Emergency Department Information System Implementation and Process Redesign Result in Rapid and Sustained Financial Enhancement at a Large Academic Center

Authors

  • Jason S. Shapiro MD, MA,

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • Kevin M. Baumlin MD,

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • Neal Chawla MD,

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • Nicholas Genes MD,

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • James Godbold PhD,

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • Fen Ye MS,

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • Lynne D. Richardson MD

    1. From the Department of Biomedical Informatics, Columbia University (JSS), New York, NY; and the Department of Emergency Medicine (KMB, CH, LDR), the Department of Community Medicine (JG), and the Departments of General Medicine (FY) and Emergency Medicine (JSS), Mount Sinai School of Medicine, New York, NY. Dr. Shapiro is currently with the Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Dr. Chawla is currently with the Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA.
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  • Presented at the Society for Academic Emergency Medicine annual meeting, San Francisco, CA, May 18–21, 2006.

  • Dr. Shapiro is supported in part by NLM 1K99LM009556-01/02 and 4R00LM009556-03, which has run from July 16, 2007, to the present. There is/was no direct support for work on this project.

  • In 2006 Dr. Baumlin became President and CEO of SunriseSolutions Group (SSG) Inc. During late 2007 and 2008, PICIS contracted SSG to perform services related to assessing processes and performing application training for physicians and other staff members. PICIS in no way sponsored nor offered financial or other support for this research and the consulting engagement ended by late 2008.

Address for correspondence and reprints: Jason S. Shapiro, MD, MA; e-mail: jason.shapiro@mssm.edu.

Abstract

Objectives:  The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to “break even” on the initial investment.

Methods:  A before-and-after study design was performed using a framework of analysis consisting of four 15-month phases: 1) preimplementation, 2) peri-implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break-even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost.

Results:  Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5-year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained-effects periods.

Conclusions:  A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break-even point.

ACADEMIC EMERGENCY MEDICINE 2010; 17:527–535 © 2010 by the Society for Academic Emergency Medicine

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