Technology in the emergency room

Dr Kelly, ER doctor at Beth Israel Deaconess Medical Center and Executive Clinical Consultant at Imprivata, tells us about the role of tech in the ER

Dr Sean Kelly is an ER doctor at Beth Israel Deaconess Medical Center and Executive Clinical Consultant at Imprivata, has been a practicing ER doctor for over 20 years. 

Why did you decide to become an ER doctor?
Going through medical school, I really enjoyed different aspects of each core clerkship rotation I completed. I was actually a little worried that I wouldn’t be able to pick one because they were all so fun in their own way. 

I’m a person who enjoys thinking and acting quickly, as well as the surprise of what’s coming through the door, so I decided to do an ER rotation. The first day I walked in, I went up to the clerkship director to introduce myself. A patient needed chest compressions, so I started doing them in my first few seconds in the emergency department. The empowerment of being able to do something right away as a student, being able to act quickly but also under supervision, was really appealing to me. That set off my interest in emergency medicine. 

Being in the ER gave me the ability to always be a little surprised about what was coming in next and to be able to juggle multiple tasks at once. That was what appealed to me about emergency medicine and it’s what I still enjoy about it today. 

Is there a typical day in the ER room?
A typical day is almost always busy. There’s generally many different types of patients of many different ages with many different problems. It’s a mix of medical issues, traumatic incidents, social issues, and psychiatric issues. You see everything from sore throats, to GI distress, to strokes, to trauma, lacerations, and broken bones. 

The role requires multitasking and efficiency, but also the ability to quickly connect to people and understand what their concerns are and try to communicate as best as possible to understand. Another aspect of the role is coordinating care with a number of different consultants and deciding which patients need to be admitted to the hospital versus which ones can go home, or perhaps need to be discharged to other levels of care facilities.  

What role does technology play in the ER?
Technology is a large part of how we work in medicine and in the emergency department. It really is an incredible factor that can either help providers do their job faster and better, while providing safe and high quality care, or it can interfere and get in the way. Unfortunately, a lot of electronic medical records are designed in mind to help with billing and compliance, more so than actually improving patient care. 

Sometimes, providers find themselves fighting the technology a little bit as far as taking time to access their records and to do the work within the records. Usability factors don’t tend to be as high as they are in other industries, such as consumer. It’s ironic that we have some of the best technology, and then some of the worst and oldest technology side by side in our role in the emergency department.

But technology is constantly improving, and I think we as doctors and nurses, and from my role as a CMO on the healthcare tech side, should lead from within and really drive improvements in technology. When technology is done right, it’s usable, efficient, productive, and really does help with care. 

What technology do you use in your work?
One piece of technology that’s essential is quick access to medical records, like single sign-on technology. Good identity and access management allows me to tap in and access patient records, order things, and move to a different system if I need to. This is essential because it allows me to quickly do my job, and many of the healthcare conditions I see in the ER are time dependent, like heart attacks, strokes, and trauma. In those cases, it’s essential to very quickly access records and be able to act on them. 

I think patient communications and communication in general for healthcare is also important. Having good technology that allows me to collaborate with other clinicians and patients is essential. Many times, communications can be the key to providing effective care or not. 

How does AI currently support ER doctors?
I would say that AI is slowly coming of age. However, it’s really important for AI to work in the background, but it’s even more important for all of us that are clinically savvy that work in direct operations and patient care to understand what questions we want to ask data, what answers we want back, and what we’re going to do with it.

To me, AI can work in the background to find patterns human beings might not notice and can be incredibly effective if you feed it the right data and ask it the right questions. The places where I think AI is becoming more helpful are things like imagery and predictive analytics. 

The other thing is that AI has to be actionable. A really good predictive analytics and AI system working in the background is great, but if I never see that data or if it doesn’t come to me at a point where I’m making a decision in my clinical decision support or somewhere in that care pathway, it’s not going to do any good for me or my patients. 

The best AI takes a focused approach in certain high-yield cases that are evidence-based, and is served up to me in the electronic record or in the clinical decision support, where it can present me an opportunity to act on.

What cybersecurity concerns do you have?
Cybersecurity is becoming more and more of a concern everyday. I think that traditionally, the healthcare industry has thought about cybersecurity incorrectly. It’s always been a choice of either making something more secure, and compliant, and audible, or making it more open and usable. I don’t think it has to be that way, where you’re forced to choose between one or the other. The more cyber secure and compliant solutions also need to be more usable and make the provider more efficient and productive. 

Things like a good digital identity framework and maturity can lead to identity and access management systems using technology like biometrics and multifactor authentication. Basically, every endpoint for every digital front door is essentially locked, but easily accessible with multiple factors of authentication that are served up according to the workflow in hand. 

When you’re employing modern technology, those access points can be locked down and safe so only the right person can get into it for the right use case for the right time at the right level of security. There really needs to be a zero trust philosophy when it comes to cybersecurity, because breaches are happening on a daily and hourly basis and you can’t just put a firewall around the four walls of a hospital. 

We live in such a borderless environment for healthcare that digital care is extending everywhere, and the only way to solve it is to use digital identity as the new control plane and really lock down all those endpoints.

How do you see technology helping your role to evolve in the future?
I’m personally a big fan of adopting any type of technology as a means to the ends of providing the highest level of patient care. And I fully believe that the digital evolution will continue in healthcare. 
Part of care can be in-person and part of it potentially is digital, and more and more of it will be digital through the years as technology improves and particularly as we went through the COVID pandemic we learned that we could adopt lots of these things like virtual health and telehealth. 

I think we’re going to see increasing digital maturity and continued adoption of virtual health so that digital platforms become more and more prevalent. 


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