both Medical Errors and Wait Time

Sources: JAMA, August 2000; B. Rogers Presentation, AMP 2002; Cephid Corporate Documents

Next Generation Real-Time PCR

Bacterial and Viral Genome Sequencing Projects

In the ED setting, emerging real-time PCR tests for conditions such as pneumococcus, meningitis, bloody diarrhea and septicemia will replace laboratory evaluations for occult bacteremia and due to rapid, accurate test results, may sharply decrease the use of antibiotics. Early targeted disease detection will speed recovery.

Extraction, Amplification and Detection< 25 minutes

Rapid Diagnostics Example: Real-time PCR


Game-changing feature:improved speed

Reduces test turnaround timeDecentralized into rapid-response labs, as the technology becomes faster and easier

Operations

Total costs for real-time PCR platforms and automated DNA extractors ~$100,000 to $400,000Marginal reimbursement (at best) CPT codes not keeping pace

Finances

Infectious disease; hospital infection controlCancer

Impact on:Service Lines

Technology ImprovementsTraditional PCR—3 steps

Real Time PCR—2 steps

Next generation real-time PCR—1 step

1 Original Target

30 Cycles

1 Billion PCR Products

Real-Time PCR Expedites Diagnosis and Improves Accuracy of Clinical Decision Making


Technology Implementation in EMS Will Save Time and Improve Patient Outcomes

Santa Cruz County, CATele-electrocardiography

UCSF-designed study, being tested in Santa Cruz County

New “tele-electrocardiography”system takes reading every 30 seconds

Data transmit to ED via cell phone

Study to determine if the system will improve survival and long-term health of heart attack victims

Sources: UCSF, 2003; iHealthBeat.org, 2004; LifeNet EMS web site, 2004

Electronic Patient Care ReportingSystems

Paramedics to enter patient information to Tablet PCs and transmit the data to ED via wireless connection

Improve care delivery by allowing the hospitals to anticipate the patient arrival


ED Information System Will Streamline the Care Process

High Risk alert Length of stay (LOS) Nursing timers Order status for labs, X-rays, EKGs Patient acuity Patient bed/location


Patient Registration and Tracking Technologies Will Improve ED Patient Flow

Patient registration using self registration kiosks and handheld portable computers

Patient tracking using infrared and radio frequency technologies

Legoland in Denmark uses RFID to let parents track their children.


Lab Automation Can Break the ED Bottlenecks

Improved throughput and room utilization by 20%Reduced patient wait time 40%Raised Press-Ganey scores to 80th % goal

Overall ED Project Improvement

Draw & Hold at NorthwesternPatients enter EDStanding orders guide test selectionTests sent to automated lab Results ready for physicianAdd-on tests in 6 minutes


Effective Patient Triage Models Will Shorten Patient Turnaround Time

Source: Sg2 Analysis

Improved ED Workflow Model

Triage at PresentationTransfer patients with asthma directly to the

pulmonary observation unit

ICU Admission

Pulmonary Observation Unit

Standard Admission Discharge

Secondary Triage

FAST A

ND

EFFICIEN

T

Strategies for improving the ED paradigm

Initial AssessmentObjective assessment of airflowHistory and physical examination

Discharge

ED Management

Chest x-rayOxygen therapyPEF or FEV1Inhaled β2 agonistCorticosteroidsLabs +/- blood gas

ICU Admission

Standard Admission

FAST

SLOW

Impending Respiratory

Failure

Current ED paradigm: slow turnaround

Streamlined ED Triage Example: Asthma Patient Management

Medicare currently reimburses hospitals for observation care provided to patients with asthma, chest pain and CHF. Future expansion to other diagnoses is forecasted.


System of the Future Provides the Right Care to the Right Patient in the Right Setting

Primary Care Centers

Comprehensive Disease

Care Centers

Birthing Centers

Acute Custom Care Facility

Acuity

Low

Broad, CustomizedFocused High-Volume Routinized

Clinical Focus

High

ASCs

PhysiciansPhysicians


Lower Costs Can Be Achieved Through Clinical and Operational Excellence

30% Savings

Clin

ical

Pro

cess

Business Process

Busine

ss M

odel

Weak Weak

Strong

Strong


Hospital’s Technology Adoption is the Foundation for Planning

Innovators EarlyAdopters

Consensus Adopters

CautiousAdopters

LateAdopters

Possesses, but doesn’t develop the latest technologies

Reports on the first wide-spread use

Developers, strong in research

Early-stage initiatives cited at national meetings/journals

Outdated technology and systems

Lacks focus, with few decisions related to strategy/future development

Lags in adoption of mature technologies

Capital-constrained or has limited staff

Focuses on technologies broadly available

Organizational incentives reinforce consistency in approach/process

Clinical Change

Operational Change

Financial Change

1

2

3

4

5


1Remote monitoring

2Hospitalist and intensivist models

2

2

1-3

1

1-2

1

2

2

2

1

Technology Adoption*

Regionalization of care

Lab automation

CT angiography

Electronic medical record (EMR)

Clinical decision support systems (CDSS)

Advanced imaging modalities

Rapid diagnostics

STAR** Delays in Treatment

EMS technologies

ED information systems

Impact on

Effective triage models

ED Utilization

Medical Errors

Technology

Impact of Technology on Emergency Department

* Technology adoption categories with current national adoption rate** Sg2 Technology Advantage Rating (STAR) assigns 1 star (lowest impact) to 5 stars (highest impact) to each technology or operational innovation according to its impact on ED clinical outcomes, operational efficiency and financial performance for the next eight years (2004 – 2012).Source: Sg2 Analysis, 2004


3ICDs

4Statins

3

2

4

1

1

Technology Adoption*

Chronic disease management

VADs

Pneumococcal vaccines

Web-based health services

Patient registration and tracking technologies

STAR** Delays in Treatment

Impact on

ED Utilization

Medical Errors

Technology

Impact of Technology on Emergency Department (Continued)

* Technology adoption categories with current national adoption rate** Sg2 Technology Advantage Rating (STAR) assigns 1 star (lowest impact) to 5 stars (highest impact) to each technology or operational innovation according to its impact on ED clinical outcomes, operational efficiency and financial performance for the next eight years (2004 – 2012).Source: Sg2 Analysis, 2004


The Path to Change Requires Technology Investments and Planning

Market Position

Competitive Landscape

Technology Profile

Industry Outlook

Technology Evaluation

Technology Priorities

Acquisition & Introduction

Diffusion

Monitoring

Profile Plan Manage

Technology Assessment Technology Adoption

Where are we?

Where do we need to be?

How do we get there?

Sg2 Technology Evaluation & Planning (STEP) Program


The Bottom Line…

ED is a reflection of the community.

Technology changes outside the ED are more powerful in changing ED work flow than technology in the ED.

ED is only as good as the weakest part of the hospital.

Accelerate Technology Adoption – Improve Care

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