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Associated Press Features EMA in National Story

Date: January 3, 2005

The following article, written by New Jersey-based Associated Press reporter Linda Johnson, was sent out nationally over the news wire, and featured in newspapers and online business and medical websites.  The article in its full text is featured here, and can also be seen by going to the following link from the ABC Business News Site at http://abcnews.go.com/Business/wireStory?id=376448.

 

ABC News

Co. Helps ER Doctors Focus on Medicine

New Jersey-Based Company Helps ER Doctors, Hospitals Focus on Medicine, Not Paperwork

The Associated Press

LIVINGSTON, N.J. Jan 1, 2005 — The tiniest details matter at Emergency Medical Associates, a doctor-owned staffing company that keeps emergency departments humming.

Livingston-based EMA supplies ER doctors around the clock to 17 hospitals, handles billing and tracks virtually every aspect of roughly 750,000 patient visits each year.

How long it took patients to get through triage, see a doctor and be discharged or admitted, plus the symptoms they had, tests they got, diagnosis, treatments given … no trifle is overlooked.

Constant analysis of all that computerized data lets EMA improve operations to get patients through emergency departments quicker, provide better care and cut waste. Doctors entering data as they treat each patient are prompted by EMA's software to consider specific tests or diagnoses. And EMA supervisors in each hospital can review data on every patient case to spot weaknesses in individual doctors and guide them in adjusting.

"We spend a lot of time making sure patients are happy with us," responding to every issue, said Jonathan Rothman, who directs data management at EMA and created its computer software and database. "Our physicians have completely bought into what we're doing here."

Over the region it covers central and northern New Jersey, New York City and its suburbs EMA can use its rich data to spot spikes in specific illnesses and adjust ER staffing accordingly, and to detect unusual symptoms. That data, which EMA sends regularly to public health authorities, also could serve as an early warning system if bio-terrorists struck.

While there haven't been any attacks, EMA data detected an outbreak of rotavirus, which causes infant diarrhea, and helped document "Bill Clinton syndrome," when middle-aged men surged into hospitals wanting their hearts checked after the former president had quadruple-bypass surgery on Labor Day, Rothman said.

Since the day after Christmas, EMA's emergency departments have seen an average 8 percent jump over normal patient volume, mainly from people with colds and stomach viruses. The number of flu cases remains surprisingly low, Rothman noted.

He started building his database in 1998, after EMA doctors at two hospitals mentioned a spike in gastrointestinal disorders and he saw the value of having detailed patient data, updated daily. The Sept. 11, 2001 terrorist attacks added urgency.

EMA then began working with doctors in New York City and at the U.S. Department of Defense and Centers for Disease Control and Prevention to together develop national coding standards for 11 categories of disease, such as certain respiratory and gastrointestinal illnesses, that could signal a possible bio-terrorist attack, said Lt. Col. Julie Pavlin.

Pavlin, who works for the Defense Department's Global Emerging Infections Surveillance and Response System, said the government recently started using data on veteran and military patients, plus other sources, to monitor for key disease categories.

"You can detect things early and maybe order more lab tests to spot things before outbreaks get too large," she said.

Dr. Farzad Mostashari, assistant commissioner for epidemiology at the New York City Health Department, said that unlike other health care companies, EMA has been very generous in sharing its "high-quality data" from the past several years, which covers far more than the diseases doctors must report to public health authorities.

He said EMA's data work is part of a science discipline developing since 1998 called syndromic surveillance, where instead of just relying on delayed reports of people diagnosed with disease, health authorities aggressively track ER visits, ambulance dispatches, absenteeism rates and sales of nonprescription drugs.

"EMA has been a really important contributor to this process," Mostashari said.

The company's doctors run ERs at medical centers from a 120-bed community hospital to 500-bed teaching hospitals and three regional trauma centers. Founded in 1977, EMA now employs 174 full-time and 43 part-time emergency medicine or pediatric emergency doctors, nearly all board certified.

Saint Vincent's Hospital, a top-level trauma center in Manhattan, signed on in November; two more hospitals are about to retain EMA.

One early client, the Saint Barnabas Health Care System, has had EMA run the emergency department at its flagship hospital, Saint Barnabas Medical Center in Livingston, for 20 years. It now uses EMA doctors at five of its nine emergency departments, and all nine hospitals use EMA's patient data system, said Dr. John Brennan, the system's Senior Vice President for Emergency Department and Clinical Services.

EMA supplies detailed data on how long patients wait for services, patient satisfaction for each physician and quality indicators such as whether patients with a particular disease got appropriate tests and treatments, said Brennan, who previously worked for EMA.

"We really look at this data at a microscopic level and really look at trends," he said. "It's probably the best data that I've seen."

EMA has helped the system improve efficiency, Brennan said, with changes such as having computer terminals throughout the ER that hold electronic patient records, test results and digital versions of CT scans and X-rays, cutting out most of the time doctors and nurses spend running back and forth from patients to get information they need to provide treatment. In addition, he said, nurses at EMA analyze patient satisfaction data for each hospital gathered from mail surveys by an outside company and make suggestions on where and how to improve.

Because the doctors are part owners, EMA's success in attracting hospitals and holding down costs affects their income, said Dr. Ray Iannaccone, EMA's Director of Emergency Services at Hudson Valley Hospital Center in Westchester County, N.Y., where the wait for a patient to be seen by a doctor is down from an hour to 20 minutes.

"There's an incentive for folks to work harder to make changes in their practice patterns to improve efficiency and quality," he said.

Still, Iannaccone said, getting periodic reports comparing every aspect of their performance with colleagues is "a little unnerving" to new hires initially.

EMA has dozens of competitors across the country, from Jersey Emergency Medicine, a small physician group that only serves Community Medical Center in Toms River, part of the Saint Barnabas system, to national leader EmCare, which has ER doctors in more than 300 hospitals in 37 states.

However, many other companies don't provide billing services or detailed data on operations and quality of care, Rothman said