America's Emergency Rooms in Crisis

Overcrowding and Misdiagnosis

Problem: Overcrowding and misdiagnosis
Solution: Digitize everything

Even in this high-tech age, the majority of hospital records are kept on paper and stored in manila folders, and in some ERs patient status is still tracked on dry-erase boards. These antiquated systems can cost lives as healthcare professionals waste precious time searching for patient information. "Health care has lagged behind other industries by about 20 years," says Dr. Smith. "Most hospitals have less sophisticated computer systems than the cashiers at the local supermarket."

The foundation of ER One is a computer software system, called Amalga, that addresses this problem. invented by Dr. Smith and Craig F. Feied, MD, a former Washington Hospital Center ER physician (both were recipients of the Ladies' Home Journal Health breakthrough award this past September), the system was acquired by Microsoft in August 2006 for nationwide marketing. Amalga will be deployed around the country at such top centers as New York-Presbyterian Hospital, the Johns Hopkins Hospital and Health system, in Baltimore, and the H. Lee Moffitt Cancer Center and Research Institute, in Tampa.

ERs with Amalga have computer screens mounted in a central location so patients' information is available at a glance. There's no more running around looking for charts. Need to see a patient's angiogram? The image comes right up on the screen, along with her whole medical record at that hospital. (Because data from all patients at MedStar hospitals is in Amalga, a clinician at one network hospital can view data on a patient at a different network facility. Eventually, experts hope, Amalga will pull data from private practitioners and other hospitals in Washington, D.C.)

"Our experience suggests the majority of a doctor's time is spent seeking information," says Dr. Feied, the former director of ER One. "But when the existing data are just a click away, it cuts the search by many orders of magnitude, allowing us to spend more time with a patient and make more accurate diagnoses." With proper diagnosis, unnecessary tests are avoided and treatment can begin faster.

Amalga also has a significant security aspect. If there is a suspicious disease outbreak -- be it anthrax, SARS, or West Nile Virus -- the system can alert doctors to a cluster of similar symptoms among people seen by facilities in the network, something individual physicians seeing different patients might not recognize on their own.

Treating patients faster also increases how many people an ER can handle -- and how long they have to wait for help. In 1995, the year before the prototype of this software was installed, the Washington Hospital Center ER handled 37,000 patients, and waits could stretch up to nine hours. Today more than 80,000 patients visit the ER annually, and 60 percent are treated and discharged from the hospital in 3.5 hours.