Improving diagnostic accuracy using EHR in emergency departments: A simulation-based study

Abstract

It is widely believed that Electronic Health Records (EHR) improve medical decision-making by enabling medical staff to access medical information stored in the system. It remains unclear, however, whether EHR indeed fulfills this claim under the severe time constraints of Emergency Departments (EDs). We assessed whether accessing EHR in an ED actually improves decision-making by clinicians. A simulated ED environment was created at the Israel Center for Medical Simulation (MSR). Four different actors were trained to simulate four specific complaints and behavior and 'consulted' 26 volunteer ED physicians. Each physician treated half of the cases (randomly) with access to EHR, and their medical decisions were compared to those where the physicians had no access to EHR. Comparison of diagnostic accuracy with and without access showed that accessing the EHR led to an increase in the quality of the clinical decisions. Physicians accessing EHR were more highly informed and thus made more accurate decisions. The percentage of correct diagnoses was higher and these physicians were more confident in their diagnoses and made their decisions faster.

Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments

“…One solution implemented for research purposes is a simulated ED in which ED physicians are asked to use the EHR system in a set of typical cases. One such study has shown that using EHR reduces diagnosis mistakes, saves time and increases physicians' confidence level [82].…”

“…System use was more frequent on crowded days. Ben-Assuli et al [82] Track-log file database analysis Viewing medical history via EHR and using an HIE system was associated with a reduction in single-day admissions and the rate of readmission within seven days. Overhage et al [104] Randomized controlled trial No effect of using an electronic patient records system on admission rate or repeat visits was found.…”

Towards routine use of national electronic health records in Australian emergency departments

“…• Improved decision making 13 • Improved workflow 14,15 • Improved sourcing and documenting of a patient's history 3,16…”

“…1,3, 11,13,16 It has been documented that the transition of care across multiple health care providers can be better coordinated through EHR use. 14,25 EHR clinician use is particularly motivated by repeat and complex patients who present to the ED. 25 Therefore, a single sign-on to My Health Record from the ED clinical information system was considered a critical success factor for use.…”

A Natural Language Processing Approach to Automated Highlighting of New Information in Clinical Notes

“…Almost all the medical complaints, diagnoses, processes of clinical care, laboratory results, and medication use from various departments of most domestic hospitals are readily available from EMRs. The immediate accessibility of patient information is likely to help healthcare professionals improve patient care delivery and enhance the quality of medical decision-making [3,4]. Moreover, the development of integrated clinical decision support systems and EMRs has achieved substantial success in reducing medical errors and improving patient safety [5].…”