Quality and Safety Implications of Emergency Department Information Systems

Heather L. Farley, Kevin M. Baumlin, Azita G. Hamedani, Dickson S. Cheung, Michael R. Edwards, Drew C. Fuller, Nicholas Genes, Richard T. Griffey, John J. Kelly, James C. McClay, Jeff Nielson, Michael P. Phelan (+3 others)
2013 Annals of Emergency Medicine  
The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services "meaningful use" incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals' electronic health records. System
more » ... nctionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital's or physician group's approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order-wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system's ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or enterprise systems. [Ann Emerg Med. 2013;xx:xxx.] workflow, communication, and, ultimately, the overall quality of care and patient safety in a particularly challenging clinical environment (eg, high volume, time sensitive). However, the technology is constantly evolving and vendors are adapting to meet new demands by clinicians, health care administrators, and government, and as such, active engagement by front-line clinicians in improving these products is critical. Recently, studies have emerged in the literature examining the benefits and unintended consequences of these systems. [7] [8] [9] [10] [11] [12] The unique characteristics of EDs, including rapid turnover, frequent transitions of care, constant interruptions, 13 large variation in patient volumes, and unfamiliar patients, make the ED environment particularly error prone. These factors and Volume xx, . x : Month 
doi:10.1016/j.annemergmed.2013.05.019 pmid:23796627 pmcid:PMC3880777 fatcat:aw5jywxzljfcbdy4klixgt4hqq