EDITS Data - Operational Overview

EDITS Data is a software program that facilitates the manual, retrospective capture of all useful information from ED charts. The data are not captured by physicians or nurses, but rather by clerical personnel and personnel potentially capable of performing CPT and ICD-9 coding. These individuals rapidly enter data from the medical records through the use of "light pens" which are mouse surrogates.

To increase efficiency, the program is designed to minimize the amount of manual data entry required. As such, the software has been designed to allow all substantive demographic and insurance information that exists in a hospital computer database to be downloaded into it. Although the software can accept this information on a periodic basis through the use of "batch" downloads, the ideal configuration allows this information to be entered automatically when patients register for care. These "real-time" demographic downloads are created by exporting the information captured by the hospital during registration and exporting it through a printer port into the EDITS Data program. The creation of a demographic download "interface," whether it be in a batched mode (perhaps once daily) or real-time, as each patient registers, is generally not difficult and most hospitals already have created similar download programs for other PC programs.

As patients complete an ED visit, certain minimal data elements traditionally required for the ED log can be entered by departmental clerks. Thus, an electronic logbook is created by EDITS Data that can easily retrieve needed information that, heretofore, required the traditional manual searching associated with a paper logbook.

The vast majority of the data extraction and coding occurs after the patient has left the department. It is done in a quiet area by a carefully trained data capture specialist (chart sweeper). Generally these individuals are very familiar with ED procedures and have a nursing background. Typically they are given the authority, based on the documentation in the ED chart, to assign room charges (based on criteria specified by hospital management) as well as capture all of the charge and quality-related data on the chart. With regard to productivity, depending on the amount of data being captured and whether or not CPT and ICD-9 coding is being performed, it is reasonable to anticipate that a minimum of 20 charts per hour can be "swept" and coded. Although this is slower than a "coding only" process, the ability to generate charges for the hospital, potentially code for both the hospital and physicians, and generate profiling and management data (all potential sources of revenue) more than compensates for the additional time spent with each record.

Over 140 elements are included in the database of each patient, not including all of the drugs, tests, supplies and nursing services involved with a patient's care. The following list outlines the scope of the information that is captured - it is, by far, the most comprehensive in the field of emergency medicine.

DATA ELEMENTS:

• Comprehensive demographic information
• Full insurance information
• Key service times
• All nursing staff involved with the patient's care
• All physicians involved with care, including referrals and consultants
• Mode of arrival
• Final disposition
• Triage and nursing acuity
• All drugs administered or prescribed for the patient
• All tests performed on the patient
• All supplies used in the care of the patient
• All chargeable nursing services involved with the care of the patient
• All capturable CQI data pertaining to the patient's care
• Any physician-dictated and subsequently transcribed histories and physicals
• First and last set of vital signs
• All CPT and ICD-9 codes
• Additional user-defined data elements

And, when coupled with EDITS Scan software, the entire medical record, including physician and nursing notes and aftercare instructions The EDITS Data report writer has been written de novo in an attempt to create an instrument that is powerful, yet user friendly. Reports can be output in the variety of customary means. In the process of capturing data, all chargeable items involved with the care of a patient are also gleaned. The return of this information to the hospital can be provided as a printout for manual entry into the hospital's computers; however, an upload interface provides the most elegant means of returning information to hospitals. EDITS Data provides upload information in a standardized manner. The creation of upload interfaces between EDITS Data and highly proprietary hospital information systems has been the greatest challenge associated with the implementation of the EDITS Data software. With the growing use of interface "engines" this challenge has been lessened. As a substantial part of the EDITS Data installation process, key users of the program are instructed in use of the report writer so that they can generate reports of their choosing. In addition, the software is loaded with approximately 70 preformatted reports.

EDITS Data currently is a DOS-based program written with the FoxPro relational database software. The program is network compatible and quite stable. In the Fall of 2000 work will begin to rewrite the program in a Windows-based, web-compatible language. A detailed operational manual is provided during the installation process and an implementation plan is also available. Telephone support is provided nationwide. "PC Anywhere" software allows telephone connectivity between the onsite program and the office of Knight Systems Software to update and query the program.