Juno Emergency Services Solution Allows ERs to Handle Wave of COVID-19 Patients

Len Strickland, Senior Product Line Manager for DSS, Inc. (DSS), spent the first half of his career in emergency departments and trauma centers as a staff nurse and then director. At DSS, he manages the Juno Emergency Services Solution (JESS) offering.

JESS delivers innovative solutions to clinical decision-makers through real-time comprehensive nurse and physician documentation. In addition, the software provides medical content aimed at reducing errors, mitigating risk and improving overall patient outcomes in the emergency room.

Recently JESS was updated to help address the COVID-19 pandemic. The following conversation has been edited for length.

Q: Could you describe the type of patient information emergency department workers require to do their jobs?

While first responders are generally understood to be police, fire and rescue personnel, emergency department nurses and doctors could be considered first responders as well. Many patients walk directly into emergency departments and personnel there see them first. Emergency workers see all kinds of patients and must quickly ascertain their problem and the best course of action.

The less obvious the medical distress of the patient, the more information emergency workers need to glean to determine treatment. It’s a highly trained skill to quickly narrow down to the important factors. For example, workers today need to rapidly determine whether there had been possible COVID-19 exposure, which would require isolation while a sprained ankle may not. Since COVID-19 symptoms don’t present right away and people can spread the virus without having any symptoms, everyone needs to change their behavior to protect others even when they believe they are not infected.

Emergency nurses and physicians see patients of all ages and problems. The triage assessment needs to be conducted within a few minutes, if not immediately, of the patient’s arrival in the emergency department. The primary purpose of triage is to prioritize and identify those patients who have an immediate need and to get the emergency care process started based on those findings. 

Q: Can you please describe the recent JESS updates?

JESS recently updated the Infectious Disease content so that all patients can be assessed for potential COVID-19 exposure or infection. Triage begins the assessment of what resources the patient needs and how quickly they need them while in the emergency department, usually done by a triage nurse.

Rapid decisions made at triage can literally mean the difference between life and death. The nurse determines the next care level needed by the patient. For trauma patients determining the mechanism of injury is critical – was the patient in a 15-mph car accident or a 115-mph accident? These answers get documented via questions presented by the system for the nurse to ask. Then JESS can guide the proper medical decision through clinical decision support, putting huge amounts of medical data at the fingertips of care givers.

Q: How do these new capabilities help fight the spread of COVID-19?

In response to the pandemic new questions have been built into JESS – does the patient have a cough, trouble breathing, has traveled recently etc.? Based on the triage assessment findings, the JESS Clinical Decision Support tool proactively alerts the triage nurse of the potential risk. 

If the patient has been identified as a potential risk based on the assessment guidelines for COVID-19, immediate measures can be made to isolate the patient for the protection of others in the department, including the clinical team.

All our customers are using the latest version of JESS with the COVID-19 updates. It has proven effective in triggering alerts for patients at-risk due to COVID-19 indicators.

Q: How can caregivers access these new functionalities?

JESS was designed by emergency medical professionals with an understanding of emergency department workflows. So for the caregiver gathering the infectious disease risks of a patient is as easy as documenting a patient’s temperature. Alerts are strategically placed in the workflow for both nurses and physicians so that they are not missed, the appropriate care can be provided and testing can be ordered. 

Since JESS was designed around the unique flow of emergency rooms, emergency personnel don’t have to “think” about how to use it. Workflows are unchanged and assessment content and alerts are presented directly to the clinician. An analogy is an upgrade of your bank’s ATM software. New functionality might occasionally be added – for example, the option of a receipt delivered by email - but you don’t have to relearn how to withdraw $60 because each step is familiar and clearly presented.

JESS is also designed perfectly to support urgent care centers, which have exploded in scope in recent years.

Q: How easy is it for facilities to acquire this advanced software?

I can answer that in two ways – how a facility can acquire JESS initially and then how the information is constantly updated. For a facility to implement JESS in its emergency department only takes between 30-90 days. This is largely because JESS is cloud-based services as opposed to on-prem.

For the updates, new content versions of JESS are provided on a regular basis and takes less than five minutes. Content is created and tested by emergency clinical experts. Deployment is quick and seamless and without interruption to the customers.

Conceptually it’s much like updating the operating system of a smartphone over the air. So the information is constantly updated to take advantage of new information, which is especially vital when dealing with fast moving crises such as the COVID-19 pandemic.

Q: Is there anything else you would like to add? 

COVID-19 underscores the ever-changing nature of the healthcare environment. In such situations medical learnings increase daily, so the software that supports care needs to have the ability to rapidly adjust as well. And just as important as the updates are the ability to share them with care givers within familiar workflows, so providers don’t have to take time away from patients to learn new work processes.

Many emergency departments will be stretched to the limit in the weeks ahead, and those caregivers need the best support we can provide.