Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

Kennebeck, Stephanie; Timm, Nathan; Farrell, Michael; Spooner, S. Andrew

doi:10.1136/amiajnl-2011-000462

Cited by 45 publications

(28 citation statements)

References 16 publications

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“…Our study also does not focus on the ramp-up period of EHR implementation as several studies have already well highlighted the disruption caused by the ramp-up period immediately following EHR adoption. 21,22 Our results have face validity, showing a disruption in operational measures immediately after introduction of EHR technology (Figures 1 and 2); however, our study focuses on the long-term performance across a series of operational measures of performance. Second, not all operational measures were available and this study is not a comprehensive assessment of the effect of EHRs on clinical care and delivery.…”

Section: Limitationsmentioning

confidence: 72%

“…Several groups have found that length of stay increased during ED EHR implementation with a return to baseline in the post-implementation ramp-up period. 21–23 Other studies have found conflicting results with reduced length of stay and improved efficiency. 1 However, these are single site studies at academic facilities limiting the generalizability of their findings.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Electronic Health Record Implementation on Community Emergency Department Operational Measures of Performance

Ward¹,

Landman²,

Case³

et al. 2014

Annals of Emergency Medicine

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Objective To study the effect of electronic health record (EHR) implementation on the operational metrics of a diverse group of community emergency departments (ED). Methods We performed a retrospective before/after analysis of 23 EDs from a single management group that experienced EHR implementation, defined as the date of implementation of electronic clinical documentation in the ED. We obtained electronic data for 4 length-of-stay (LOS) measures (arrival-to-provider, admitted, discharged and overall LOS) and 4 measures of operational characteristics (left-prior-to–treatment-complete, significant returns, overall patient satisfaction and provider efficiency). We compared the 6-month “baseline” period immediately prior to implementation with a “steady-state” period commencing 6 months after implementation for all 8 metrics. Results For the LOS measures, there were no differences in the arrival-to-provider interval (difference of −0.02 hours, 95% CI of difference −0.12, 0.08), admitted LOS (difference of 0.10 hours, 95% CI of difference −0.17, 0.37), discharged LOS (difference of 0.07 hours, 95% CI of difference −0.07, 0.22) and overall LOS (difference of 0.11 hours, −0.04, 0.27). For operational characteristics, there were no differences in the percentage who left-prior-to-treatment-complete (difference of 0.24%, 95% CI of difference −0.47%, 0.95%), significant returns (difference of −0.04%, 95% CI of difference −0.48%,0.39%), overall percentile patient satisfaction (difference of −0.02%, 95% CI of difference −2.35%, 2.30%) and provider efficiency (difference of −0.05 patients/hour, 95% CI of difference −0.11,0.02). Conclusions There is no meaningful difference in 8 measures of operational performance for community EDs experience EHR implementation between a baseline and steady state period.

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Section: Limitationsmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

The Effect of Electronic Health Record Implementation on Community Emergency Department Operational Measures of Performance

Ward¹,

Landman²,

Case³

et al. 2014

Annals of Emergency Medicine

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“…Clinical impact, however, depends on the setting. In the study of emergency department activity, the overall length of stay and time to see a doctor increased during EHR implementation by 5%–20% but returned to baseline within 3 months 81. Another emergency department study reported that average length of stay increased and patient satisfaction reduced transiently, returning to baseline by 8 weeks.…”

Section: Resultsmentioning

confidence: 99%

What to expect from electronic patient record system implementation: lessons learned from published evidence

Priestman

Sridharan

Vigne

et al. 2018

BMJ Health Care Inform

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BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.

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“…1 With every application implemented, there is TYPICALLY an associated username and password, OFTEN with a predetermined session inactivity timeout. 2 With every timeout or reactivation from a privacy mode screen saver, the end user is required to enter their associated application username and password. Care providers have become overwhelmed with the need to remember several user names and associated application passwords in order to perform patient care activities when interacting with the computer.…”

Section: Introductionmentioning

confidence: 99%

Examining user satisfaction with single sign-on and computer application roaming within emergency departments

Hope

Zhang

2015

Health Informatics J

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In an age where mandatory computer usage within clinical care settings is a non-negotiable term of employment, the amount of applications a provider must access to document care is rapidly increasing. Each application contains an associated username and password. The increasing frequency with which clinicians have to log in and out of different applications is a source of frustration for many healthcare professionals. Healthcare executives see lost productivity. Single sign-on with added computer application roaming capabilities on shared workstations is a viable solution for both the clinician and the organization. The aim of this study is to assess the effect of implementation of single sign-on technology with application roaming on shared workstations. This study focuses on the perception of satisfaction with the implementation of single sign-on technologies within a midsized integrated delivery health network's five emergency departments. We contribute to theory with the following: (1) the development of a construct called facilitated technology interruptions, (2) validation of the construct facilitated technology interruptions, and (3) application of a quantitative method to test the relationship between facilitated technology interruptions and user satisfaction. We surveyed five emergency departments and proposed five hypotheses. We found the positive relationship between facilitated technology interruptions and user satisfaction; the positive relationships between effort expectancy and satisfaction, and effort expectancy and willingness to recommend; and the positive relationship between satisfaction and willingness to recommend. We did not confirm the positive relationship between facilitated technology interruptions and willingness to recommend. We conclude that single sign-on technology increases user satisfaction. Other organizations may use the findings from this study and perform pre-single sign-on versus post-single sign-on evaluations. In practice, single sign-on improved productivity and ensured compliance with the Health Insurance Portability and Accountability Act, minimization of errors, and disruption for critical work.

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Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

Cited by 45 publications

References 16 publications

The Effect of Electronic Health Record Implementation on Community Emergency Department Operational Measures of Performance

The Effect of Electronic Health Record Implementation on Community Emergency Department Operational Measures of Performance

What to expect from electronic patient record system implementation: lessons learned from published evidence

Examining user satisfaction with single sign-on and computer application roaming within emergency departments

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