Devices & Technology

Health Care beyond the Emergency Room


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Suzi Birz, principal, HiQ Analytics, LLC  

Emergency department physicians often find themselves wondering if patients who leave the emergency room with instructions to follow up with a physician actually do follow instructions: Are they able to find a physician? Do they get an appointment in a timely manner? A new Web-based application may provide answers to these critical questions.  

“The emergency room is society’s air traffic controller, completely focused on safety—proactive and responsible,” said John Whitcomb, M.D., medical director of emergency medicine at Aurora Sinai Medical Center in Milwaukee, Wisconsin. “In the ER, we should drill down to the science of what is emergency medicine and treat those patients while finding a medical home for patients that do not need emergency care.”  

Michael Eaton, president of Global Health Direct, in Delafield, Wisconsin, explained that the company offers a Web-based application, My Health Direct, that matches up patients being discharged from an emergency room with physicians and secures them a specific appointment date and time.  

“Our goal is to connect this population of patients with a primary care medical home,” Eaton explained. “Two elements were important to us in developing this web application: We wanted to build something into the existing workflow and we wanted to build something that addressed the drain caused by non-emergent care in the emergency department.”  

Serving essentially as “match makers,” Global Health Direct has worked with physician offices that are willing and, in some cases, eager to see the Medicaid population. These offices designate time on the schedule that can be “booked” by emergency department clinicians to patients about to be discharged from the ED.  

“It can also be used by clinicians on an inpatient unit that are discharging a patient that will require primary care and does not have a physician,” Eaton added.  

How does it work?  

“There are no barriers to entry,” Eaton said, describing the computer requirements needed by any of the users.  

Someone at the physician office uses any Internet connection and a Web browser to access the application. Then, they load open care slots into the calendar. They can designate the available slots by payer type, such as Medicaid, charity care or sliding fee.  

Then, when someone at a hospital wants to connect a patient with a community-based physician, they access this Web application. Again, they can use any Internet connection and a Web browser. They can search for an available slot, using as criteria the payer type, appointment time or type of physician, and “book” the appointment online. Currently, appointments can be made for primary care, pediatrics and obstetrics and gynecology.  

“It’s not instantaneous—there is no interface to our hospital systems, so it takes about 10 minutes to enter the data,” noted Whitcomb. “But if you can spend this time and know that the patient is going to be seeing a physician that can provide ongoing primary care that will better care over time, it just makes sense.”  

Clinical benefit  

“Aurora Sinai has a unique focus for their emergency department: making it available for emergencies. The emergency room is not a good place to do primary care,” explained Whitcomb.  

Global Health Direct has been successful in securing enough physicians with donated discounted care appointments so that clinicians using the service have a certainty of finding an appointment for the patient in an appropriate time frame.  

“We have set a goal of having the patients get appointments in the same day or the next day 90 percent of the time,” stated Eaton.  

While no one can be sure that the patient will be compliant and go to the appointment, a few aids are provided to make this easier.  

“The system provides an appointment confirmation including the date, time, office address and reason for referral along with public transportation directions. A map is coming in the next version,” Eaton added.  

“Making this connection to a community-based physician can aid in improving patient outcomes, avoid having the patient become sicker and avoid a repeat visit to the emergency department,” he explained. “This changes two people in this equation: It changes the patient by providing them access to primary care, and it changes the physician, who now has confidence that the patients will have ongoing care targeting their needs.”  

Aurora Sinai has trained people in various parts of the treatment, so that the appointment can be made when it best fits in the workflow.  

“For instance, nurses doing triage would make an appointment via My Health Direct for patients determined to not require emergency care, such as patients seeking a work excuse,” explained Whitcomb. “Physicians, case managers, scribes, nurses and physician assistants have been trained.”  

Whitcomb offered a case example: A patient presents in the ED with asthma symptoms. Historically, in addition to breathing treatments, the patient would have left the ED with a medication prescription and verbal instructions to not let his or her medication run out. With My Health Direct, the patient will be discharged from the ED having had breathing treatments, but rather than medications, he or she would have an appointment with a community-based physician that will treat this episode as well as get to know the patient as a person and what medications work. This will result in better long term care.  

Take-away message  

“Think about it from the patient perspective,” Whitcomb concluded. “Someone hands you the appointment date and time along with a map, how would you feel? This is a great change.”  

Resources:  

Aurora Health Care 

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