Landmark Medical Center is a nonprofit, full-service health care network committed to providing health and human services with the highest ethical and quality standards as well as delivering care with integrity and compassion for all patients. Serving northern Rhode Island and Massachusetts communities, Landmark Medical focuses not only in the treatment of specific illnesses, but also in caring for the whole patient through a multidisciplinary approach.


Approximately 70 percent of Landmark Medical's hospital admissions come through the Emergency Department (ED), which treats about 47,000 patients annually. This is the area where making optimal treatment decisions can literally mean the difference between life and death and, less dramatically, can ensure that each patient receives quality care in the shortest possible time frame. As a result, it's extremely important to know how many patients are waiting for treatment and exactly where they stand in the treatment process. Equally critical, clinicians need rapid access to patient information that is being developed, processed and funneled in from specialty areas throughout the hospital. Many health care experts agree that EDs represent the most critical access point in our nation's health delivery system.


Landmark Medical uses a triage model where the patient is registered, evaluated by midlevel clinicians and then treated by a physician. In this environment, using the traditional ED whiteboard to manage patient flow has some real shortcomings: it's virtually impossible to update a whiteboard as frequently as clinicians prefer, and critical time can be lost in checking patient status and location when people must walk to the whiteboard location.


To get to the next level in patient management and care delivery in the ED, Landmark Medical selected the Forerun ED system from Forerun, Inc. Built on InterSystems Ensemble, the rapid integration platform from InterSystems Corporation. The Forerun ED provides a global, real-time view of what's happening in the ED. In addition to tracking the true time that a patient spends in the ED prior to hospital admittance or discharge after treatment, the system enables rapid identification of life-threatening conditions that must be addressed immediately.


Seven physicians and eight midlevel clinicians and nurses are utilizing the Forerun ED application on a 24x7 basis. Using Ensemble, information from the medical center's registration, laboratory, pharmacy and radiology systems flow to the Forerun ED system across the organization's network. A large, easily visible plasma screen in the ED can be checked at any time to get a clear perspective of where things stand with patient flow. The global view displayed on a single screen ensures that clinicians know how many patients are in the waiting room, and they can scan for life-threatening conditions even before patients reach triage. Individual patient data is accessed as needed via PCs in a central ED location or on movable carts. All clinically relevant data (such as tests ordered and completed, prescriptions ordered and clinician notes) is visible on a single screen for each patient. As a result, clinicians are confident that they aren't missing critical information while the ED workflow is simultaneously improved.


The system officially went into production at 2007 year-end, and Landmark Medical is in the process of determining how to most effectively accumulate quantifiable data to statistically measure the results of the Ensemble-based Forerun ED implementation.At an individual level, however, it's clear that communication among caregivers has improved and there is faster patient discharge or patient admittance, depending on what is appropriate. There is no doubt that the Forerun ED is helping to identify and eliminate bottlenecks by providing much needed objective data. And, clinicians have been very open to adopting the new system. They began to embrace it even while the Forerun ED was operating in beta mode, and they are now totally comfortable with what has proven to be a high-value application.


In addition to contributing to the quality of care delivery at Landmark Medical, it's also reasonable to assume that the Forerun ED will have a positive impact on the hospital's bottom line. In the early 90s, an estimated 2,000 people per ED bed were treated annually, according to industry experts. Today, most hospitals plan on serving only about 1,200 people annually due to the amount of work needed to process each patient.1 Technology such as the Forerun ED can make it possible to increase patient throughput while simultaneously providing top-tier care.



  1. Harvard Graduate School of Design, "Emergency Department Design," Harvard Seminar, August 9, 2006.

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