Main Points
Many of the nation’s hospital emergency departments are operating at critical capacity and are looking to advances in technology to improve patient care, increase patient safety, and improve efficiency and use of resources.
Electronic medical records are valuable in a medical emergency, because emergency physicians often don’t have access to patients’ medical histories.
ACEP is committed to the development of electronic medical records and health information technologies, such as a nationwide health information network to link all parts of the health care system.
ACEP sponsors education for emergency physicians about the latest technologies and advocates for a national, real-time disease surveillance system as an early warning system for biologic, chemical and nuclear agents.
Q. What steps are being taken to promote electronic medical records?
Q. What are the challenges to implementing electronic medical records?
- A survey of 3,000 hospitals found that most of the nation’s hospitals do NOT have electronic medical records (only 9 percent). (NEJM 2008)
—Fewer than 2 percent of hospitals have comprehensive electronic records in all units (NEJM 2008). The same survey found cost to be the single largest obstacle to adoption.
—Only about 17 percent of the nation’s physicians are using computerized patient records
- Cost, interoperability (different software platforms), usability and protecting patient privacy are significant challenges to adopting a system in the United States.
—The capital outlay required to purchase a system is considerable. Although the federal government estimates an annual savings of $140 billion through improved use of IT (DHHS and ONC, 2005), reimbursement in the emergency department is not always straightforward, making it challenging to determine ROI for EDIS.
—ERs are dependent on exchanging information with external departments such as the laboratory, radiology, admissions, inpatient wards, and outpatient offices, which often have disparate computer systems that are not interoperable. Improved standards will facilitate interoperability.
—Poor usability of some health IT systems can reduce the usefulness of an application in the emergency department and even turn a helpful one into a harmful one. More operations research regarding information systems specific to emergency care when compared to other interventions and settings could help address this problem.
—Health information technology (HIT) should facilitate the delivery of patient care, conform to relevant data interoperability standards, and comply with applicable privacy and security constructs to ensure the secure availability of relevant health care information.
Q. What are the benefits of technology in the emergency department?
New technologies are developing every day to improve patient care — from ensuring correct doses of medications to tracking pain levels in patients. By automating processes, the time a physician spends looking for charts, tracking down laboratory results, mobilizing staff, and repeatedly recording information that someone else already recorded can be dramatically reduced. Today’s Today’s emergency departments are working to speed the flow of patients through bottlenecks, eliminate redundant patient records, share complete medical records, and allow laboratory tests and films to be viewed instantly and simultaneously at multiple sites.
Computerized emergency care can also decrease health costs and increase revenues while improving care and efficiency. It also can help reduce legal liability through decreased documentation omissions and decreased labor costs found in electronic (not paper-based) systems. In addition, it can decrease the number of patients who leave without being seen when waiting times are too long, which also will increase hospital revenues as these patients continue to receive care throughout the hospital system.
Q. What is the future of technology in emergency medicine?
Experts say technology alone cannot be expected to solve all the problems of the health care system. However, its application has the potential to save lives and transform the practice of emergency medicine. The future will include:
- More portals into regional health information exchanges (HIEs); HIEs will begin to integrate with heath and emergency department information systems.
- Personal Health Records will become more popular and these will also integrate into the existing data, but likely as a secondary, less trusted source.
- Patient data entered through patient kiosks for registration (chief complaint, history of present illness, review of systems, family/social histories, medications, and allergies) will begin to be used.
- The American Recovery and Reinvestment Act of 2009 includes financial incentives for hospitals who use qualifying EHRs in a meaningful way as well as key provisions to advance the interoperability of systems over the next several months.
Q. What is the Frontlines of Medicine Project?
- Frontlines of Medicine is a collaborative effort among emergency medicine, public health, informatics, and other agencies to develop standardized methods of reporting emergency patient data across the United States. Standardized data will be effective in conducting syndromic surveillance, a public health priority because of the threat of terrorism. The Centers for Disease Control and Prevention has recommended the Frontlines of Medicine Project be fully integrated with the National Electronic Disease Surveillance System (NEDSS).
- ACEP’s Board of Directors in 2002 focused ACEP’s syndromic surveillance and health data communication standards efforts through this non-proprietary project.
Q. What is Project ER One?
ER One is a federally funded project to design an architectural prototype for the next-generation emergency department to respond to large-scale catastrophic events, including acts of biological and chemical terrorism. Developed at the Washington Hospital Center in the nation’s capita l, it’s a working laboratory for new approaches to the medical consequences of terrorist attacks, natural disasters, and emerging illnesses.
