GENERAL SUMMARY

As of this date, I know of ten companies publicly offering for sale integrated Emergency Department (ED) software products for total information management, with the first installation occurring just ten years ago in 1987. All had or were converting to Windows 95 or Windows NT workstations. File servers included UNIX, Win 95, and NT. Languages were dominated by C++ but included Java, Turbo Pascal, Foxpro, and Visual Basic. Installation numbers varied from 5 to 50 for eight vendors, and 1 installation for two others. Many have tiered modules with many more installations of simple modules such as discharge instructions and ED logs.

Most have extensive interfacing experience. All use a client-server environment, about half with SQL capabilities. Most prefer Ethernet networks but are looking at NT. Databases are widely varied, with Foxpro and Oracle predominating. All rely on fixed workstations, but two are emphasizing hand held light laptops with RF spread spectrum wireless communication.

All will work in an ED, but the process is much more difficult than many think. Many prefer touch-screen technology, two prefer light pen, but almost all can use both plus mouse or keyboard. The products that first shipped the longest time ago are generally playing catchup in design and features to the newer systems, but obviously have more experience and stability. Four companies appear to be well funded with capital, but all claim to be profitable. Two systems come from a Macintosh background and have a better graphical look and feel.

All provide 24 hour per day technical support by modem, as well as extensive department and QA reports. Most attempt to document a physician history and physical in some manner, but none equal the completeness and flexibility of a dictated report, though templates are becoming more important. Some solve this by importing dictation/transcription. One uses discrete speech input, and many others are looking at the newer continuous speech products for input and command and control.

Costs are similar, in the $150,000 to $250,000 range for software licenses. One   will capitalize the cost themselves and charge by the patient over 3-5 years to recoup their cost. Support and upgrades are all around 15% to 17%.

As of June 1997, ORCA, despite being well-funded by venture capitalists, went out of business, but in October was acquired by Spacelabs Medical. This may be a good lesson that even well funded companies aren’t necessarily long-term players. I’m beginning to think only a steady, plodding, private and committed company can develop an ED product, and that eventually they will have to sell out to one of the big boys in hospital information services or other major companies that realize they need a niche ED product for whatever reason. Or maybe a more medium sized company can have sufficient financial resources to stay private and make cooperative arrangements with the big boys, such as Datamedic with SMS.

Another major possibility to consider is combining several products to form a complete system. This obviously has its own integration problems, but may allow choosing more advanced individual systems. For example, two of the most advanced tracking systems use inexpensive infrared badges that can be worn by patients and staff for instant tracking with no computer hand input needed. One of these is Com-net (3080 South Tech. Blvd, Miamisburg, OH 45342, 937-885-5974 or fax at 937-885-5974; email: com-net@comnet-fids.com; web: http://www.comnet-fids.com). It is used by over 160 airports nationwide, and has no problem doing as many as 90 interfaces and can create bar codes for tracking patients by scanning. Another one is Executone's InfoSTAT ED (478 Wheelers Farms Road, Milford, CT 06460, 203-876-7600, fax 203-882-0400, 800-807-1305; http://www.executone.com). It too uses inexpensive infrared tracking technology in a Windows NT environment and can interface with the ADT system, and deliver management reports. Either of these two products could be used instead of the tracking system of the integrated products in this list, or be complemented by other coding and information systems.

Donald R. Bishop, President, CEO

1202 Corporate Drive West

Arlington, TX 76006

817-633-6665

Fax 817-633-1239

Dr. Mark Shaw, Physician User Group Director

Luke Thomas, Director Sales & Marketing

Email: emergisoft@airmail.net

J. Jay Flynn, Northeast Regional Sales Manager

P.O. Box 7812

221 Commercial Ave., Suite 200

Pittsburgh, PA 15215

412-781-8616

Fax 412-781-3437

Privately held company with small investor group from Pittsburgh and Dallas areas. The company claims four straight years of double digit growth and profitability. Emergisoft is their only business. New headquarters building is still in planning stages for groundbreaking in 1998. Founded in 1983 by George A. Bridgemon who is the technical brains and one of the principal minority shareholders. A dozen people own about 80% of the stock; Dr. Donald Bishop has the largest minority share. Array is planning a public stock offering sometime in late 1998.

They developed a UNIX based system and shipped in 1993. They have 20 licensed users, with six in contract negotiations. Server is a DEC Alpha 64 bit 300 MHz with either OSF UNIX or Microsoft NT as the operating system. Workstation uses Windows 95 (minimum Pentium 150 with 16 MB RAM) or Windows NT (minimum Pentium 200 with 24 MB RAM. The system will run in Ethernet or Token Ring and also supports TCP/IP. Software is written in C++. Database is an unusual non-proprietary object-oriented relational database called ICUS, delivered with source code and a developer's license, allowing the user to change screens on the fly. Uses a Fujitsu hand held RF spread spectrum device and many brands of laptops. Prefers touchscreen, no light pen support. Uses Fujitsu flat panel 42" monitor for tracking. They are a Microsoft, IBM, and DEC business partner.

Third-most free-form system with no mandatory templates, though the client can choose to use other clients’ templates, or have the flexibility of customizing their own. It is dictionary driven and clinical pathway templates can be designed into the software. They deliver about 900 pre-defined discharge instructions, all of which can be site-customized as well as modified on-the-fly. Concurrent multi-user access is supported.

They now have a complete physician documentation module that allows for a paperless ED and are working to make it compliant with HCFA documentation requirements by the first quarter of 1998. The History of Present Illness(HOPI) can be done in pre-defined datapoints or free form typing (but then data points are lost). They are considering the use of the inexpensive consumer version of Dragon Naturally Speaking for the HOPI input, but have no interest in making it the front end. Physician documentation is integrated with Nursing Assessment to eliminate duplicate data entry. Medical decision-making is not covered except for a differential diagnosis list. Normals in the Physical Exam can be modified by the individual physician, but all other normals are facility specific.

They have the most complete Reference Data online. There is a charge for interfacing to HIS, Pyxis, heart monitors, or hand-held workstations. Excellent interfacing experience with most major vendors and all interface engines. A training hospital is available for on-going or new employee training. Their system will track professional credentials and licensure information for all staff. Order entry is included, and they have order sets for lab and radiology by diagnosis, as well as prompting for a HCFA required diagnosis for certain lab tests.

Sample Sites: Crozer-Chester Medical Center (55,000) Upland PA

Kathy Lehman, E.D. Manager 610-447-2188

Stephanie March Davis, (HIS) 610-447-6733

Richard McDowell, Med. Director 610-447-6254

Danville Regional Medical Center (54,000) Danville, Virginia

Beau Carter, E.D. Manager 804-799-2107

Doylestown Hospital (23,000( Doylestown PA

Pat Vida, Admin. Director E.D. 215-345-2828

Good Samaritan Hospital (40,000) Cincinnati OH

Dr. Michael Bain, Med. Director 513-872-298

Bonnie Sheedy, E.D. Director 513-872-4089

Walter Ludmann 513-872-2786

The Medical Center (40,000) Beaver, PA

Dr. Mark Shaw, Med. Director 412-773-3456

Cathy Glenz, E.D. Manager 412-773-3489

Oakwood Hospital (60,000) Dearborn, MI

Paul Randall 313-724-4556

Mary Horton, RN 313-593-7461

Karen Bostick, RN 313-593-7454

Riverside Regional Medical Center (55,000) Newport News VA

Janice Porter, ED Manager 804-594-2977

Dennis Loftus, (HIS) 04-594-2806

Saint Vincent's Hospital of New York (65,000)

Carol Agrillo, I.S. 212-604-8346

Suzanne Mason, E.D. 212-604-7000

Suburban Hospital, Inc. (35,000)

Cindy Gillum, CIO 301-896-3132

Kathy McClusky 301-896-3880

William Beaumont Hospital (90,000) Royal Oak MI

Ray Jackson, MD

Jackie Curry, RN 810-551-6107

Heidi Shepard, RN 810-551-1995

Cost: $200,000 for software alone. Turnkey systems including hardware for $200,000 (20,000 visits) to $500,000 (100,000 visits).

Future Plans: Their technical group is currently evaluating Dragon and Philips Speech Processing and an IBM product for possible use. They plan graphical charting; signature stamp; video/photo charting; EKG and digital X-ray storage; WAN with data repository among hospitals; E-mail links; specialty templates (critical paths) for cardiac arrest, major trauma, burns; on-line CD- ROM texts; pediatric ED module with integrated charting.

Clinical Resources Group

301 Congress Ave., Suite 700

Austin, TX 78701

512-472-0191

Fax 512-472-5245

Sales Contact: Debra Good

Dr. Charles (Buddy) Owen, Physician Director

One of the two oldest ED software systems, originally marketed by Clinical Resources Systems, Inc. and first sold in 1987. Company sold to BRC Health Care in August 1996, a $160M publicly traded health care software company. The company has big plans for its Clinical Resources group and is investing 2 million dollars in research and development to improve EmStat. They have 50-80 employees in their Clinical Resources Group and estimated 1998 EmStat sales of $7M. They have a philosophy of going out and acquiring modules of software to complement what they already have. For example, they recently acquired Coderight and, after a significant rewrite, will soon incorporate their Docu-Write physician module and transcription and coding services in EmStat. Their graphical interface still looks like a DOS interface other than for a few icons. It is installed with complete screens, reports, and discharge instructions, but all are fully customizable by the end-user.

They have integrated Micromedex's Clinical Knowledge Objects. They now have 31 contracted installations with 26 fully installed. Plans are for an additional 10 installations in 1998. EmStat is a 3-tiered client/server product so they can change the client product without redoing the underlying code. They use a UNIX server, and workstations of Win 95 and NT. Client software is programmed in JAVA, making it cross-platform compatible, easily updated in the future, and intranet ready. The database is Oracle. They use TCL scripting tools for run-time screen and rules customization. Requires a Pentium 133mHz processor with 16 MB RAM for the client workstation. Uses a 21" to 37" tracking monitor and prefers touchscreen technology. Concurrent multi-user access is supported. It has autofaxing. All modules work off the tracking screen. It prints work and school excuses, as well as wristbands and labels. They claim ten years of documented 99.95% uptime, and no deinstallations.

Excellent interfacing experience but does cost extra. The new physician module will be finished by the fall of 1998. It's beta version uses point-and-click data capture (pick lists) and includes medical decision making, as well as automated assessment of the level of service based on the entered documentation to meet recent HCFA requirements. It has multiple, robust order entry options. Discharge instructions are licensed from other vendors, with most installations using the instructions from EPIC, written at a 4^th-6^th grade level, including Spanish, and customizable by physician. . While it can capture facility charges, no such claims are made for CPT coding and physician charges. Extensive triage and Nursing Assessment module is available using standard charting forms, pick lists, and free text insertion by keyboard. They plan on full ENA nursing assessment compliance by the summer of 1998. Full prescription capability.

Standard QA reports are done via direct SQL query of the Oracle database. Ad Hoc reports are generated via querying tools using Access. No trauma registry or managed care module. Has shown interest in continuous speech dictation products. They are interested in out-sourcing for health care and joint ventures with other groups such as ED physician management companies for added-value services.

Cost: Highly dependent on ED volume and the various modules which are installed. For an ED of 25,000 to 40,000 annual visits installation core software modules, the software cost is about $200,000, or they'll install a turnkey system with around 20-40 workstations for $250,000 to $375,000. They have a unique "shared risk" program which will install everything at their expense, using their own capital and none of yours, and recoup over three to five years on a per patient charge basis (ranging from $1.50 to $7 per patient depending on volume. They can do this because BRC is a public company and on-going revenue streams are more attractive than a one-time sales charge.

Sample sites: Hennepin County (Minneapolis), Memorial Hospital (Colorado Springs), Oregon Health Sciences (Portland); Cedars-Sinai (Los Angeles), All Children's (St. Petersburg, FL), University (Augusta, GA), Jackson-Madison County (Jackson, TN), Texas Children's (Houston); Henry Ford (Detroit); DeKalb (Decatur GA), Presbyterian (Dallas), Univ of Pittsburgh, Wake (Raleigh NC).

Long Term Plans: unique personal task list and Order Rack in Spring of 1998; Integrated Physician Charting module in fall 1998; ENA assessments by summer 1998; on-the-fly generation of standard ED chart in printable format for viewing in realtime by end of 1998 (uses a summary screen now); medical logic (critical path) modules; platform independent product (NT, OS/2, UNIX); ambulatory care, primary care, and outpatient clinic products that integrate with EmStat.

David Tully-Smith, MD, PhD, President and CEO

101 Golf Course Drive, Suite A220

Rohnert Park, CA 94928

Just released for emergency medicine in late 1997, this newcomer to the ED market has been out for the family practice and pediatrics outpatient markets since 1995. It is a private company with a 9 member Board with 5 physicians and no debt. It is not quite a complete system but soon will be with the addition of a tracking module that will use the LA County tracking system.

This is a platform independent system that is written in Visual Basic and C++ with ActiveX controls. The 32-bit version for Windows 95 and NT will be out in the first quarter of 1998. While they have no ED installations yet, they have 80 active users, such as at Nesbit Hospital in Wilkes-Barre, PA. Currently runs on all Windows platforms. Requires only a 486 processor with 8MB RAM and 20MB hard disk space minimum.

It has a prescription writer, unlimited records, extensive customization tools, ICD-9 and CPT modules, and integrates with wireless network technology from Proxim. Prefers light pen. Good reporting tools. Due to its unique physician licensing, the data potentially moves with the physician (a less important point in EM), It's primary focus is on the physicians clinical record and a plain English translation of data points, with a specialty-specific vocabulary that is scalable to Access and Oracle.

COST: Currently licensed not to sites, but to individual practitioners at a cost of $2500 each for the 16 bit program with full customization tools, $500 for the ADT interface, and $150 per year for the ICD-9 and CPT module. The 32-bit Windows program will be available for around $3500 per provider with the EM vocabulary, or for $5000 with the automated customization tools

SITES: none in EM yet.

(LifeServ Technology)

1686 Dell Avenue

Campbell, CA 95008

800-366-1922

408-378-3900

FAX: 408-378-3901

Rick Sullivan, VP Sales

888-671-0490

Email: ricks@lifeservtech.com

Mr. Robert W. Larson

Eastern Regional Sales Manager

313 Sidley Road

Malvern, PA 19355-1132

610-407-0855

This is a privately held company founded in 1988. It has primarily marketed a perinatal and NICU System as well as Offsite Clinic System designed for OB (60 sites) and neonatal. Its ED system was introduced in 1996 and interface engine was brought out in 1996. It plans release for med/surg, Pediatrics, and ICU systems in 1996 and 1997. It is primarily a database engine being customized to each site using it, similar to the Lancet model. It can therefore be used in many sites, from hospitals to clinics to offices and home. It and RLIS were the only two companies not to exhibit at the 1997 PaACEP computer symposium.

The system runs on NT and an SQL server and uses Oracle for its database. It provides for registrations and ADL interfacing, triage, tracking, extensive log and QA reporting, critical paths, lots of word-processing capabilities, on-line clinical resources and patient education and discharge materials, chief complaint customization, nursing and physician charting modules, multidisciplinary documentation, order entry via picklists, and billing charges. As a customizable database, it has great flexibility but requires lots of work for implementation in a facility.

Steve Kahane, President & CEO

20 Oser Avenue

Hauppauge, NY 11788

516-435-8880

800-446-4021

Fax 516-435-1062

Mr. Rick Seiger

National Sales Manager, Emergency Medicine

36 Cheltenham Drive

Wyomissing, PA 19610

610-670-0632

Datamedic is a large, privately held company with substantial financial resources, lately helped by a $7M stock investment from Fidelity Investments and Bessemer Ventures. Founded in 1972, Datamedic was originally a large practice management and billing company. In 1993 they sold off the profitable billing business to purchase CIAI, a company marketing EMstation. This product used the Dragon Systems discrete speech engine and was marketed by Lanier. The development team was kept in place. Datamedic has been adapting the product to be more input-friendly and expanding it into a complete ED software management solution.

The company has about 300 employees and annual revenues of $30M. They market a practice management system called PMstation as well as a family of clinical patient record products called CHARTstation that includes emergency medicine and other specialties. Prospects for the company going public in the next few years appear excellent. They claim to have 50 ED installations. They are an "allied partner" of SMS and can easily fold ED data into the SMS hospital data repository.

Datamedic only recently got into complete ED solutions. They essentially started with the hardest part of the ED management process, the physician charting module, and have arguably developed that beyond any of their competitors. They have added logging, triage, lab and X-ray results reporting, report analysis and management, prescriptions, discharge instructions, and ICD9 and limited CPT coding to date. With the addition in June 1997 of a complete tracking module, they will have met criteria for being a complete ED solution.

The product is a client-server architecture, with the server running Novell network or Windows NT and the clients running Windows 95. They utilize all forms of input devices, including mouse, pen, voice, keyboard, and wireless RF (not touchscreen). They use the Fujitsu portable but are considering using a Mitsubishi which is half the weight and size. There are provisions for graphical diagramming. It is written in C++ and uses the Centura database (formerly Gupta) written in Sequel.

The physician charting module is uniquely developed and includes pick lists that are translated into grammatically correct English. It includes highly developed medical knowledge bases and presents them in chart format with prompts to highlight risk management and reimbursement issues. It includes provision for a waveform sound file embedded in the text that a transcriptionist can type to complete the chart; this is for difficult cases that don’t fit the templates. Also, they have switched from the Dragon voice engine to IBM VoiceType for Emergency Medicine, for a discrete speech product free text insertion.

The knowledge bases and their chart presentation in the physician module can be customized by individual physician, as can prescription preferences, but not discharge instructions (these can be patient or site customized). Multiple sites could be potentially linked for data gathering and report purposes by the addition of their PMstation practice management product. A complete history of all previous visits is instantly available. Prescription and discharge instructions are customizable and provided by a company called First Databank. Drug interactions of prescribed drugs with entered patient previous medications are immediately brought to the prescribing physician’s attention. Fax capability to primary physicians is included.

COSTS: I estimate the total cost for a 20,000 ED visit site with single physician coverage to be $140,000. This breaks down as follows:

Double coverage by physicians adds $17K to the basic software cost.

Support: 15% for 8a-5P Mon-Fri, with separate charges per after hours incident, or else 20% for unlimited support.

SAMPLE SITES: Oschner Clinic (New Orleans); Children’s Hospital (Boston); St. Mary’s Hospital (Huntington WV); Advocate Hospital Systems in Illinois; Healthsouth (Richmond, VA); Hamot MC (Erie PA).

FUTURE PLANS: Nursing module by end of year (in beta now); order entry by mid-1998.

285 Century Place

Louisville, CO 80027

303-926-2000

Fax 303-926-2007

HBOC is a $900 million company with 5000 employees. In late 1997 released their first ED software program. It is an extension of their Pathways Care Manager for hospitals, and reflects their late entry into this field as well as the low priority it has in their overall plans. It has been forced on them by hospitals concerned by the cost of ED services as well as the large amount of information generated for which charges must be coded or managed care companies shown than costs are being controlled and efficiency improved. They see their program as helping "turn down the heat" rather than their competitors more idealistic goals of improving patient care by helping the providers communicate better by improving the gathering and use of information as well as chart documentation. Only time will tell which attitude is correct.

The server is an HP, RISC-based UNIX and Data General platform. The recommended workstation is a Pentium 75 with 16 MB RAM with a 15 inch VGA monitor. For a large tracking display they recommend a 35-37 inch color SVGA monitor.

The product at first offering is very ordinary, but presents a case for use in hospital already using HBOC. It has standard quick admit and triage functions that can be used before the ADT registration interface is accessed. They have a standard tracking board with orders information, and ED staff can completely customize the tracking board. Laboratory and Radiology order entry is available, along with automatic data capture from patient monitors. Standard management reports are pre-configured, and quality improvement reports can be constructed via fairly easy and powerful query and reporting tools. The systems biggest advantage is that it is completely interfaced with their hospital information system, so all information from the ED, as well as all on-line hospital patient information, is immediately available throughout the entire hospital information system.

COST: unknown at this time.

SITES: unknown at this time.

One Kendall Sq. Bldg., #200

Joe McNulty

Sales Engineer

Lancet Technology, Inc.

One Kendall Sq. Bldg. 200

Cambridge, MA 02139

800-3LANCET x121

This company has been in business since 1987. It is employee-owned but was founded by a trauma surgeon and I.J. Gujral. Mr. Gujral is president and majority stockholder. Mr. Leon Bowmen is COO. They market the well- known Trauma One trauma registry as well as Transplant One and Fire/Rescue One. The ED product is a logical extension and is for the Windows platform. It has a complete choice of appropriate modules (see comments on EmCare). Its unique feature is a potpourri of data points that the end user can customize on their own to serve their own needs; therefore, it a not a turnkey system and requires much HIS department and clinical personnel involvement, similar to the Cygnet system. Lancet will design the first set of data entry pages, pathways, and reports as part of the purchase price. The user site then performs future modifications as needs in the ED change.

Written in C++ and uses a Foxpro database, but converting that to Microsoft SQL Database Server in one year for their backend so that they can use any database. The system can use any input device but prefers mouse or touchscreen, and imports scanned or digital images. They have seven installations with the first in 1994. There are complete discharge instructions, billing and coding, and extensive reports that can be customized by the user. Telephone support is provided Monday-Friday 7am - 6pm EST through a toll-free 800 number to handle technical, operational and training support issues. For system critical issues, each site is given a second tool-free 800 number. Support via this 800 number is available 24 hours per day seven days a week. Most service calls are responded to within one half hour during normal business hours. A Lancet Support Engineer will travel to the customer site if a system critical issue cannot be resolved within 48 hours. They recommend that the hospital IS dept. handle all hardware and third party software-related issues.

They recommend an NT or Novell server with Ethernet with a Pentium 133. Workstations should be Pentium 120 with 24 MB RAM running Win 95 or NT. One of its biggest advantages is it integrates easily with a Datagate interface. They do install the system and have extensive interfacing experience. They have done SMS and Meditech interfaces.

The basic module includes Data Entry and Log, Nursing Assessment and Notes, QA and other Reports, Tracking, and 14 days of training and support with an unlimited number of workstations. In addition to the basic module, they have recently added Physician Charting (using the Codonix physician charting system) and Discharge Instructions (using Exit-Writer). Over 300 discharge instructions are written at an 8^th grade level and are available in Spanish and English, customizable by staff member. They recently added the CodoniX charting system, which contains a coding mechanism based on symptoms entered to maximize reimbursement. It generates a level of acuity, e-codes, and ICD-9 and CPT visit codes based on internal references. It has a Rule Tables module that can establish rule-based patient care with provider reminders. It can generate prescriptions, remind of drug and food interactions, and produce work and school forms. In addition, Order Entry is now included. It does extensive nursing assessments, but they are not ENA compliant. Translates all data points into English text for printing., but it is all data points for reports. Uses rich graphical diagrams, does e-codes, and is HCFA documentation compliant. The formulary is customized by each physician.

Lancet and Codonix have partnered with EmCare to develop an integrated product that EmCare is exclusively developing for its client hospital ED's (now including their newly acquired Spectrum ED's). This product might be available to all others via Lancet and Codonix., as EmCare is not permitted to market their product outside their company.Sample Sites: five in New Mexico including Guadeloupe (Santa Rosa, NM), San Juan Regional (Farmington, NM), Emerson (Concord, MA), St. Joseph's (Tacoma WA).

Cost: $150,000 software, offer Datagate interface engine for $25,000. They have a 20% support fee with unlimited phone support and upgrades. A more basic system is available for $50-150,000 depending on number of visits, that does not include Discharge Instructions, Physician Charting, charge codes, or two-way ADT and Lab and Radiology interfaces. The price does include 14 days of work at the site for training or customization.

Dr. David Elvig, President

Stephen Casper, Director of Business Development

P.O. Box 224

800 Wisconsin St.

Eau Claire, WI 54702-0224

715-839-0700

800-848-0099

A private company owned by Dr. Elvig with sales of $2.5M per year, 90% from ED products. Profitable for six years, 40% growth per year. Have 55 employees. Started with Checkout discharge instructions. Have 400 installations of all levels with 31 integrated Level III sites. Philosophy has always been conservative. They are not the bleeding edge types and let others make mistakes first. Has always been a DOS product (now used with memory management in a Windows environment), and is in beta testing for Win 95, NT, and OS/2. Prefers touchscreen, also uses mouse, light pen, and keyboard. Written in C++, first released in 1987.Database is Ctree, going to Oracle. Lots of interfacing experience. Built-in QA with some clinically pertinent reminders. Has Managed Care module with Payor Rules. They now feature their Clinical Teacher's P.E.T (Patient Education Tool), for delivering complete patient information on subjects such as medications, diet, diagnoses, and follow-up. It also creates customized work and school releases. They are a preferred provider for Columbia/HCA (which uses Meditech for the hospital). Excellent at marketing. They are a CDC Dataset Charter member (DEEDS). They do not have a nursing or physician charting module, nor do they have order entry. Unique status board at hospital physician exit for primary care/specialist doctor lookup of their ED patients. Has a lookup table for what lab needs to be back for physician re-evaluation. No charges/billing modules. No critical paths, EMS, or photo modules. Has autofax and physician dictation management. Completely MS Office compatible for reports. Has shown interest in continuous speech dictation products. They have done multisite and multicampus installations. The Checkout discharge instructions cover over 1500 topics.

Cost: Level III, 1-15 Stations=$95,000; 15-25 stations=$115,000; unlimited=$132,000. Level II (triage, tracking, log, QA) for about $30,000 which may be appropriate for ED visits fewer than 20,000.Sample Sites: Kaiser, especially Parma General (OH) and Cleveland Clinic (OH), Central DuPage (Chicago), Sarasota Memorial (FL), Northside (Atlanta), Akron General (OH).

Future Plans: Windows in 1998; nursing/physician rules-based charting with clinical pathways in early 1999; custom triage rules. 

InteSys Division

15220 NE 40^th St.

PO Box 97013

Redmond, WA 98073-9713

425-882-3700

800-251-9910

Fax 425-885-4877

Carl Lombardi Jr.

Director, Emergency and Surgical Products

Derek Delahunt, Marketing Manager

The Orca product was acquired by Spacelabs Medical in October 1997. Spacelabs is one of the two largest patient monitoring companies in the country with annual revenues of $300M. ED Chart will be part of their InteSys division's Chartmaster line which currently includes surgery, pediatrics, and OB products. It will be marketed by all of their 100 US monitoring sales reps. Their goal is a hospital-wide chart and information system. The ED product was originally owned by Jack and Molly Ciliberti, an ED doc and ED nurse wife, from Overlake Hospital in Bellevue, Washington. Started in 1989 on Mac, to Win 3.1 in 1993. Controlling interest sold to Sequoia Capital and Delphi venture capital partners in electronics and healthcare, in January 1996. Went from 8 to 40 employees. Spacelabs hired the Ciliberti's and several other ex-Orca employees. They released the updated product in late 1997. Win 95/NT-platform release 9/96. They had 15 installations one year ago, twenty now. Server uses hardwire or wireless Ethernet, 200 MHz Pentium with 32 MB RAM and 2GB Hard drive. Workstation is Win 95 or NT on a 166 MHz Pentium with 32 MB Ram and 1 GB hard disk. Written in Visual Basic in past, has Microsoft look and feel and plan on using all Microsoft products.. Uses a 32-bit Visual Foxpro database. Going to SQL server for speed, and have ActiveX controls now. Can export to Access, and will use Crystal Reports for reporting. Prefers touchscreen interface, but can use anything. It can run a pen-based mini laptop with RF modem hooked up live to tracking board on the main system, with full drag and drop capability. They have recently bought Ameritech's CareWindows, a hospital-wide Clinical Data Repository, into which ED Chart will be integrated. This clearly places them in direct competition with the big hospital information vendors, but with a complete ED product to start, unlike HBOC.

Some lagging on features in recent years, but recent cash infusions seem to have changed that. Physician and nursing modules coming. No EMS or photo capabilities. Structured program with much end-user configuration capability. Features "care plans" for ED abusers, similar to Wellsoft’s "special patients. They have done 20 interfaces, shared 50/50 with HIS dept. Tracking board works like a spreadsheet. Discharge instructions (in English and Spanish and modifiable) are included, as is a quality assurance and report generation feature which exports to an Excel spreadsheet. They plan on thoroughly integrating with their monitoring products, and accordingly provide multiple automatic alarms that can be remotely viewed at any workstation. This means any workstation can be used as both a charting terminal and a remote patient monitor. Have algorithms for specialized care. The product includes medical releases, prescriptions, transfer forms, and recording capabilities for patient phone conversations and call-backs. The triage module allows for nursing notes. X-ray discrepancies and culture reports can be integrated with patient records. Automatic faxing of patient records to their physician is available. The interface supports HL7 and TCP/IP standards. No e-codes, but does ICD-9 codes.

Cost: Not yet set. Previously in its Orca incarnation, was $150,000 for software only for 20,000-visit site. With recommended hardware it cost $225,000 to $275,000 for 20,000 to 50,000 visit sites. Preferred to do software part only as found hospital IS departments preferred their own vendors, but this may change with the Spacelabs acquisition.

Sample Sites: Mayo Clinic (Minneapolis), St. Vincent’s (Indianapolis), St. Elizabeth South (Edgewood, KY—getting new hardware). Best demo site in Seattle.

Future Plans: portable devices, clinical orders end of 1997, diagnosis coding. They are migrating away from a modular system as data tables get larger and slow down interface. They are going to an integrated system, working with Duke University using Active X technology and a Navigator Internet interface, which will allow cross-platform development and easy upgrading similar to BRC’s plans. Big plans for "problem-solving engine" in order entry for appropriate prompt screens for the chief complaint. Addressing procedures as well as diagnostics in order entry. They plan nursing and physician modules by June 1998.

MediMouse Systems

(A Subsidiary of Penta Software)

Charles A. Lankford, CEO

107 Lakefront Drive

Hunt Valley, Maryland 21030-2259

410-771-0301

Fax 410-771-4020

Penta Software acquired MediMouse in September 1996 and relocated the company to Hunt Valley, Maryland. Penta, like BRC, is a large company that has been developing software for publication processes especially in medical fields for over 25 years installing several hundred large systems in the U.S., Canada, Europe, and the Pacific Rim countries, giving the product some capital backing. Originally this system was the brainchild of MESA, a large Chicago ED group. MESA was taken over by EmCare and the MediMouse product was sold.

MediMouse includes registration, triage, nursing assessment, physician history and physical, Images and patient drawings, order entry, discharge instructions, prescriptions, autofaxing, and hospital billing. It can interface with medical monitoring devices, and reports are made in Access.

The system utilizes a template system for charting called the Clinical Knowledge Base, which includes standard descriptions of the vast majority of patient complaints that are encountered. It is modifiable by the end-user, and sounds similar to the Telemed and Datamedic physician charting templates that help with proactive QA.

The system uses a barcoded patient ID card to facilitate registration and identify previous ED visits for immediate review. It generates barcoded patient bracelets and specimen labels. Documents such as EMS run sheets can be scanned in, as can film photos, or digital photos can be imported. Anatomical drawings are included and can be annotated. Order entry can occur at the bedside, critical ones can be flagged for immediate notification, and the physician is automatically notified when results are back.

All orders and procedures are immediately CPT coded and priced, so that a demand bill could actually be rendered by the hospital at the time of discharge, or as is more usual, the information can be immediately sent to the hospital documentation and coding review for approval and final transfer to the HIS billing operation.

The system uniquely has Electronic Signature capability, so upon review of the screen image of the patient record, the clinicians can "sign off" as chart complete. This then allows the chart to be moved to a "priors" database and can immediately be retrieved for review, follow-up, answering subsequent patient questions, or should the patient revisit the ED in the future. If, however, that was an observation, test, or other activity that was considered critical to the Institution’s standard practice for an encounter, which was not accomplished prior to discharge, the item will be brought to the attention of the physician, and appropriate action will be required prior to the completion of the discharge process. It has an Interface Error Monitor that notifies the user of other systems on downtime or an order that was not properly entered or completed.

MediMouse runs in a Microsoft environment using PCs supporting Windows (including 95) and an NT server. It uses Microsoft Access for all reports in its MediReporter module added in 1997, with numerous standard reports and easily customized ones.. They have an optional interface for transferring completed patient charts into a data repository using an industry standard data format.

Cost: Approximate software cost for a 20,000-visit site would be $85,000. Standard implementation and training include 16 weeks of MediMouse time and cost an additional $15,000.

Sample Sites: At the time of acquisition, Kaweah Delta District Hospital in Visalia, CA had been live

with the MediMouse System for 3 years and was the only live client. Since the acquisition, Mercy Hospital in Portland, ME went live with tracking and triage in May 1997. They have scheduled implementation of the remainder of the system in their Express Care in August 1997 and will immediately expand to the rest of the ED; also, Roger Williams Hospital (30,000 visits) in Providence, RI went live with MediMouse in their Express Care in May 1997, with the ED planned for 12/97. Both Grace Hospital in Detroit, MI (part of the Detroit Medical Center, with 60,000 visits) and The University of Arkansas for Medical Sciences are planning September1997 go-lives.

Future Plans: Its HL7 interface is in development and will be completed this fall providing an industry standard protocol for data transfer. MediMouse is integrating the Philips Voice Recognition System into their

product line. MediMouse is nearing completion of an electronic interface to a physician billing system that will provide more automated and a quicker turn-around for physician billing.

210-490-1800

800-496-7547

A privately owned company (by Dr. Ross). They are negotiating with several major non-medical but big-name companies for a partnership arrangement. This possibility is enhanced by their eight patent licenses (which themselves provide financial stability to this company since they could be easily licensed if needed). These patents include realtime generation of data on the fly into English summary text (which allows quick data searches fully stripped of all identifying information, compared to all other products which do text string searches that take large servers, much time, and can never be fully stripped of identifying information). One of the other patents involves pre-phrased text that's editable. It can be customized at installation, but after that the end user is not expected nor encouraged to modify the interface. This is done purposefully to encourage familiarity with the product among many users and to prevent constant retraining problems. It and Cygnet were the only two companies not to exhibit at the 1997 PaACEP computer symposium; in this company's case, it's because their current negotiations don't allow them to follow-up on contacts currently.

Requires a surprisingly inexpensive NT server and workstation platform that uses a Pentium 166 with 48MB RAM and 6 GB Hard drive in the former, and a Pentium 120, 32 MB RAM, 200 MB hard drive in the latter. Uses touch screen or mouse. Uses Foxpro and SQL, written in C++. Advanced graphical interface designed to replace 80-90% of physician dictation with normal macros and touch screen pick screens (as opposed to pull-down menus). Mainly the history of present illness has to be dictated and can then be imported. Looking at voice input. Interface is more intuitive than most and is fast. Has intelligent warnings (e.g., allergies shown when Rx written, pregnancy status reminder when X-rays ordered). Printable patient questionnaires are included for patient manual completion of historical factors and then review by the interviewing physician.

It has a complete differential diagnosis list with visual drawings and a graphical ED tracking view; overall a very deep and built-in clinical knowledge base. It is fast and easy to use, which results from both it newness and excellent design. Takes data and inverse parsecs into plain English text. Extensive nurse charting/documentation which is now called progress notes since physicians can use it too. It now has an enhanced and color-coded tracking board. Report generation has been recently enhanced and all custom reports are supplied. It can use a Smart Card with chip for sign on (no password), or traditional initials and password. Handles multiple complaints well. Has complete order entry and is HL7 compliant. The product is good enough to generate a completely paperless chart and reports (including autofax capabilities), but all of it can be printed if desired.

Cost: $200,000 for software only or will lease for $6-10,000 per month. Will do on a "per chart" basis at smaller sites.

Sites: San Antonio

Future Plans: Version 2.0 will be available in six months.

Denise Helfand, Marketing Director

Jim Peck, Director of Technical Services

605 Franklin Blvd, Suite 5

Somerset, NJ 08873-3645

732-828-5470

800-597-9909

A private company owned by Dr. John Santmann, President, and ER doc, who has his own private sources of capital through another family business. He has a degree in biophysics from Johns Hopkins. The company is profitable based on support costs and no debt. They are in some Columbia/HCA hospitals. Wellsoft was originally a DOS system with a recent Win 3.1, Win 95, and NT release. They released their 32-bit Windows product (95 or NT) in June 1997. The DOS product was discontinued in September 1997. Runs on any LAN, but prefers Novell or NT. Started with HomEasy discharge instructions in 1988, ICMS released in 1994. Twelve sites with the latter. Written in Delphi (C++) in an unusual nonproprietary Btree database. Extensive interfacing experience and they develop and support them using HL7 protocols. Server optimally requires a Pentium 200 with 128 MB RAM and 8 GB hard drive with mirroring. Workstation optimally requires essentially the same with 48 Mb RAM and a 3 GB hard drive. Prefers light pen, can do touchscreen, mouse, and keyboard. They recommend using a HP LaserJet 5N printer. Claims to be particularly fast, with 45 seconds required for a discharge instruction compared to twice that time with other programs. Software can be easily customized by Wellsoft with changing displays such as the tracking monitor, with no costly or time-consuming source code programming changes that they claim is unique compared to other vendors. The program is DEEDS compliant. Spends less on marketing as they feel the market is not yet mature and will grow slowly.

Physician charting was released the end of 1997. It uses about 25 pre-defined text templates in a fast, proprietary word processor, and includes enough points for a chosen level of service. All points can be deleted or changed from picklists, or free text can be typed in. No voice input yet, but can do mouse input equally well. Does not use touch screens. Touch is not encouraged as it has too much information in too few lines. The use of a word processor adds the disadvantage of needing to do text searches for data reports, but their proprietary model is faster than commercial word processors. In practice, it takes 3-4 weeks to learn and become proficient and efficient with the physician charting module. They find that 40% of the charts are done faster, 30% are the same, 20% are slower, and 10% need dictation.

It is rich features, no photos. Uses ENA assessment in nursing and triage module. No critical paths by design secondary to medical device regulation concerns. They have a GSA contract with the federal government. They have 20 employees in New Jersey and a few in the field. They support RF hand-helds. They have a trauma registry that they’ll customize for your state. Has a "special patients" module for ER abusers similar to Spacelabs ED Chart "care plans."

The discharge instructions cover 2000 illnesses, drugs, surgeries and procedures. Prescriptions, work releases, and drug interactions are available, as are Spanish versions. It will do physician charting now with diagnosis-based templates that allow free-form text insertion, while meeting new HCFA documentation guidelines. ICD-9 and CPT codes are automatically assigned. Includes Order Entry, Telephone Log, and Staff Directory with Auto-Dialer. Extensive report generator which is customizable. Wellsoft gives a 100% unconditional money-back guarantee.

Cost: They used to charge by the workstation ($10,000 each), but now do a site software license fee like the other vendors, averaging $100,000 to $350,000 per site, except that discharge instructions are still charged by the workstation at $5000 each. Interfaces are $5000 each (they "guarantee" the interface) using HL7 protocols, and they have done multicampus installations. Support is 17% a year and available toll-free 24 hours per day using PC Anywhere. Able to provide a complete hardware/software package and see to all details of implementation, including on-site setup, installation, and staff training, the latter at $1000 per day plus expenses. New module upgrades will be priced separately.

Future Plans: They plan document scanning , voice recognition, and photo and graphic image import and manipulation in 1998.

Sample sites: St. Bernard Regional MC (Jonesboro, Arkansas), Bridgeview MC (Waconia, MN, near Minneapolis).

Dr. Ed Barthell

1251 Glen Oaks Lane

Mequon, WI 53092

414-290-6710

Fax 414-290-6780

RuthAnn Nelson, Director

Healthcare Division

Herndon, Virginia

703-708-6761

This new system is the least developed but one of the most interesting. Currently with the name of "EMCR Lite", it is a log and patient tracking system with QA and management reports. It is the first of many planned modules including an EMDS module, nursing notes and protocols, registration, order entry, and physician documentation.

This system is a cooperative venture of Infinity HealthCare (IHC), an emergency physician and computer specialist group based in Milwaukee, and Oracle Corporation. It is object technology-based, is being converted to the new object compliant Oracle 8 database, and uses web based interfaces for easy use. This is the first product to be based on an object based data model that is likely to become a national standard, consistent with the Data Elements for Emergency Department Systems (DEEDS) effort led by the Center for Disease Control, and incorporating the Essential Medical Data Set for displaying past medical history information. The program is also unique in its use of the web-based interfaces that are so popular and familiar for users of the Internet.

Infinity and Oracle embrace the use of CORBA, the Common Object Request Broker Architecture that is rapidly emerging as an interoperability standard in health care computing applications. This open design allows all applications to communicate no matter where they are, who designed them, or what platform they are running on. It will run on most operating systems, including Windows, OS/2, and UNIX. The system architecture is especially

Suited to distribution and exchange of clinical information over wide area networks and between multiple institutions for regional analysis and reporting, rather than being limited to a single emergency department.

Byron C. Scott, MD, Director of Medical Program Development

Jim Williams Chief Information Officer

1717 Main St. Suite 5200

Dallas, TX 75201

214-712-2480

This one is actually a combination of Lancet’s (Emergency One) integrated system that has everything except charting, combined with CodoniX excellent physician charting (designed to replace dictation), billing, and diagnosis system. EmCare has put them together in what looks like an excellent interface. Particularly interesting is its easy Datagate interface to make hospital computer system interfacing easy.

The program has been installed, minus order entry for now, at Adena Hospital in Chillicothe, Ohio. They plan installations in a couple of their other EmCare facilities in Pensacola, FL and New Orleans. Their contract with Lancet and Codonix allows them to only install in EmCare facilities, though with their recent acquisition of Spectrum those facilities are now open to them also. No doubt Lancet and Codonix will sell anyone a similar, customizable product.

Cleveland, OH and Woburn, MA

1-800-DICTATE

Phil Cohen, Senior Vice President of MRC

While developed as a continuous speech recognition solution for transcription using the Dragon speech engine, this has reportedly evolved into a complete ED solution. It includes charting structures and free text, imports lab results, writes prescriptions and discharge instructions, and handles reports. Handles HIS HL7 interfacing. Does Triage, Registration, Nursing notes, Tracking, real-time risk management, ICD-9 and CPT coding analysis with electronic capture and automated delivery for billing. Will use Massachusetts ACEP discharge instructions and maybe Micromedix for drug interactions. Sites must buy the note generator (physician reporter), the other components will be sold as modules. Multiple providers can dictate on one patient report.

Uses Windows 95 and NT. Server requires Pentium 200 with 64 Mb RAM, 2 Gb hard drive, and Ethernet. Workstation requires Pentium 100, 32 Mb RAM, and 1 Gb hard drive.

Beta tests planned in January 1998 in suburban Boston. Pilot group planned for April 1998, with a release date planned for June 1998.

Disclosure: I have a minority stockholder position in and am a member of the Board of Directors of Vocalex, Inc., a master VAR and licensed developer for the Philips SpeechMagic software program.

Copyright Notice: The reader may freely quote and distribute any or all of this review with direct source attribution to Mark L. DeBard, MD, FACEP.