Working with Data
Redefining Emergency Medicine Excellence Through
Continuous Process Improvement
Our goal at Emergency Care Partners (ECP) is to improve patient experience and satisfaction by optimizing Emergency Department (ED) throughput, highlighting areas of opportunities that yield the biggest improvements, and assist in change management and implementation. If you would like to learn more about our approach with data or if you would like to discuss how we can help your emergency department, contact our team of experts.
Electronic Medical Record (EMR) Data Integration
to Drive Process Improvement
Emergency Care Partner’s ability to integrate with a hospital’s EMR support our partners with the ability to better manage patient volume, optimize coverage, and evaluate provider productivity, therefore maximizing ED throughput efficiency. We are also able to assist with billing reconciliation, provide data quality improvements for accurate reporting and support implementation of patient census tracking. Process improvements are made possible by deploying the following resources:
- Standard inbuilt reports providing valuable insights which can be used to evaluate baseline processes in the emergency department and identify target areas for improvement by automatically compiling reports from different sources.
- Daily/weekly/monthly automatic reports sent directly from the ECP Analytics platform to facilitate continuous monitoring and control.
- Customizable data visualizations with ability to be drilled down to the specific patient level. Project-specific reports built on demand to rapidly assist in pilot improvement projects and initiatives.
- Continuous data validation helping to provide governance around clinical quality measures by identifying inconsistent and missing data.
- Automatic alerts on critical measures to notify process owners of any deviations from Key Performance Indicator (KPI) goals.
- Discrete Event Simulation Modeling and Analysis.
ED Flow Simulator
Piyush Nain, Emergency Care Partner’s Senior Industrial Engineer, walks through and demonstrates a discrete event simulation model. The simulation was created leveraging the integrated EMR data from a partner group’s hospital.
Doing More with Data
Dr. Mark Laperouse, Chief Medical Officer at Professional Emergency Physician Associates (PEPA) talks about how they are leveraging data to customize solutions and improve outcomes in the emergency departments they serve.
How We Do It: Our Secret Formula
Our process begins by focusing on 4 EMR data file exports: demographic, lab orders, radiology and caregiver. These 4 extracts, or flat files, are triggered to be sent daily which includes data from the past 3 days of runtime. Our team imports these files into our analytics platform to provide digestible and customizable reports.
This extract includes all individual process events that occur from the time the patient gets registered in the emergency department to the time they are discharged or admitted to the inpatient floor. Time-stamps are associated with patient flow depending upon acuity, disposition and chief complaint. These data points are then used to analyze and report various ED throughput metrics including but not limited to Length of Stay (LOS), Door to Provider, Door to Disposition, Door to Decision to Admit, Left Without Being Seen (LWBS). This methodology allows our partners to keep track of any trends and correlation between these overall KPIs and patient satisfaction scores. Patient arrival-time patterns by hour of the day and build-up in ED provide useful insights for both management and clinical leadership teams to evaluate any changes in the existing coverage and plan for future needs. Demographic data is integrated with the other EMR data file exports to provide a holistic view of the current state of the process metrics and visualize opportunities for improvements in the ED.
This extract includes all laboratory tests ordered for each patient in the emergency department. Each order has an associated timestamp for when it was entered in the EMR, when the sample was collected by the staff, when the sample was sent to lab for testing and when results are available for the clinical team to review. These timestamps enable the ED operations team to analyze trends in overall turnaround times by quarter, month, weekday and/or by hour of the day.
This extract includes all radiology studies ordered for each patient in the emergency department. Each order has an associated timestamp for when it was entered into the EMR, when the contrast was given to the patient in case of CTs, when an order was initiated and completed by the radiology technician, when radiology images are available for the provider to review and when the report is finalized by the radiologist. These timestamps enable throughput improvement teams to analyze trends in turnaround times for when an image was made available for the provider and the total turnaround time of when a study was finalized by the radiologist. This data is provided by quarter, month, weekday and/or hour of the day.
This extract includes the names of all clinicians involved in providing care to the patient along with the time they were assigned to the patient’s chart in the EMR. This report helps to provide accurate clinician productivity reports.
Electronic Medical Record (EMR) Integration
Our team of experts are able to integrate with various EMRs including but not limited to EPIC, Cerner, Meditech and McKesson. Our integration process is planned over 3 phases.
Phase 1 begins with the distribution of a specification document with a detailed description of each field in the EMR files requested from the hospital. Our team collaborates with the hospital integration team to discuss and resolve any issues or concerns related to the scope and requirements of the project before we kick-off to the next phase.
Following the initial review of the specifications, the hospital integration team creates sample test files which can be shared with ECP team via a secure file sharing portal. In this phase, the majority of time is focused on data validation and verification against the set of requirements mentioned in the specification document. Multiple iterations of sample test files may be required depending upon the completeness and correctness of data in each file. Continuous support from the ED Medical Director and clinical analysts is required to assist in locating any missing data points in the sample files.
Upon agreement from all project stakeholders, the sample test files are finalized and uploaded to production for daily run. A one-time historical data load with a requested custom timeline for each file is sent to ECP. The project is signed-off by all parties and a hospital point of contact is provided to ECP for any future changes or modifications in existing builds.
Evaluating, Validating, and Improving Data Quality
The received data is processed and validated daily through multiple checkpoints before it is uploaded into ECP’s data warehouse. Various sets of rules are built-in to flag any incorrect or erroneous data in new or existing records. These rules are defined under 2 broad categories depending upon their severity and use case for each facility.
These set of rules are built to restrict loading incorrect data in our database and would require manual intervention to understand what went wrong in the file. These issues could include but are not limited to data formatting, missing data, and missing files. Our data engineering team is notified in real time to resolve these conflicts and take appropriate measures to remedy the issues. In some cases, we share these findings with hospital leadership to make suggested changes in the files on their end to improve data efficiency.
These set of rules are built to analyze and identify any trends in data completeness, data relevance with respect to process and specific issues for any given facility. These constraints do not limit nor impact any data loading procedures but enable us to identify inconsistencies among the fields received in daily files. These issues are then discussed in bi-weekly meetings with the clinical leadership team to address areas for improvement via training or education at the group or facility level.
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