Using Electronic Medical Record Systems for Admission Decisions in Emergency Departments: Examining the Crowdedness Effect

Abstract

Many medical organizations have deployed electronic medical record (EMR) information systems (IS) to improve medical decision-making and increase efficiency. Despite their advantages, however, EMR IS may make less of a contribution in the stressful environment of an emergency department (ED) that operates under tight time constraints. The high level of crowdedness in the EDs itself can cause physicians to make medical decisions resulting in more unnecessary admissions and fewer necessary admissions. Thus this study evaluated the contribution of an EMR IS to physicians by investigating whether EMR IS leads to improved medical outcomes in points of care in EDs under different levels of crowdedness. For this purpose a track log-file analysis of a database containing 3.2 million ED referrals in seven main hospitals in Israel (the whole population in these hospitals) was conducted. The findings suggest that viewing medical history via the EMR IS leads to better admission decisions, and reduces the number of possibly avoidable single-day admissions. Furthermore, although the ED can be very stressful especially on crowded days, physicians used EMR IS more on crowded days than on non-crowded days. These results have implications as regards the viability of EMR IS in complex, fast-paced environments.

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

“…In another study [18], a similar effect on single-day admissions was found, this time under changing levels of crowdedness.…”

“…The ED is a unique medical environment, and is characterized by a relatively high workload and cognitive load, tight time constraints and the lack of a prolonged doctor-patient relationship, thus making it stressful and challenging for the medical A c c e p t e d M a n u s c r i p t staff [18]. The implementation of any technology in the ED has great potential to impact ED efficiency and performance [80].…”

“…Of the various points of care available in the healthcare sector, the ED, more than any other, demands timely and efficient care, while being burdened by an overcrowded, stressful and challenging environment [18].…”

Health information exchange systems and length of stay in readmissions to a different hospital

“…An Israeli study on the effects of the use of the OFEK system on ED physicians' admission decisions found that the patient's medical history was viewed in only 31.2% of all 281,750 ED referrals . In another Israeli‐based ED study, even lower usage levels were found, with the OFEK system having been accessed in only 16% of all 3,219,910 ED referrals . Low levels of HIE use have also been reported in the United States.…”

The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses

“…We assumed that there are some single-day admissions that are uncalled for, and might be prevented if a proper medical history was available. Such scales and assumptions have been used in previous studies in the field [6,18-21]. The method of using subsets of several main differential diagnoses enabled us to compare more similar groups of patients.…”