In 1991, in an effort to create state-of-the-art departments, a non-profit multi-hospital network in the Los Angeles area attempted to develop service standards for its EDs that would clearly distinguish them from their competitors. The Medical Directors and Nurse Managers of these departments met over ensuing months, but it quickly became clear that none of the EDs had the information to even begin assessing their performance in any meaningful way. This dearth of information, along with a refocusing by management on managed care programs and a concomitant series of fiscal setbacks, resulted in the discontinuation of the ED "center of excellence" project.

Despite the abandonment of the project by the hospital system, one of the EDs in the system, San Gabriel Valley Medical Center, began the unilateral development of the project. Specifically, an endeavor was initiated to develop a software program that would allow the capture of comprehensive data from the ED medical record. In the process of performing the systems analysis required to develop the software, it became very clear that many additional tangible benefits would be derived for multiple parties if the software could be successfully created and implemented. It also became clear that charge capture, as traditionally performed by nurses, was fundamentally problematic.

An audit of 1,700 consecutive ED records indicated that, on average, the nurses missed $19 per chart in drug and supply charges. Based on this knowledge, the hospital agreed to abandon nurse charge capture and outsourced the task to the ED physician group through use of the EDITS software. In the year after implementation of the program, the hospital netted approximately $200,000 in additional revenue without any increase in patient volume. The cost to the hospital for the process totaled approximately $40,000, providing a 500% return on their investment. Recent similar audits at over 20 hospitals nationwide have demonstrated average losses per chart of $25-$30 each.

Since April of 1993, San Gabriel Valley Medical Center has had comprehensive data from over 100,000 patients entered into EDITS Data. The system became commercially available in a limited manner in 1995; however, only in the past few years has there been any formal attempt to license the system to other hospitals or emergency physician groups. Currently, EDITS software is being used in over 50 emergency departments.

The EDITS software programs have been developed by the CQ Systems division of The Center for Medical Education, Inc. (CME) of Sierra Madre, California. The Center for Medical Education is believed to be the second largest provider of continuing medical education in the field of emergency medicine, following the American College of Emergency Physicians. The Center has been in existence since 1977 and produces three publications - Emergency Medical Abstracts (subscribed to by over 4,000 emergency physicians), and Primary Care Medical Abstracts. In addition, CME has conducted more than 250 courses in emergency medicine and primary care, which have been attended by more than 23,000 physicians. Each year CME client-physicians earn more than 80,000 Category 1 continuing education credits. CME, with its principal office in the greater Philadelphia area, is debt-free and consistently profitable, and has the economic resources to successfully implement and support the installation and maintenance of EDITS programs.

One of the components of CME's two physician publications is a software program distributed monthly to several thousand subscribers that includes an abstracts database, a sophisticated search engine, a self-study continuing medical education module and a variety of supporting utilities. The development of this highly successful commercial software program by Knight Systems Software of Santa Monica, California, was the precipitant of a long-standing relationship between CME and Knight Systems that has resulted in multiple collaborations culminating in the development of the three EDITS software programs, EDITS Data, EDITS Scan and EDITS Chart.