Minimal impact of an electronic medical records system.

BACKGROUND Electronic medical records (EMRs) implementation in hospitals and emergency departments (EDs) is becoming increasingly more common. The purpose of this study was to determine the impact of an EMR system on patient-related factors that correlate to ED workflow efficiency. METHODS A retrospective chart review assessed monthly census reports of all patients who registered and were treated to disposition during conversion from paper charts to an EMR system. The primary outcome measurement was an analysis of the time of registration to discharge or total ED length of stay as well as rate of those who left without being seen, eloped, or left against medical advice. These data were recorded from 3 periods, for 18 months: before installation of the EMR system (pre-EMR), during acclimation to the EMR, and post acclimation (post-EMR). RESULTS A total of 61626 individual patient records were collected and analyzed. The total ED length of stay across all patient subtypes was not significantly affected by the installation of the hospital-wide EMR system (P = .481); however, a significant decrease was found for patients who were admitted to the hospital from the ED (P < .00001). The percentage of patients who left without being seen between the pre-EMR and post-EMR periods was 1.8% and 2.7%, respectively, representing a significant increase (P < .0001). The number of patients who left against medical advice did not change across the periods of the present investigation (P > .25). CONCLUSIONS Installation of a hospital-wide EMR system had minimal impact on workflow efficiency parameters in an ED.

[1]  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.

[2]  Steven R. Offerman,et al.  Applying Lean: Implementation of a Rapid Triage and Treatment System , 2011, The western journal of emergency medicine.

[3]  D. Jerrard,et al.  How Long Are Patients Willing to Wait in the Emergency Department Before Leaving Without Being Seen? , 2012, The western journal of emergency medicine.

[4]  Paula H. Mayer,et al.  Impact on Length of Stay After Introduction of Emergency Department Information System , 2010, The western journal of emergency medicine.

[5]  U. S. Centers for Medicare Medicaid Services,et al.  Centers for Medicare & Medicaid Services (CMS) , 2013 .

[6]  C. Lindsell,et al.  Transient and sustained changes in operational performance, patient evaluation, and medication administration during electronic health record implementation in the emergency department. , 2014, Annals of emergency medicine.

[7]  Madhu C. Reddy,et al.  Peripheral Activities during EMR Use in Emergency Care: A Case Study , 2009, AMIA.

[8]  E. Kulstad,et al.  Occupancy Rates and Emergency Department Work Index Scores Correlate with Leaving Without Being Seen , 2010, The western journal of emergency medicine.

[9]  D. Handel,et al.  Implementing electronic health records in the emergency department. , 2010, The Journal of emergency medicine.

[10]  Sun Young Park,et al.  The effects of EMR deployment on doctors' work practices: A qualitative study in the emergency department of a teaching hospital , 2012, Int. J. Medical Informatics.