Technology will have major impact on shaping future EDs, say the experts
Shift seen toward treating sicker patients, as retail clinics grow
Peering accurately years into the future requires a crystal ball that no one possesses, so how do you prepare? Observers of emergency medicine share common visions in several key areas. They are certain that technology will have an enormous impact and that EDs might come closer to their original mission of treating only the sickest patients.
"In the ED of the future, let's say a patient comes in who has been treated in your ED or system before," offers Linda Laskowski-Jones, RN, MS, ACNS-BC, CCRN, CEN, vice president of emergency, trauma, and aeromedical services, Christiana Care Health System in Wilmington, DE. "They will have some ability to self-triage to the lower or higher acuity side."
For lower-acuity cases, she explains, patients will be able to use self-registration kiosks. On the higher acuity side, Laskowski-Jones says, they will still require personnel to assess and initiate treatment. "I can see them using some kind of biometric authentication devices like palm vein scanning or retinal scanning, where there is basically a biometric link to a previous encounter in the hospital, and the patient has an actual medical record number," she adds.
Recently, says Laskowski-Jones, she had a glimpse into the technology of tomorrow. "I saw a mattress cover, which you can put on either a stretcher or a bed, that automatically monitors the heart and respiration — with no need for leaders or for the patient to remove their clothes," she shares." This technology, called the LifeBed, from Hoana Medical, of Honolulu, "takes any bed or stretcher and turns it into a call bell," Laskowski-Jones explains. "If the patient tries to get out of bed, a voice will tell them to get back in."
An added benefit, she says, is that the cover can be used with patients on hallway stretchers. "We have these stretcher patients we're worried about, but if we do not solve our intake problems, we can at least provide safety for unexpected surges," Laskowski-Jones offers.
Thom A. Mayer, MD, FACEP, president and CEO of Best Practices, an emergency medicine, pediatric emergency medicine, and physician leadership management firm based in Fairfax, VA, agrees with Laskowski-Jones on the importance of information technology, but warns of the dangers it presents. "Anything that puts you closer to a patient is good thing; anything that puts you farther away is a bad thing," Mayer says. Short-term, information technology could be devastating to ED, he says. "All of a sudden, the doctors are sitting in front of computers and not patients," Mayer says.
The future, he says, will require the creation of a new position in the ED. "Doctors will not interface with computers, but with scribes, who are better at working with computers," Mayer envisions. These would be pre-law students, pre-nursing students, or paramedics. "We truly need to keep doctors away from computers," he insists. Nurses also will have scribes, he says. "Why should we take these highly trained people and sit them in front of a computer?"
Long-term future is bright
While the short-term challenges will be significant, Mayer does see a brighter future that includes technology. "We will have patient ID cards, which will contain all of their medical information, and they will be updated with each encounter," he says. "Providers will have universal access to that information through a centralized system."
This information, Mayer says, will improve the predictability of emergency care. "Not only will we have what our intuition tells us when things are out of whack, but an IT system that says, for example, that this patient has been in the ED for chest pain three times," he explains.
Technology already has begun to affect the way patients interact with providers, adds Denise King, RN, president of the Emergency Nurses Association. They are going to become more responsible; the good news, she says, is that patients also will be more responsible about providing more complete and accurate information about their medical history and their current medications.
Already, the increased responsibility of patients is apparent, King says. "They come in today to the ED much more educated than they were 20 years ago," she says. Patients go on the Internet; they diagnose themselves, King says, and then "come in and tell you what they want."
Peering accurately years into the future requires a crystal ball that no one possesses, so how do you prepare? Observers of emergency medicine share common visions in several key areas.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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