Return on Investment for an Emergency Department Electronic Documentation System

2.50
Hdl Handle:
http://hdl.handle.net/10755/162656
Type:
Presentation
Title:
Return on Investment for an Emergency Department Electronic Documentation System
Abstract:
Return on Investment for an Emergency Department Electronic Documentation System
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Gallagher, Ann, RN
P.I. Institution Name:Lehigh Valley Hospital
Title:System Analyst, Department of Emergency Medicine
Contact Address:Cedar Crest and I-78, P.O. Box 689, Allentown, PA, 18105-1556, USA
Contact Telephone:(610) 402-6917
Co-Authors:Valerie Rupp, RN, BSN; Christina Lewis, RN, BSN, MPH, CHE
[Clinical Poster] Clinical Topic: Institutions expect to incur high up-front costs when purchasing an electronic documentation system (EDS), yet the data on their return on investment (ROI) remains undefined. In 2002, this tertiary suburban emergency department (ED) located in southeastern Pennsylvania explored the possibility of switching from a paper system to an EDS. Paper charting had caused repeated problems with illegible, lost, and incomplete records, and consequently, lost revenue as billable items fell through the cracks. An EDS was viewed as a tool to address these problems. In particular, we believed an EDS would enable more comprehensive documentation of patient data, improve information transfer, streamline internal efficiencies, and provide staff with real-time chart access, resulting in reduced operating costs. In turn, these changes could improve patient safety and regulatory compliance.

Implementation: In December 2002, the ED management team conducted a prospective cost-benefit analysis. On the expense side, the team considered variables such as the actual price of the system, the cost of implementation and training staff, while on the benefit side, variables that could both directly and indirectly impact financial gains were considered. These included improved legibility to aid in extracting important billing information, declines in lost medical records, improvements in ED efficiency, and increased regulatory compliance. A multidisciplinary team of physicians, nurses, and staff from finance and information services developed a plan for purchasing the system based on a literature review and site visits to other facilities, as well as, attending information systems conferences and vendor exhibits. The system was finally purchased and installed in 2004. To determine the ROI in 2005, a financial analysis of reimbursement before, during, and after EDS implementation was conducted. In addition, data related to ED elopements and diversions were analyzed to assess system processes and efficiencies that may result in lost revenue.

Outcomes: Professional billing payments in fiscal year (FY) 2004, before implementation of the EDS averaged $79.22, compared to $81.07 in FY 2005, during the transition from paper to EDS and $98.72, in FY 2006, after total implementation of EDS. These results reflect an average increase in payment per patient visit from pre- to post-implementation of $19.50. The savings can be attributed to more legible and complete documentation practices that enable coders to extract information and capture charges that were previously disregarded. A follow-up analysis conducted one year after complete installation, in 2006, reflects a decrease in the number of missing charts, suggesting additional charge capture. While we predicted a decline in the number of elopements and diversions post-installation, the numbers remains constant, possibly because EDS has improved our efficiency in registering ED patients, so the waiting room still fills as before and demand continues to outpace our capacity. Nonetheless, the analysis demonstrates we have improved our operating efficiency and achieved our goal of increasing reimbursement, and thus returns on our investment. Other important variables impacted by EDS, which we did not measure directly, include patient safety, staff satisfaction, communication between staff, and regulatory compliance. Because the system alerts clinicians to documentation mandates established by regulatory bodies, compliance improved as well. Future studies might gauge changes in patient safety by pre- and post-measures of time from lab results availability to staff awareness, medication reconciliation, and frequency of incomplete documentation. Staff satisfaction, communication between staff, and greater compliance with coding regulations could be measured through surveys and reviewing medical records.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleReturn on Investment for an Emergency Department Electronic Documentation Systemen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162656-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Return on Investment for an Emergency Department Electronic Documentation System</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Gallagher, Ann, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Lehigh Valley Hospital<br/></td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">System Analyst, Department of Emergency Medicine<br/></td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Cedar Crest and I-78, P.O. Box 689, Allentown, PA, 18105-1556, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(610) 402-6917</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Ann.gallagher@lvh.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Valerie Rupp, RN, BSN; Christina Lewis, RN, BSN, MPH, CHE</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Institutions expect to incur high up-front costs when purchasing an electronic documentation system (EDS), yet the data on their return on investment (ROI) remains undefined. In 2002, this tertiary suburban emergency department (ED) located in southeastern Pennsylvania explored the possibility of switching from a paper system to an EDS. Paper charting had caused repeated problems with illegible, lost, and incomplete records, and consequently, lost revenue as billable items fell through the cracks. An EDS was viewed as a tool to address these problems. In particular, we believed an EDS would enable more comprehensive documentation of patient data, improve information transfer, streamline internal efficiencies, and provide staff with real-time chart access, resulting in reduced operating costs. In turn, these changes could improve patient safety and regulatory compliance.<br/><br/>Implementation: In December 2002, the ED management team conducted a prospective cost-benefit analysis. On the expense side, the team considered variables such as the actual price of the system, the cost of implementation and training staff, while on the benefit side, variables that could both directly and indirectly impact financial gains were considered. These included improved legibility to aid in extracting important billing information, declines in lost medical records, improvements in ED efficiency, and increased regulatory compliance. A multidisciplinary team of physicians, nurses, and staff from finance and information services developed a plan for purchasing the system based on a literature review and site visits to other facilities, as well as, attending information systems conferences and vendor exhibits. The system was finally purchased and installed in 2004. To determine the ROI in 2005, a financial analysis of reimbursement before, during, and after EDS implementation was conducted. In addition, data related to ED elopements and diversions were analyzed to assess system processes and efficiencies that may result in lost revenue.<br/><br/>Outcomes: Professional billing payments in fiscal year (FY) 2004, before implementation of the EDS averaged $79.22, compared to $81.07 in FY 2005, during the transition from paper to EDS and $98.72, in FY 2006, after total implementation of EDS. These results reflect an average increase in payment per patient visit from pre- to post-implementation of $19.50. The savings can be attributed to more legible and complete documentation practices that enable coders to extract information and capture charges that were previously disregarded. A follow-up analysis conducted one year after complete installation, in 2006, reflects a decrease in the number of missing charts, suggesting additional charge capture. While we predicted a decline in the number of elopements and diversions post-installation, the numbers remains constant, possibly because EDS has improved our efficiency in registering ED patients, so the waiting room still fills as before and demand continues to outpace our capacity. Nonetheless, the analysis demonstrates we have improved our operating efficiency and achieved our goal of increasing reimbursement, and thus returns on our investment. Other important variables impacted by EDS, which we did not measure directly, include patient safety, staff satisfaction, communication between staff, and regulatory compliance. Because the system alerts clinicians to documentation mandates established by regulatory bodies, compliance improved as well. Future studies might gauge changes in patient safety by pre- and post-measures of time from lab results availability to staff awareness, medication reconciliation, and frequency of incomplete documentation. Staff satisfaction, communication between staff, and greater compliance with coding regulations could be measured through surveys and reviewing medical records.</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:54Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:54Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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