The need for speed in the emergency department (ED) cannot be overstated because seconds and minutes can make all the difference in ED patient outcomes. Ironically, however, some hospitals’ recent moves to replace best-of-breed emergency department information systems (EDIS) with enterprise electronic health record solutions may jeopardize ED physicians’ ability to provide quality care in our industry’s fastest-paced environment.
While enterprise EHRs or single-vendor solutions are designed for use upstairs, best-of-breed ED EHRs are designed to support the unique and demanding workflows of an ED clinician.

“Piece of work” or patchwork?
As they come to understand the radically different workflows and information needs of an ED, as compared to other areas of the hospital, many enterprise software companies have, or are attempting to build ED modules from scratch, or buy and incorporate ED systems into their EHR. While the companies may promote their “integrated” offerings as superior to best-of-breed software from an interoperability standpoint, the reality is that the systems in enterprise solutions run on different platforms – removing the main “advantage” over best-of-breed solutions.

Thus, hospitals that buy an enterprise system are often really getting a hybrid solution that includes individual technologies more or less pieced together rather than an organic, integrated and seamless solution.

Let the buyer beware
A provider implementing an enterprise system that includes an ED module should be aware that the vendor most likely has not kept the departmental application up-to-date with the latest emergency medicine protocols and order sets. Building and sequencing order sets requires considerable time, meaning hospitals buying enterprise solutions must endure a long wait to roll out computerized physician order entry (CPOE) to enhance patient safety and efficacy of care.

Unlike enterprise vendors, some best-of-breed vendors offer built-in, evidence-based order sets. Some also hire ED physicians to ensure their systems are current and accommodate clinician needs and workflows from the outset. Those companies focus constantly on developing and upgrading their software because EDs are their sole source of revenue. In contrast, enterprise EHR vendors typically regard the ED as an afterthought since the specialty is a small revenue source for them – not to mention, in light of meaningful use’s main focus on inpatient systems, enterprise vendors are devoting most resources to fulfill that particular need, not the ED.

The singular market focus of best-of-breed vendors enables them to respond to clients’ requests for service faster than other vendors. For example, when news of the H1N1 virus spread to governments and millions of people worldwide in 2009, Clara Maass Medical Center’s best-of-breed vendor, EDIMS, and its physician team built templates for ED treatment, order sets and discharge instructions within 24 hours.

As some hospitals will be faced with retrofitting enterprise software for ED use, they must ask themselves whether they can afford the time and expense of waiting for their vendor to bring their ED component up to speed. By implementing and interoperating a best-of-breed system with an enterprise solution, a facility can improve care, safety and mine information to improve outcomes in the ED more rapidly than it would using an enterprise system.

John Fontanetta, MD, is chairman of the Department of Emergency Medicine at Clara Maass Medical Center, Belleville, N.J., and chief medical officer of EDIMS.