Elsevier

Healthcare

Volume 2, Issue 3, September 2014, Pages 201-204
Healthcare

The impact of electronic health record implementation on emergency physician efficiency and patient throughput

https://doi.org/10.1016/j.hjdsi.2014.06.003Get rights and content

Abstract

Background: In emergency departments (EDs), the implementation of electronic health records (EHRs) has the potential to impact the rapid assessment and management of life threatening conditions. In order to quantify this impact, we studied the implementation of EHRs in the EDs of a two hospital system. Methods: using a prospective pre–post study design, patient processing metrics were collected for each ED physician at two hospitals for 7 months prior and 10 months post-EHR implementation. Metrics included median patient workup time, median length of stay, and the composite outcome indicator "processing time." Results: median processing time increased immediately post-implementation and then returned to, and surpassed, the baseline level over 10 months. Overall, we see significant decreases in processing time as the number of patients treated increases. Conclusions: implementation of new EHRs into the ED setting can be expected to cause an initial decrease in efficiency. With adaptation, efficiency should return to baseline levels and may eventually surpass them. Implications: while EDs can expect long term gains from the implementation of EHRs, they should be prepared for initial decreases in efficiency and take preparatory measures to avert adverse effects on the quality of patient care.

Introduction

Clinical care in the United States is being impacted by health information technology (HIT), particularly the implementation of electronic health records (EHRs). In 2005, a team of researchers at the RAND Corporation modeled the benefits to be realized by the health system after widespread adoption of health information technology (HIT).1 Included in those projections were $81 billion in annual savings and thousands of deaths averted each year. As part of the American Recovery and Reinvestment Act of 2009, the U.S. Federal Government mandated that all public and private healthcare providers will have implemented “meaningful use” of EHRs by 2014.2

This massive administrative restructuring of the healthcare sector has been expected to affect quality of care, provider and patient satisfaction, productivity, and cost of care. The newly accelerated uptake of HIT spurred by the Recovery and Reinvestment Act has led many to speculate we have reached a tipping point and the gains in reduced mortality, morbidity and expenditures are only a few years off.3 While there have been positive reports of some progress4, 5, many potential gains have remained elusive despite greatly increased uptake of HIT.6, 7, 8, 9 Recent work has highlighted an important discrepancy between the current state of progress and the underlying assumptions of the RAND model: the existence of interconnected and interoperable systems, widely adopted and used effectively.1, 10

Nowhere is it more important to understand the effects of these widespread changes than in the Emergency Department (ED), where patient outcomes hinge on rapid assessment and care. The ED is a high patient volume area within health systems that operates under constant time pressure. Unlike general ambulatory care, where HIT implementation has been studied11, 12, 13, in the ED patients must be quickly and efficiently triaged, stabilized, treated and processed for admission or discharge. HIT has the potential to either disrupt or improve the processes of clinical care, with serious implications for patient outcomes and quality of care.

To date, the impact of HIT changes in the ED setting has been poorly studied. Our aim was to address this gap by studying the effects of introducing HIT into the operations of two busy EDs. Informed by previous work looking at HIT and efficiency in the inpatient setting,14 our driving hypothesis was that the implementation of an EHR in the ED would adversely impact physician efficiency, as measured by physician-patient throughput time.

Section snippets

Study setting and population

We conducted a quasi-experimental, pre and post-intervention study. Data were collected for seven months prior to the intervention and 10 months post-intervention. Our study sites were the EDs in two suburban hospitals. Both hospitals are community hospitals and not referral or trauma centers. SITE A has an overall volume of 60,000 annual visits. It has both adult and pediatric EDs, with 80% of the visits for adults and 20% for children. Twenty-seven percent of adult patients are admitted,

Results

In total, 34 physicians were involved at the two hospitals during the full study period. Median processing times, combined from both sites, increase immediately after implementation and then slowly return to the baseline level, eventually dropping below the initial starting point of August, 2012 (Fig. 1, Fig. 2). Of note, due to the smaller sample, there was larger data variance at Site B than at Site A. In the two months after implementation, processing times increase by an average of 8% (p

Discussion

We have found that implementation of new EHRs in the ED setting at two hospitals was associated with an initial decrease in physician efficiency as indicated by processing time. With physician adaptation, efficiency returned to baseline levels and ultimately surpassed them. While EDs can potentially expect long-term gains from the implementation of EHRs, they should take measures to ensure the initial decreases in efficiency do not affect the quality of patient care. In our study, an additional

Author contributions

NR contributed to the drafting of the manuscript. DA and FB contributed to the data collection and analysis. BG, EW, LP and JMH all contributed to the study design, hypothesis development, implementation and oversight. All authors contributed to the text and revision of the manuscript.

References (21)

There are more references available in the full text version of this article.

Cited by (9)

  • Improving emergency care through a dedicated redesigned obstetrics and gynecology emergency unit at the Women's Hospital, Doha, Qatar

    2022, AJOG Global Reports
    Citation Excerpt :

    This positive impact was observed from availability of history, ordering investigations and review of results, drug ordering, admission, inpatient care to discharge. Furthermore, there was an improved turnaround time for all investigations and results as these could be ordered and reviewed on the electronic system with priority given to emergency cases.27 The improvement project started in 2012 transformed the quality of the services provided.

  • Health information technology and hospital performance the role of health information quality in teaching hospitals

    2020, Heliyon
    Citation Excerpt :

    In the banking and aviation industry, human errors are reduced through effective use of IT (Turan and Palvia, 2014), and, in the same way, medical errors are reduced using HIT (Balicer and Cohen-Stavi, 2020; El-Kareh et al., 2013; Rodziewicz and Hipskind, 2019). If there is available electronic access to complete a patient's health information, this will reduce medical errors that occur because of gaps in knowledge about issues like allergies, relevant medication and laboratory information, past medical history, and poor communication among providers (Risko et al., 2014; Rodziewicz and Hipskind, 2019; Wears, 2015). Health Information Technology (HIT) systems, like automated decision making and knowledge acquisition support tools, can bring electronic patient information (health information) that can be effectively used by health care practitioners, thereby reducing errors of omission due to gaps in provider's knowledge and failure to use that knowledge in health care practice.

View all citing articles on Scopus
View full text