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The Future of Emergency Care in the United States Health SystemThe Role of Technology on Future Emergency Care
Michael A. SachsChairman
msachs@sg2.com
June 25, 2004
AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Care Delivery ChallengesThe Path to Change
AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Emergency Care ChallengesThe Path to Change
4Confidential and Proprietary © 2004 Sg2
What’s Going to Happen
Sg2’s Focus
When It’s Going to Happen
What’s the Impact
?
… and the actionable strategies
5Confidential and Proprietary © 2004 Sg2
Impact of Change™Database and Edge
Analysis
Impact of Change™Database and Edge
Analysis
Publicly Available
Utilization Data Sets
Publicly Available
Utilization Data Sets
Sg2 Team Covers the Industry
Demographic and Sociocultural Data
and Research
Demographic and Sociocultural Data
and ResearchClinical and Management Conferences
Clinical and Management Conferences
Clinical Advisors and
Clinical Experts at Member Hospitals
Clinical Advisors and
Clinical Experts at Member Hospitals
FDACMSFDACMS
Timing and Volume Impact of Evolving Minimally Invasive
Surgical Approaches
Benefit Design and Impact of
Consumer-Driven Health Plans
Annual Growth Rate for CT Angiography
ExampleExampleExample
Claims DatabaseClaims
Database
6Confidential and Proprietary © 2004 Sg2
Impact of Change™ Model
Impact of Change™
Forecaster
2002 - 2012Technology
Inpatient Discharges and Days
Inpatient Discharges and Days
Outpatient Volumes
Outpatient Volumes
Payment
Sociocultural
Economy
Popu
latio
n
Outpatient Shift
Emergency Department
Visits
Emergency Department
Visits
7Confidential and Proprietary © 2004 Sg2
Sg2’s Edge Core Topics
Clinical Enterprise of the FutureE-Care: TelemedicineEmergency DepartmentsIntensive Care UnitLab of the FutureMedical PrivacyMedical WorkforceOutpatient CarePharmacy of the FuturePhysician OrganizationsPoint of Care TechnologyProcedure CentersSelf-CareSpecialty HospitalsWiring Clinical Care
Commercial Health InsuranceConsumer Driven Health Plans Disease ManagementHealth Care Economic ForecastMedicaidMedicare PaymentPatient as PayerPayment for TechnologiesPayment Redesign
Cancer CareCardiovascular ServicesChronic DiseasesImaging ServicesInfectious DiseaseNeurosciencesOrthopedicsPediatricsSurgical ServicesWomen’s Health
Organization and DeliveryEconomics and PaymentClinical Services
AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Emergency Care ChallengesThe Path to Change
9Confidential and Proprietary © 2004 Sg2
ED is a Window on the Community
Consumerism
Sociocultural
Economy
Population
Competition
Medical Practice
Technology
Care Organization
10Confidential and Proprietary © 2004 Sg2
EDs Serve Multiple Patient Types
Chronic Conditions
Trauma and Accidents
Acute Medical Insults
Primary Care(Non-emergency)
Types of ED Patients Current Major Emergency Care Issues
Inappropriate Utilization
Medical Errors
Delays in Treatment
High Costs
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60,000
80,000
100,000
120,000
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
ED Visits are Increasing
Sources: Division of Care Statistics, National Center for Health Statistics; CDC NHAMCS 2002 ED Summary, 2004; US Census
Emergency Department VisitsUS Market, 1992-2002
Visits(Thousands)
1992-200223% Total Growth
As Compared to 10% US Population Growth
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25
30
35
40
45
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
ED Use Rates are Also Increasing
Sources: Division of Care Statistics, National Center for Health Statistics; CDC NHAMCS 2002 ED Summary, 2004
Emergency Department Use RatesUS Market, 1992-2002
Number of VisitsPer 100 Persons Per Year
1992-20029% Total Growth
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1.01.01.21.31.31.41.4
1.71.81.92.02.12.3
2.62.72.7
3.14.0
6.730.6
DysrhythmiaNausea/vomiting
BronchitisPneumonia
GastrointentinalFever of unknown origin
AllergyCOPD
Skin infectionAsthma
Other lower respiratory infectionViral infection
Urinary tract infectionBack problem
HeadacheOtitis media
Chest painAbdominal pain
Other upper respiratory infectionInjury
EDs Treat a Broad Range of Problems
Emergency Department Visits by the Top 20 DiagnosesUS Market, 2002
(Millions)
Sources: CDC NHAMCS: 2002 data; Sg2 Analysis, 2004
Top 20 diagnoses represent 66% of total
ED visits.
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4.43.1
2.74.3
3.33.8
2.02.92.9
3.13.7
2.93.7
2.83.0
2.04.7
4.32.22.3
DysrhythmiaNausea/vomiting
BronchitisPneumonia
GastrointestinalFever of unknown origin
AllergyCOPD
Skin infectionAsthma
Other lower respiratory infectionViral infection
Urinary tract infectionBack problem
HeadacheOtitis media
Chest painAbdominal pain
Other upper respiratory infectionInjury
Treatment for Complex Medical Problems Can Be Expedited
Emergency Department Average Hours Per Visit* by the Top 20 DiagnosesUS Market, 2002
(Hours)
* From arrival time to discharge timeSources: CDC NHAMCS: 2002 data; Sg2 Analysis, 2004 Average = 3.2
Technology Examples toReduce Treatment Time
CT angiography
Rapid diagnostics
Handheld/portable ultrasound
Functional MRI
Electronic medical record
Clinical decision support system
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ED Utilization is Driven by the Elderly and Young adults
39.743.6
39.2
30.1
37.5
61.1
0
10
20
30
40
50
60
70
Under 15 15-24 25-44 45-64 65-74 Over 75
Visits per 100 Persons Per Year
Emergency Department Use RatesUS Market, 2002
Source: CDC NHAMCS 2002 ED Summary, 2004
Overall ED Use Rate 38.9
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0
20
40
60
80
100
120
140
1970 1980 1990 2000 2010 2020 2030 2040 2050
Age 55-64 Age 65-84 Age 85+
Aging Will Increase Utilization and Acuity of Care
Population(Millions)
Elderly* and Upper Middle-age Population US Market, 1970 - 2050
Note: Data for 2010 – 2050 projections based on Census Bureau’s Interim Projection by Age, Sex, Race, and Hispanic Origin Source: U.S. Census Bureau*Elderly population consists of both the 65-84 and 85+ age cohorts
9.8% 11.3% 12.6% 12.4% 13.0% 16.3% 19.7%Elderly* as % ofTotal Population 20.4% 20.7%
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Cardiovascular Disease Prevalence Will Increase
28
3331
36
2000 2010
Male Female
CVD prevalence grows by 18% as “Baby Boomers”
reach 65+ years.
Projected Population with CVD (millions) US Market, 2000–2010
Sources: American Heart Association, 2001 Heart and Stroke Update; U.S. Census Bureau
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Neurological Disease Prevalence Will Increase
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
Parkinson's Epilepsy Stroke Alzheimer's
2000 2005 2010
Number(Thousands)
Overall Disease Prevalence US Market, 2000 – 2010
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Patients with Multiple Diseases Will Also Increase
141
125133
149157
164171
118
100110120130140150160170180
1995 2000 2005 2010 2015 2020 2025 2030
44.7%
46.2%47.0%
47.7%48.3%
48.8%49.2%
45.4%
Percent of the Population with a Chronic Condition
Growth in Chronic Disease, 1995-2030
Sources: Rand Corporation; Partnership for Solutions
Number of People with Chronic Conditions
Poor patient management of chronic diseases and poly-pharmacy issues
attribute to increased ED utilization.
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Hospital Quality Initiatives Will Reduce ED Readmissions
Hospital Quality Initiative (HQI)
Source: CMS
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Growing Health Care Costs Have Led to Insurance Changes
Sources: (GDP) Bureau of Economic Analysis, US Department of Commerce, 2004 (Employer Cost Data) Bureau of Labor and Statistics, US Department of Labor, 2004
Annual Percent Change
ED utilization by insured persons will continue to increase:Patients rejected from the managed care gatekeeper modelsAccessibility to treatmentReduced access to primary care physicians
Annual Employment Cost Trends1982 – 2003
0
5
10
15
20
25
1982 1985 1988 1991 1994 1997 2000 2003
Health Insurance
Total CompensationGDP
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Patient Cost-Sharing Will Reduce Non-Emergent Care Volume
$6,656
$4,819
$2,875
$2,137
$2,412
$1,619
$508
$334
$0 $2,000 $4,000 $6,000 $8,000 $10,000
2003
2000
2003
2000 Employer ContributionWorker Contribution
Relative Share of Premium Cost:Employers vs. Workers, 2000 and 2003
$1752000
$2012001
$2512002
$2752003
Average Annual Deductibles for Single PPO Coverage: 2000 - 2003
+57%
Source: KFF/HRET Employer Health Benefits
Single
Family
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Forecast of Emergency Department VisitsEmergent vs. Urgent* **
US Market, 2002-2012Visits (Thousands)
0
20000
40000
60000
80000
100000
120000
140000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2002-2012 Total Growth
Overall 13%
Emergent 8%
Urgent 15%
* Visits with unknown or no triage status are proportionally distributed to urgent and emergent volumes** Emergent visit is defined as a visit in which the patient should be seen in less than 15 minutes. Urgent volume includes all other ED visits Sources: CDC NHAMCS: 2000-2002 data; IoC Analysis, 2004
Actual Forecast
ED Volume Will Increase–Urgent Care More Than Emergent
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Demographic Growth the Largest Driver of Volume
11.8%
1.2%
7.7%
-0.4%
-4.9%
0.1%
Demographics Total Percent Change
Components Attributed to Emergency Department Volume Percent ChangesEmergent vs. Urgent*
US Market, 2002-2012 (Cumulative Changes)
Sociocultural Technology
PaymentConsumerism and Economic
* Emergent visit is defined as a visit in which the patient should be seen in less than 15 minutes. Urgent volume includes all other ED visits Sources: CDC NHAMCS: 2000-2002 data; IoC Analysis, 2004
Emergent Cases Urgent Cases
10.5%
8.6%
15.3%
-0.8%
-3.4%0.4%
Demographics Total Percent ChangeSociocultural Technology
PaymentConsumerism and Economic
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41%
34%
10%
15%
Key Trends Will Impact Each Patient Type Differently
Polysaccharide vaccines for pneumococcal diseaseIncreased cost sharingIncreased uninsured population due to high premiumsReal time PCR Proton pump inhibitorsEconomic reboundAccess to technologyIncreasing societal dependence on ED
Primary Care(Non-emergency)
Emergency Department Volume Distribution by Type of PatientsUS Market, 2002
(Percent)
Medical therapies for osteoporosisIncreasing activityEmerging safety measures
Trauma and Accidents
Anti-inflammatory agents for COPD (next generation)Anti-IgE monoclonal antibodies for chronic asthmaDisease management
Chronic Conditions
Statins for atherosclerosisNoninvasive coronary angiography (CTA)Implantable cardioverter-defibrillators (ICDs)
Acute Medical Insults
100% = 110.2 million visits Highest Impact Technologies or Factors for Each Patient Type
Sources: CDC NHAMCS: 2000-2002 data; IoC Analysis, 2004
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Pharmaceutical Advances Will Impact Emergency Care
-1800
-1600
-1400
-1200
-1000
-800
-600
-400
-200
0
200
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Cumulative Impact(Thousands)
Forecasted Technology Impact On ED Visits By Select Technology ClassUS Market, 2002 - 2012
Protein-based
Targeted drug therapies
Implantibles/Nanotechnology
Vaccines
Energy delivery (e.g., CRTs)
Minimally Invasive
AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Emergency Care ChallengesThe Path to Change
28Confidential and Proprietary © 2004 Sg2
ED Volumes Are Rising, But EDs are Declining–More Volume Per ED
4,652
4,037
1992 2002
A decline of 13%, due to hospitals closing their EDs
Number of Emergency DepartmentsUS Market, 1992-2001
Source: Hospital Statistics™, 2004
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Molecular MedicineRedefining disease and treatments
ImagingReducing the unknown
ImplantablesKeeping parts working longer
Minimally Invasive SurgeryReducing patient trauma and shifting locations of care
Digital InformationAccess to care 24 x 7
Technology Changes Care Deliveries
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Entering the Era of Targets
1. Disease is in the cell2. Precision in treatments3. Decentralization of care
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v
New Care Delivery Models Will Emerge to Promote Efficiency
Anticipatory Processing
Parallel Processing
Future ED Care Delivery
Bedside/ Decentralized
Care
Medical IT
Operational Innovations
Traditional Triage
Serial Management
Current ED Care Delivery
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Enterprise-wide
Operational Innovations
Advancements in Clinical
Technology
ED-Specific Technology and Care
Pattern Changes
Technology Will Impact the ED in Multiple Ways
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Advancements in Clinical
Technology
Clinical Technologies will Change the ED Patient Mix and Reduce ED Utilization Mismatch
High Impact Technologies on ED Volume
Devices
ICDs
VADs
Chronic disease management
Medical therapies
Statins
Polysaccharide vaccines for pneumococcal disease
34Confidential and Proprietary © 2004 Sg2
ICD Utilization Will Continue to Grow as Indications Expand-Expect More ED Visits
Sources: NHDS, 2001; IoC™ Database, 2003; JP Morgan MedTech Monitor, 2003; Sg2 Analysis, 2004
80,000 per year0-2,000 per year
Annual ICD market
Up to 9 years18 monthsBattery life1 day3-5 daysALOS< 0.5%2.5%Mortality
1 hour2-4 hoursProcedure time
Pectoral incisionMedian sternotomy or lateral thoracotomy
Implant site/Incision
≤ 40 cm3120-140 cm3Device size
Electrophysiologistor surgeon
Cardiac surgeonPhysician
20001980s
ICD InnovationsUS Market, 1980-2000
ICD Utilization for Approved Indications
0
20
40
60
80
100
120
CardiacArrest
VT/VF Non-tolerated
VT Tolerated High RiskPost-AMI
Number of patients with ICD implanted per year
(thousands)
The positive impact of ICDs on ED volume is mitigated by the new generation of “smart” pacemakers and ICDs, which include home monitoring systems that transmit detailed cardiac information to the physician offices.
35Confidential and Proprietary © 2004 Sg2
LVADs Will Improve Patient Survivability and Will Generate Additional ED VisitsSurgical Technology Example: Left Ventricular Assist Devices (LVADs)
* Randomized Evaluation of Mechanical Assistance for Treatment of Congestive Heart FailureSource: NEJM, 2001; Dr. Eric Rose
rate per 100 patient days
DeathNeurologic DysfunctionBleedingLocalized InfectionSepsisThromboembolic EventArrhythmias:Cardiac ArrestArrhythmias:VA with cardioversionArrhythmias:SVA with cardioversionSyncopeNon-periop MIRenal FailureHepatic DysfunctionPsychiatric EpisodeLVAD Related RHFLVAD Periop BleedingDriveline or Pocket InfectionPump Inflow or Outflow InfectionDevice Thrombosis
0.2 0.1 0 0.1 0.2 0.3 0.4
LVASOMM
REMATCH* Study Results: Serious Adverse Events and Death, Rates Per 100 Patient Days
LVADs vs. Optimal Medical Management (OMM)
LVADsOMM
Rate per 100 Patient Days
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Disease Management Will Prevent Patient Readmission and ED Use
0
100
200
300
400
500
600
700
800
Pre- Post-Disease Management
Four-Year Validation of CHFDisease Management Program
Sample Hospital, 2001
All Hospitalizations
CHF Hospitalizations
Hospitalizations
Source: UCLA Medical Center, 2002; Journal of the American Geriatric Society, 1990
1. Computer collects daily touch-tone answers
2. Algorithms trigger exception reports
3. Patients who have not called receive automated outbound reminder
Patient phones with weight and symptom report
Weight gain/loss or symptomatic
CHF nurse assesses patient
via telephone
Reviews adherence to
medications and diet
Readjusts medications, counsels and
educates, triages cases
Overview of CHF Tel-Assurance™ Process
-46%
-50%
Disease Management Example: Congestive Heart Failure
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Statins Will Reduce Chest Pain Presentations to ED
Sources: CDC NHAMCS: 2002 data; JP Morgan Prescription Pad, 2003; Journal Gen Intern Med 2004; Sg2 Analysis, 2004
1,500
2,000
2,500
3,000
1999 2000 2001 2002 2003
Statin Prescription GrowthUS Market, 1999-2003
Prescriptions (thousands)
Future statin prescription growth will continue due to:
Personalized medicine and pharmacogenomics
Combined therapy with advanced cholesterol treatment, including synthetic HDL infusions and cholesterol vaccines
1999-2003 Total Growth
60%
Over 3 million people present to the ED with chest pain
ImpactStatins have been shown to reduce the incidence of coronary events by 35%, causing a significant impact on reducing ED visits
IssuesPoor statin adherence among patients treated for primary and secondary prevention of CHD due to copayment costs
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Pneumococcal Vaccines Will Reduce ED Visits
Heptavalent pneumococcal conjugate vaccine (PCV-7) has been in widespreaduse since FDA approval in 2000.
More than 2.6 million patients presented to ED with otitis media and eustachiantube disorders in 2002
PCV-7 has been shown to be immunogenic for children under 2 years old. This age group was not protected by the traditional 23-valent vaccines
* Prior to vaccine approval (4/95 – 3/00) and after approval (4/00 – 3/02)Sources: CDC NHAMCS: 2002 Emergency Department Summary, March 2004; Pediatric News and Family Practice News, 2003; Sg2 Analysis, 2004
Herd immunity, decline in pneumococcal disease in older children and adults, has also been observed
Overall efficacy of all pneumococcal vaccines in preventing invasive disease is approximately 60%. ED visits of these patients will continue to decline
39Confidential and Proprietary © 2004 Sg2
Enterprise-wide Operational Innovations
Operational Innovations Will Reduce Medical Errors and Wait Time at the ED
High Impact Technologies on ED Efficiency
Web-based health services
Electronic medical record (EMR)
Clinical decision support systems (CDSS)
Hospitalist and intensivist models
Remote ICU monitoring
40Confidential and Proprietary © 2004 Sg2
Web-based Health Services Will Improve Access to Primary Care
41Confidential and Proprietary © 2004 Sg2
Adoption of EMR Will Reduce Medical Errors
Hospitals are adopting EMR.
About 19% of health care providers have implemented a fully operational EMR system.
An additional 37% are currently in the process of implementing.
Impact of EMR in Emergency Care Settings
Paperless ED with EMR for triage, patient tracking, registration, order entry, nursing and physician documentation, discharge instructions and prescription writing
Reduction in medical errors with immediate access to patient records
National computerized information systems, as reported by IOM, required to significantly reduce medical errors and acceleration of EMR adoption/ implementation
Sources: HIMSS, 2004; IOM, 2003; Sg2 Analysis, 2004
42Confidential and Proprietary © 2004 Sg2
Clinical Decision Support System Will Expedite and Promote Appropriate Care
Point of care “on demand” “just in time” information for
decision making
Scientific Evidence Clinician Experience
Information TechnologiesEthics and Values
Sources: Annals of Emergency Medicine, 2002; Sg2 Analysis, 2004
Impact of Evidence-Based Clinical Decision Support System in EmergencyCare Settings
Improved accuracy in clinical decision making with customized diagnosis and treatment based on evidence-based guidelines and up-to-date protocols
Increased staff productivity with operational efficiency through real-time, patient-specific decision support
Faster patient throughput
43Confidential and Proprietary © 2004 Sg2
Intensivist and Hospitalist Models Will Streamline Hospital Efficiency
IntensivistsServe as the gatekeepers of the ICUs
Reduce hospital and ICU mortality
Improve hospital efficiency by reducing inappropriate ICU admissions and length of stay (hospital and ICU)
Reduce ED patient wait time and ED bottlenecks
Are in demand as hospitals are required to adopt full-time intensivist model to meet the Leapfrog ICU Physician Staffing standard. Only 10% of ICUs in the US meet this standard.
HospitalistsReduce admission times for medical patients admitted from the ED through a hospitalist triage and admission intervention system implemented by Johns Hopkins Bayview Medical Center
Reduce ED patient wait time and ED bottlenecks
The University of Pittsburgh offers a combined Internal Medicine/Emergency Medicine/Critical Care Medicine Training Program, preparing both intensivists and hospitalists to care for the critically ill and patient emergencies.
Sources: The Leapfrog Group, 2004; Journal of General Internal Medicine, 2004; Sg2 Analysis, 2004
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16.0% N/CAverage LOS
26.7% 26.4% Mortality Rate
N/C
N/C
ICU
24.6% Variable costs/case
16.8% Outliers
Hospital
Estimated Impact of eICU®*
Advocate HealthCare intensivist monitors 50 patients using eICU®.
* Results of a 2-year study at Sentara Healthcare. As reported in Critical Care Medicine, 2004Sources: VISICU; Critical Care Medicine 2004; Sg2 Analysis
Remote Monitoring Will Improve ICU Throughput, Reduce ED Wait Time
Impact on Emergency Department
ED patient wait time and ED bottleneck reduction
Next-generation technology applicable to ED
Improved operational efficiency, especially during infectious disease outbreak
45Confidential and Proprietary © 2004 Sg2
ED-Specific Technology and
Care Pattern Changes
Technologies Will Enable Changes Within the Emergency Department
High Impact Technologies and OperationalInnovations on ED Efficiency
Regionalization of care
Advanced imaging modalities
CT angiography
Rapid diagnostics
EMS technologies
ED information systems
Patient registration and tracking technologies
Lab automation
Effective triage models
46Confidential and Proprietary © 2004 Sg2
Transforming ED from All Things to All People to Specialization – Regionalization of Care
5.0
7.0 6.6
8.46.87.0
14.0
7.6
12.1
10.0
LIMI PRAGUE DANAMI AIR-PAMI PRAGUE-2
Primary PCI Onsite Fibrinolysis
(1999)N=224
(2000)N=300
(2002)N=1572
(2002)N=138
(2002)N=850
* LIMI=Limburg Intervention/MI trial; PRAGUE=Primary Angioplasty After Transport of Patients From General Community Hospitals to Cath Units With/Without Emergency Thrombolysis Infusion Trials; DANAMI=Danish Multicenter Randomized Trial on Thrombolytic Therapy Versus Acute Coronary Angioplasty in AMI trial; AIR-PAMI=Air Primary Angioplasty in Myocardial Infarction TrialSource: Journal of the American College of Cardiology, 2004
Mortality Rates in Clinical Trials* Comparing Onsite Fibrinolysis vs. Transfer for PCI For STEMI Impact
Primary Percutaneous Coronary Intervention (PCI) has been proven to be more effective to treat ST-Segment Elevation Myocardial Infarction (STEMI).
Patient transfer strategies similar to regional trauma networks are needed.
Successful Networks Need
Centralized AMI facilities within reasonable distances
Integrated EMS
Experience in medical community with centralized AMI care networks
(Percent)
47Confidential and Proprietary © 2004 Sg2
Advanced Imaging Modalities Strategically Located at the ED Will Accelerate Diagnosis
Handheld Ultrasound
16- or Higher-slice CT System
Digital Radiography System(Kodak Directview DR9000 at the trauma center of St. John Medical Center, Tulsa, Oklahoma)
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CT Angiography Will Reduce Diagnostic Time for Chest Pain Choice of work-up depends on the clinical question:
Case A: assessment of functional impact of symptoms => stress testCase B: CAD likely & desire “road map” for intervention => angio or CTACase C: rapid exclusion of coronary obstructions => CTA
A
B
C
Former smokerChest painFamily history of CVDECG indicates a problem
EKGStress TestX-ray angiography
EKGX-ray angiographyCTA
EKGCTA
49Confidential and Proprietary © 2004 Sg2
Rapid Diagnostics Will Reduce Both Medical Errors and Wait Time
Sources: JAMA, August 2000; B. Rogers Presentation, AMP 2002; Cephid Corporate Documents
Next Generation Real-Time PCR
Bacterial and Viral Genome Sequencing Projects
In the ED setting, emerging real-time PCR tests for conditions such as pneumococcus, meningitis, bloody diarrhea and septicemia will replace laboratory evaluations for occult bacteremia and due to rapid, accurate test results, may sharply decrease the use of antibiotics. Early targeted disease detection will speed recovery.
Extraction, Amplification and Detection< 25 minutes
Rapid Diagnostics Example: Real-time PCR
50Confidential and Proprietary © 2004 Sg2
Game-changing feature:improved speed
Reduces test turnaround timeDecentralized into rapid-response labs, as the technology becomes faster and easier
Operations
Total costs for real-time PCR platforms and automated DNA extractors ~$100,000 to $400,000Marginal reimbursement (at best) CPT codes not keeping pace
Finances
Infectious disease; hospital infection controlCancer
Impact on:Service Lines
Technology ImprovementsTraditional PCR—3 steps
Real Time PCR—2 steps
Next generation real-time PCR—1 step
1 Original Target
30 Cycles
1 Billion PCR Products
Real-Time PCR Expedites Diagnosis and Improves Accuracy of Clinical Decision Making
51Confidential and Proprietary © 2004 Sg2
Technology Implementation in EMS Will Save Time and Improve Patient Outcomes
Santa Cruz County, CATele-electrocardiography
UCSF-designed study, being tested in Santa Cruz County
New “tele-electrocardiography”system takes reading every 30 seconds
Data transmit to ED via cell phone
Study to determine if the system will improve survival and long-term health of heart attack victims
Sources: UCSF, 2003; iHealthBeat.org, 2004; LifeNet EMS web site, 2004
Electronic Patient Care ReportingSystems
Paramedics to enter patient information to Tablet PCs and transmit the data to ED via wireless connection
Improve care delivery by allowing the hospitals to anticipate the patient arrival
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ED Information System Will Streamline the Care Process
High Risk alert Length of stay (LOS) Nursing timers Order status for labs, X-rays, EKGs Patient acuity Patient bed/location
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Patient Registration and Tracking Technologies Will Improve ED Patient Flow
Patient registration using self registration kiosks and handheld portable computers
Patient tracking using infrared and radio frequency technologies
Legoland in Denmark uses RFID to let parents track their children.
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Lab Automation Can Break the ED Bottlenecks
Improved throughput and room utilization by 20%Reduced patient wait time 40%Raised Press-Ganey scores to 80th % goal
Overall ED Project Improvement
Draw & Hold at NorthwesternPatients enter EDStanding orders guide test selectionTests sent to automated lab Results ready for physicianAdd-on tests in 6 minutes
55Confidential and Proprietary © 2004 Sg2
Effective Patient Triage Models Will Shorten Patient Turnaround Time
Source: Sg2 Analysis
Improved ED Workflow Model
Triage at PresentationTransfer patients with asthma directly to the
pulmonary observation unit
ICU Admission
Pulmonary Observation Unit
Standard Admission Discharge
Secondary Triage
FAST A
ND
EFFICIEN
T
Strategies for improving the ED paradigm
Initial AssessmentObjective assessment of airflowHistory and physical examination
Discharge
ED Management
Chest x-rayOxygen therapyPEF or FEV1Inhaled β2 agonistCorticosteroidsLabs +/- blood gas
ICU Admission
Standard Admission
FAST
SLOW
Impending Respiratory
Failure
Current ED paradigm: slow turnaround
Streamlined ED Triage Example: Asthma Patient Management
Medicare currently reimburses hospitals for observation care provided to patients with asthma, chest pain and CHF. Future expansion to other diagnoses is forecasted.
AgendaSg2…Who We AreFuture Demand on Emergency CareTechnology Solutions to Emergency Care ChallengesThe Path to Change
57Confidential and Proprietary © 2004 Sg2
System of the Future Provides the Right Care to the Right Patient in the Right Setting
Primary Care Centers
Comprehensive Disease
Care Centers
Birthing Centers
Acute Custom Care Facility
Acuity
Low
Broad, CustomizedFocused High-Volume Routinized
Clinical Focus
High
ASCs
PhysiciansPhysicians
58Confidential and Proprietary © 2004 Sg2
Lower Costs Can Be Achieved Through Clinical and Operational Excellence
30% Savings
Clin
ical
Pro
cess
Business Process
Busine
ss M
odel
Weak Weak
Strong
Strong
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Hospital’s Technology Adoption is the Foundation for Planning
Innovators EarlyAdopters
Consensus Adopters
CautiousAdopters
LateAdopters
Possesses, but doesn’t develop the latest technologies
Reports on the first wide-spread use
Developers, strong in research
Early-stage initiatives cited at national meetings/journals
Outdated technology and systems
Lacks focus, with few decisions related to strategy/future development
Lags in adoption of mature technologies
Capital-constrained or has limited staff
Focuses on technologies broadly available
Organizational incentives reinforce consistency in approach/process
Clinical Change
Operational Change
Financial Change
1
2
3
4
5
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1Remote monitoring
2Hospitalist and intensivist models
2
2
1-3
1
1-2
1
2
2
2
1
Technology Adoption*
Regionalization of care
Lab automation
CT angiography
Electronic medical record (EMR)
Clinical decision support systems (CDSS)
Advanced imaging modalities
Rapid diagnostics
STAR** Delays in Treatment
EMS technologies
ED information systems
Impact on
Effective triage models
ED Utilization
Medical Errors
Technology
Impact of Technology on Emergency Department
* Technology adoption categories with current national adoption rate** Sg2 Technology Advantage Rating (STAR) assigns 1 star (lowest impact) to 5 stars (highest impact) to each technology or operational innovation according to its impact on ED clinical outcomes, operational efficiency and financial performance for the next eight years (2004 – 2012).Source: Sg2 Analysis, 2004
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3ICDs
4Statins
3
2
4
1
1
Technology Adoption*
Chronic disease management
VADs
Pneumococcal vaccines
Web-based health services
Patient registration and tracking technologies
STAR** Delays in Treatment
Impact on
ED Utilization
Medical Errors
Technology
Impact of Technology on Emergency Department (Continued)
* Technology adoption categories with current national adoption rate** Sg2 Technology Advantage Rating (STAR) assigns 1 star (lowest impact) to 5 stars (highest impact) to each technology or operational innovation according to its impact on ED clinical outcomes, operational efficiency and financial performance for the next eight years (2004 – 2012).Source: Sg2 Analysis, 2004
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The Path to Change Requires Technology Investments and Planning
Market Position
Competitive Landscape
Technology Profile
Industry Outlook
Technology Evaluation
Technology Priorities
Acquisition & Introduction
Diffusion
Monitoring
Profile Plan Manage
Technology Assessment Technology Adoption
Where are we?
Where do we need to be?
How do we get there?
Sg2 Technology Evaluation & Planning (STEP) Program
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The Bottom Line…
ED is a reflection of the community.
Technology changes outside the ED are more powerful in changing ED work flow than technology in the ED.
ED is only as good as the weakest part of the hospital.
Accelerate Technology Adoption – Improve Care
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