Emergency Department Information System Adoption in the United States

Emergency physician Adam Landman—a former corporate consultant with a background in information systems—is eager to re-enter the digital age.

He is tired of writing scripts, thumbing through paper records and trying to decipher his colleagues’ handwritten charts. And he is a strong believer in the power of technology to reduce waste, improve outcomes and save money in health care settings.

Landman, M.D., M.I.S., M.S., says technology could be especially effective in emergency departments, where electronic information systems could help physicians with patient flow, clinical decision-making, and learning about the often-complicated medical histories of patients they rarely know. This, in turn, can improve patient safety and hospital efficiency.

“I’ve ordered radiology and laboratory studies for patients even though they had the same test a week ago, because I couldn’t access the prior results,” he said. “And even when I’m able to track down the records, sometimes I can’t read the notes and they’re completely useless.”

The need for electronic medical records is a focus for many law- and policy-makers, but emergency departments have been largely left behind.

The American Recovery and Reinvestment Act—the economic stimulus law passed in 2009—included $40 billion to update health information technology systems in hospitals and physician offices, but made little specific mention of information systems at emergency departments or other specialty sites such as operating rooms or intensive care units.

Landman wants to change that.

Landman Says Emergency Departments Should Get Federal Technology Funding

A Robert Wood Johnson Foundation (RWJF) Clinical Scholar at Yale University (2008-2010), Landman and a team of researchers conducted a study of electronic information systems using data from 356 emergency departments across the country. The sample represents the nation’s more than 4,600 emergency departments.

He found that less than 2 percent of emergency departments have fully functional information systems that can be used to track patients. Emergency departments in urban areas and those that specialize in pediatric care were more likely than others to have implemented electronic information systems, he found.

More than half—or 54 percent—of emergency departments had no electronic information system in place.

The study was published in the May 2010 edition of Academic Emergency Medicine, the journal of the Society for Academic Emergency Medicine. Co-authors include: Steven L. Bernstein, M.D., faculty with the Clinical Scholars program at Yale; Allen Hsiao, M.D., chief medical information officer for the Yale-New Haven Health System; and Rani Desai, Ph.D., M.P.H., co-director of the Clinical Scholars program at Yale University.

Every year there are more than 119 million U.S. emergency department visits by patients of all ages and backgrounds. Patients across all sectors of society may therefore reap benefits from fully functional emergency department information systems, including fewer redundant tests and improved care coordination.

Landman also notes that introduction of new technology can result in unintended consequences, such as medication errors, information overload, or billing problems. That is why he says it is important to ensure that systems are properly designed and formally evaluated.

He hopes his study will inspire policy-makers to pay more attention to emergency departments and other specialty areas as they fine-tune health information technology policy. “It’s not too late,” Landman says. “Criteria for funding are still being deliberated, so there’s time to include emergency departments and other specialty areas in the funding.”