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, Jason S. Shapiro, Suzanne Stone-Griffith, Jesse M. Pines

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

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 functionality 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.

Original languageEnglish (US)
Pages (from-to)399-407
Number of pages9
JournalAnnals of emergency medicine
Volume62
Issue number4
DOIs
StatePublished - Oct 1 2013

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Information Systems
Hospital Emergency Service
Safety
Patient Safety
Electronic Health Records
American Recovery and Reinvestment Act
Communication
Data Display
Physicians
Informatics
Workflow
Quality of Health Care
Medicaid
Medicare
Quality Improvement
Fatigue
Motivation
Emergencies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Farley, H. L., Baumlin, K. M., Hamedani, A. G., Cheung, D. S., Edwards, M. R., Fuller, D. C., ... Pines, J. M. (2013). Quality and safety implications of emergency department information systems. Annals of emergency medicine, 62(4), 399-407. https://doi.org/10.1016/j.annemergmed.2013.05.019

Quality and safety implications of emergency department information systems. / Farley, Heather L.; Baumlin, Kevin M.; Hamedani, Azita G.; Cheung, Dickson S.; Edwards, Michael R.; Fuller, Drew C.; Genes, Nicholas; Griffey, Richard T.; Kelly, John J.; McClay, James C; Nielson, Jeff; Phelan, Michael P.; Shapiro, Jason S.; Stone-Griffith, Suzanne; Pines, Jesse M.

In: Annals of emergency medicine, Vol. 62, No. 4, 01.10.2013, p. 399-407.

Research output: Contribution to journalArticle

Farley, HL, Baumlin, KM, Hamedani, AG, Cheung, DS, Edwards, MR, Fuller, DC, Genes, N, Griffey, RT, Kelly, JJ, McClay, JC, Nielson, J, Phelan, MP, Shapiro, JS, Stone-Griffith, S & Pines, JM 2013, 'Quality and safety implications of emergency department information systems', Annals of emergency medicine, vol. 62, no. 4, pp. 399-407. https://doi.org/10.1016/j.annemergmed.2013.05.019
Farley HL, Baumlin KM, Hamedani AG, Cheung DS, Edwards MR, Fuller DC et al. Quality and safety implications of emergency department information systems. Annals of emergency medicine. 2013 Oct 1;62(4):399-407. https://doi.org/10.1016/j.annemergmed.2013.05.019
Farley, Heather L. ; Baumlin, Kevin M. ; Hamedani, Azita G. ; Cheung, Dickson S. ; Edwards, Michael R. ; Fuller, Drew C. ; Genes, Nicholas ; Griffey, Richard T. ; Kelly, John J. ; McClay, James C ; Nielson, Jeff ; Phelan, Michael P. ; Shapiro, Jason S. ; Stone-Griffith, Suzanne ; Pines, Jesse M. / Quality and safety implications of emergency department information systems. In: Annals of emergency medicine. 2013 ; Vol. 62, No. 4. pp. 399-407.
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