Crossover Study

Recording information in emergency departments (EDs) constitutes a major obstacle to efficient treatment. A new electronic medical records (EMR) system focusing on clinical documentation was developed to accelerate patient flow. The aim of this study was to examine the impact of a new EMR system on ED length of stay and physician satisfaction. We integrated a new EMR system at a hospital already using a standard system. A crossover design was adopted whereby residents were randomized into 2 groups. Group A used the existing EMR system first, followed by the newly developed system, for 2 weeks each. Group B followed the opposite sequence. The time required to provide overall medical care, length of stay in ED, and degree of physician satisfaction were compared between the 2 EMR systems. The study involved 6 residents and 526 patients (277 assessed using the standard system and 249 assessed with the new system). Mean time for clinical documentation decreased from 133.7 5.1 minutes to , MD, PhD, Susum D, PhD, gi, MD, PhD reduced the length of stay in ED for triage level 2 (emergency) patients (145.4 13.6 minutes vs 184.3 13.6 minutes for standard system; P1⁄4 0.047). As for the degree of physician satisfaction, there was a high degree of satisfaction in terms of the physical findings support system and the ability to capture images and enter negative findings. The new EMR system shortened the time for overall medical care and was associated with a high degree of resident satisfaction. (Medicine 94(26):e856) Abbreviations: ED = emergency department, EMR = electronic

[1]  R FORD,et al.  Medical malpractice. , 1950, The New England journal of medicine.

[2]  Anne F. Kittler,et al.  A cost-benefit analysis of electronic medical records in primary care. , 2003, The American journal of medicine.

[3]  D. Fatovich,et al.  Entry overload, emergency department overcrowding, and ambulance bypass , 2003, Emergency medicine journal : EMJ.

[4]  G. Innes,et al.  Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (Version 1.0). , 2003, CJEM.

[5]  Gilles Reinhardt,et al.  Analysis of factors influencing length of stay in the emergency department. , 2003, CJEM.

[6]  Marian Vermeulen,et al.  Emergency department crowding and thrombolysis delays in acute myocardial infarction. , 2004, Annals of emergency medicine.

[7]  James M. Walker,et al.  Electronic medical records and health care transformation. , 2005, Health affairs.

[8]  Kenneth Bond,et al.  Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey. , 2006, Healthcare quarterly.

[9]  Kaija Saranto,et al.  Definition, structure, content, use and impacts of electronic health records: A review of the research literature , 2008, Int. J. Medical Informatics.

[10]  B. Middel.  The impact of electronic health records on time efficiency of physicians and nurses: a systematic review1) , 2008 .

[11]  Michael J Bullard,et al.  Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List version 1.1. , 2008, CJEM.

[12]  Hideo Yasunaga,et al.  Computerizing medical records in Japan , 2008, Int. J. Medical Informatics.

[13]  G. Cattermole,et al.  Rosenʼs emergency medicine: concepts and clinical practice , 2010 .

[14]  Shingo Hori,et al.  Emergency medicine in Japan. , 2010, The Keio journal of medicine.

[15]  Shunsuke Doi,et al.  Japanese EMRs and IT in Medicine: Expansion, Integration, and Reuse of Data , 2011, Healthcare informatics research.

[16]  Jesse M Pines,et al.  The association between length of emergency department boarding and mortality. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[17]  Yan Sun,et al.  Real-time prediction of waiting time in the emergency department, using quantile regression. , 2012, Annals of emergency medicine.

[18]  P. Stergiannis,et al.  The Impact of ED Boarding Time, Severity of Illness, and Discharge Destination on Outcomes of Critically Ill ED Patients , 2012, Advanced emergency nursing journal.

[19]  A. Wai.  Tintinalli’s emergency medicine: a comprehensive study guide 7th ed. , 2012 .

[20]  I. Stiell,et al.  Assessment of the impact on time to complete medical record using an electronic medical record versus a paper record on emergency department patients: a study , 2013, Emergency Medicine Journal.

[21]  Chunhua Weng,et al.  Methods and dimensions of electronic health record data quality assessment: enabling reuse for clinical research , 2013, J. Am. Medical Informatics Assoc..

[22]  Andrew Georgiou,et al.  The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature. , 2013, Annals of emergency medicine.

[23]  Yuichi Yoshida,et al.  The trends in EMR and CPOE adoption in Japan under the national strategy , 2013, Int. J. Medical Informatics.

[24]  Takahiro Hiruma,et al.  Development of information systems and clinical decision support systems for emergency departments: a long road ahead for Japan , 2013, Emergency Medicine Journal.

[25]  M. Bullard,et al.  Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines. , 2014, CJEM.

[26]  A. Ciampi,et al.  Increases in emergency department occupancy are associated with adverse 30-day outcomes. , 2014, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[27]  Hajime Sato,et al.  Motivations and barriers to implementing electronic health records and ED information systems in Japan. , 2014, The American journal of emergency medicine.