My long-time friend and fellow Emergency Physician, Tom Scaletta, MD, Chair of the Emergency Department and Medical Director of Patient Experience at the Edward Elmhurst Hospital Emergency Department, joined me at HIMSS 2015 in Chicago to talk about SMARTworks EffectiveResponse, a software that extends the emergency visit beyond the ER. [Here’s a link to the video.]


The problem being solved

According to Tom, approximately 140 million patients are seen in U.S. ERs each year; 80% of them are discharged to home. The hope is that they take their meds, follow the discharge instructions, get follow-up as suggested, and, most important, get better along the trajectory expected by the emergency physician.

Typically, emergency physicians don’t know if all those things actually take place after discharge unless something goes wrong and the patient returns to the ER (best case scenario), has a bad outcome and you hear from their malpractice attorney (bad), or comes back by ambulance in extremis (very, very bad).


The solution

In an ideal world, one without financial constraints, someone from the ER staff would contact every discharged patient the next day to see how they are doing. But, of course, the real world is not ideal, so, that is why Tom developed EffectiveResponse, an automated ER follow-up system. It is now managed by Standard Register Healthcare and has been rebranded as SMARTworks® EffectiveResponse, a part of their SMARTworks suite of technology solutions.


How it works

SMARTworks EffectiveResponse Workflow
SMARTworks EffectiveResponse Workflow

According to Tom’s presentation on Effective Response at HiMSS15, a daily extract of the hospital EHR that identifies discharged ER patients is sent to the SMARTworks HIPAA-compliant cloud server. Text or email messages are then pushed to the patients asking them to fill out a self-assessment questionnaire. At Tom’s hospital that takes care of ~90,000 emergency patients annually, 29% of them replied (62% via text and the rest via email). Hospitals have the option of supplementing outreach via a call center to reach patients not able to respond via text or email.

The self-assessment questionnaire is short—only five questions. First, patients are asked to report if they are the same, better or worse than they were when discharged. Only ~2% of patients at Edward reported feeling worse. The charge nurse was immediately alerted to reach out to them and bring them back to the ER if needed.

Patients are also asked if they have any questions about their care at home, medications, or follow-up arrangements. About 4% reported they did and they were referred to a case manager to follow-up on the issues.

The next two questions ask the patient to rate the level of concern shown by the doctor and nurse taking care of them. Service issues were reported by ~6% of patients. These issues were relayed to administrative staff for follow up with the involved clinicians. Built-in workflow tools simplify complaint management and email follow-up with patients to address their concerns and providers receive statistically valid satisfaction metrics and patient comments monthly to help them better understand how they are doing.

There is an opportunity to leave comments after each question and patients are also asked in a fifth and final question whether they have any other comments about their experience.

Once the well-being survey is completed on the smart device, patients are linked to the hospital’s patient portal. Tom says this is “an engagement strategy that is critical to attainment of the Meaningful Use Stage 2 View/Download/Transmit objective.”


The bottom line

Although SMARTworks EffectiveResponse has not been formally evaluated via a scientific study, the experience at Elmhurst suggests it is, in fact, effective. And, Tom’s team was a runner-up for the 2014 Emergency Care Innovation of the Year Award and thus named as one of two Recipients of Distinguished Recognition at the 2014 American College of Emergency Physicians (ACEP) annual meeting. Congratulations Tom! Well done.



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