The current and future of EDIE alerts in Virginia.

This is Part 2 of our interview with Washington state ACEP’s Stephen Anderson, M.D., F.A.C.E.P. on what Virginia’s emergency physicians can expect when EDIE alerts arrive this summer. Be sure to read Part 1 before continuing here.

Dr. Anderson, like many of those who have been working to implement EDIE in Virginia, calls the forthcoming statewide notification system for high-utilizing and at-risk patients a “game changer.” EDIE will connect emergency departments statewide and alert physicians and treatment staff of patients who require a closer look or may have a history of frequent ED usage.

Dr. Anderson, the president of Washington state ACEP, also regularly talks of EDIE in terms of software versions: EDIE 1.0, 2.0, and so on. Washington state is now four years into its implementation (they’re on EDIE 4.0, which he describes below), but Virginia is just getting started. From Dr. Anderson, here’s what we can expect for the upcoming and future releases of EDIE:

EDIE 1.0

“… is just putting the tool in place. That’s what Virginia is going to do on July 1.”

EDIE 2.0

“…is figuring out how to put your prescription monitoring program right into EDIE. That’s also a game-changer. Right now for most states, the PDMP is what I call ‘Three Clicks to Crazy.’ If I have to go through three screens and two log-ins, I’m not going there unless I have to. With EDIE, the PDMP is just right there in front of me. Instead of only looking up the patient that is trying to jerk me around, all of a sudden I’m seeing the PDMP on a 32-year old housewife, mother of two, with her kids playing on the floor, and I don’t understand why I’m negotiating Percocet with her. It’s just right there in front of me on the PDMP. Pushing the PDMP into EDIE is the second game-changer. It shows me people that have eight different prescribers from six different EDs and are out shopping for pills. [In Washington state we] cut down on narcotic prescriptions out of the Emergency Department 24 percent in the first year of instituting PDMP.

But it also works both ways. It shows me people who have pain management contracts who are playing by the rules, and then I say, ‘Hey, good for you. You’re playing by the rules.’”

EDIE 3.0

“…is getting your case managers to start uploading case management plans that are individualized and tell me what to do. Collective Medical [the EDIE developers] is really good at guiding 3.0. In Washington state, they hold a conference every year that the case managers are invited to. It’s the first time in the history of the state of Washington that there’s been an annual statewide conference for case managers to get together and talk. Virginia has made amazing progress in the last couple of years about getting an EDIE Directors forum started. One of the steps they want to take [in Washington] is to get a case manager statewide conference annually, and Collective Medical will help [Virginia] do that.”

EDIE 4.0

“…is PreManage, which pushes this same information [in the EDIE] back into the primary care offices. Not only are we alerting the EDs, but we’re then sending them back to their primary care with the same information pushed back to them. It’s just one more step in trying to coordinate that whole care. Some states haven’t done PreManage, but for the most part, most states that are jumping into EDIE are also jumping into PreManage. They’re kind of sold as a package. It’s a lot easier to get EDIE up and running than it is to get PreManage up and running.”

EDIE 5.0

There are still some holes in EDIE, and we’re starting to plug those holes. Virginia has a fairly impressive Department of Defense and Veterans Affairs system, and there have been some challenges getting some information exchanges in and out of the VA and the Department of Defense. That one isn’t solved at state-by-state, that one’s got to be solved at the federal government level for the VA and Department of Defense. [Veterans are] an at-risk population. In Virginia this will be very true, because it’s got a high percentage of VA and Department of Defense patients.”

EDIE 6.0

“…is adding POLST forms and advance directives. I think it’s something like 60 percent of the health care dollar is spent in the last two months of life. If people have an advance directive, knowing it right at the start when they arrive in the ED helps tremendously. There is not a national repository for POLST forms right now. If it was just one more little icon in the EDIE that you clicked on and it automatically showed you that the patient had a POLST form, it would be really cool. We’re working on trying to figure out how to do that – it’s not always the electronics that’s the challenge, it’s the legality of it.”

For more on EDIE, visit Collective Medical‘s website.

Stephen H. Anderson, M.D., F.A.C.E.P., has practiced for nearly 30 years at MultiCare Auburn Medical Center in Auburn, Mich., holding positions including Chairman of Emergency Services, Stroke Care, Trauma Care, Education, and Chief-of-Staff.  Over the last few years as President of the Washington Chapter of ACEP, Dr. Anderson fought flawed public policies surrounding restricting access to care for State Medicaid patients, and Mental Health Boarding in ED’s. He is a co-author of Washington state’s “Seven Best Practices,” a program many states now use as a blueprint to increase patient access, coordinate care of high utilizers, save lives and save states Medicaid costs. In 2014, he was elected to the National Board of Directors of the American College of Emergency Physicians, advancing the practice of its 37,000 members. He serves as secretary, treasurer & Chairman-Elect of the Emergency Medicine Foundation.

Note: EDIE is endorsed by ACEP. This interview was conducted entirely independent of Collective Medical.