Project Members: Mary-Anne Thadeu (Finance), Allison Cunningham (Finance), James Pfeffer (Administration), Sheridan Kassirer (Clinical Affairs), Steve Bohan (BWH ED), and Gil Kuperman

Working with members of Partners Finance, Administration, and Clinical Affairs, and the BWH ED an analysis was undertaken to estimate the potential benefits of implementing automated clinical documentation systems in Partners Emergency Departments, and whether a single enterprise-wide system would be beneficial.

Potential savings due to ED documentation systems could be realized due to decreased cost of paper management, improvement in level of service billing, fewer lost charts so decreased lost charges, and guaranteed completeness for billing purposes. Other benefits would include more efficient use of clerical/office staff, simultaneous access by multiple parties, knowledge of who accessed the chart (improved compliance w/ privacy regulations), remote access to the chart, the ability to capture required data for regulatory agencies, and the creation of a repository for research purposes.

Costs of ED documentation systems would include the cost of the technology, the cost of the change to the current workflow, the cost of integration with existing information systems, and the cost of ongoing maintenance, training and upgrades.

A single enterprise-wide solution would distribute the cost of software, guarantee uniform reporting capability, gain leverage with whatever vendor is chosen (even if built internally), make system-wide upgrades easier (e.g., if coding rules change), make disease management and quality measurement efforts easier to realize. Downsides of an enterprise-wide solution would include incurring political costs if all the sites are not inclined to use the same system, and there would be no guarantee that the system would be used consistently throughout the enterprise.

Site-specific solutions would be easier politically, would more easily accommodate local workflows, and would be an easier fit into the local technical environments (e.g., would be easy to implement Meditech ED application at Faulkner and NWH). However site- specific solutions there would be no guarantee of uniform reporting capability (though could mandate certain fields be captured), there would be no economy of scale, and there would be less leverage with vendors.

A report was created in September 2001. The Partners ED directors will be considering this issue at a future meeting.