Breaking the ED enterprise myth
By Dr. Robert Hitchcock

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A dangerous myth is circulating among us. It can drain your finances, reduce revenue and negatively impact patients. This myth is built on the notion that a hospital's emergency department should go enterprise.


Does your ED have an enterprise system?
  • 1. Yes, and it works well
  • 2. Yes, but it's not effective
  • 3. No, but we're considering switching
  • 4. No, and we like our system

Enterprise systems can cause issues in an ED for many reasons. The ED is so different from the inpatient or ambulatory outpatient environment that there's a need for a specialized system. You wouldn't take an office-based system and put it in your inpatient environment. Why would you put an inpatient system in your ED?

Common reasons hospitals want to go with the single system of the enterprise:

1. It's cheaper

Since many enterprise vendors "throw their ED system in," you may believe that putting in a "free" ED module is less expensive. Truth: Most of these enterprise systems are delivered without content and with an inpatient-based workflow. This means you will need (expensive) clinical experts to build and maintain the system. And when ICD-10 arrives, you'll have to do your own ICD-10 conversion.

In most cases, implementing an enterprise system in the ED results in drastic and sustained productivity loss, especially for physicians. The cost of having dedicated clinical personnel to build/maintain content and workflow, lost productivity of 20-30 percent and decreased billing makes enterprise systems universally more expensive than a best-of-breed solution.

2. It's the best way to meet meaningful use

You may believe an enterprise system is the easiest and/or only way to meet meaningful use. Truth: The meaningful use program fully supports using multiple systems. For Stage 1, more than 50 percent of hospitals used more than one certified solution. Most used an enterprise system with additional specialized systems.

Using systems for specialty areas of care they were designed for leads to a much higher clinical adoption and usage of the system and thus a significant contribution to facility attestation success. Higher usage means better outcomes for the patients, as well as better data entry and collection for meaningful use.

3. I need all my data in one place

An often-held belief is that with an enterprise system, all the data needed is in one place and therefore allows better reporting and patient safety. Truth: From a reporting perspective, today's tools are advanced enough — even the most basic tools — that you can access data from multiple sources and report. Systems that support clinicians' needs are more readily adopted and more usable, which results in increases in both volume and accuracy of data capture.

Also, while it's true that having clinical data available for clinicians at the point of care is necessary, having it all in one place doesn't mean it will happen. Just because data is in one repository doesn't mean it will be accessed and used appropriately by clinicians at the point of care.

Also noteworthy — many enterprise systems were built by acquisitions, using their own internal interfacing with multiple representations of the data. One system from one vendor does not necessarily mean one data source.

Robert Hitchcock, M.D., FACEP, is the chief medical informatics officer and vice president at T-System, Inc.