Absence of health IT in EDs is a missed opportunity

BOSTON—Opportunities to engage patients using health IT in emergency departments (ED) are not being taking advantage of nearly as often as they should, according to the panelists of a Sept. 16 presentation at the 2012 Medicine 2.0 Congress.

Megan Ranney, MD, MPH, an assistant professor of emergency medicine at Brown University in Providence, R.I., and an attending physician at several affiliated hospitals, said she doesn’t counsel ED patients on addiction or risky behaviors. “Emergency providers see three or more patients per hour. This doesn’t leave me a lot of time to counsel patients. That’s a shame. The average ED visit lasts more than two hours. We need to be taking advantage of this time. We can do behavioral screens, engage patients and explain illnesses to them in this time.”

More than 136 million patients visit an ED per year and 50 percent of hospitalizations begin in the ED. Assume that most patients bring a caregiver, friend or family member when visiting the ED, and “you’re talking about reaching a huge number of people each year,” Ranney said.

“We do a pretty good job as a specialty,” added Nicholas G. Genes, MD, PhD, an assistant professor of emergency medicine at the Mt. Sinai School of Medicine in New York City. “There’s a lot of conversation, but it’s mostly among providers. When it comes to talking to patients, we don’t do so well.”

Managing so many patients leaves emergency providers with no time to perform interventions or preventive care counseling, but health IT can take their place. Rather than addressing only the “downstream effects” of behaviors, the ED should be expanded to help change behavior, according to Esther Choo, MD, also an assistant professor at Brown. Gamification, graphic representations and smartphone applications (apps) all can be deployed in the ED to educate and engage patients.

Some EDs have used health IT to encourage behavior change, Choo said. The University of Michigan Health System, headquartered in Ann Arbor, has experimented with a personalized smartphone app to educate patients about the risks of binge drinking. Emory University School of Medicine in Atlanta installed computer kiosks that patients in triage are asked to use to answer a questionnaire about partner violence. Researchers from the University of Massachusetts Medical School in Worcester developed the Dynamic Assessment & Referral System for Substance Abuse, a self-administered, computerized survey.

These projects are all promising, but are still being researched and not ready for wide implementation. “Most research has looked at acceptability and feasibility,” Choo said. “We need to move on to effectiveness and broad implementation.”

EDs and their employees should be more proactively seeking out and testing health IT tools that can make their jobs easier and provide timely interventions that could improve health outcomes. “There are a lot of possibilities here and I don’t know if anyone is exploiting them,” Ranney said.