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. 2014 Jun;63(6):723-30.
doi: 10.1016/j.annemergmed.2013.12.019. Epub 2014 Jan 10.

The effect of electronic health record implementation on community emergency department operational measures of performance

Michael J Ward  1 , Adam B Landman  2 , Karen Case  3 , Jessica Berthelot  3 , Randy L Pilgrim  3 , Jesse M Pines  4
Affiliations

The effect of electronic health record implementation on community emergency department operational measures of performance

Michael J Ward et al. Ann Emerg Med. 2014 Jun.

Abstract

Study objective: We study the effect of an emergency department (ED) electronic health record implementation on the operational metrics of a diverse group of community EDs.

Methods: We performed a retrospective before/after analysis of 23 EDs from a single management group that experienced ED electronic health record implementation (with the majority of electronic health records optimized specifically for ED use). We obtained electronic data for 4 length of stay measures (arrival to provider, admitted, discharged, and overall length of stay) and 4 measures of operational characteristics (left before treatment complete, significant returns, overall patient satisfaction, and provider efficiency). We compared the 6-month "baseline" period immediately before implementation with a "steady-state" period commencing 6 months after implementation for all 8 metrics.

Results: For the length of stay measures, there were no differences in the arrival-to-provider interval (difference of -0.02 hours; 95% confidence interval [CI] of difference -0.12 to 0.08), admitted length of stay (difference of 0.10 hours; 95% CI of difference -0.17 to 0.37), discharged length of stay (difference of 0.07 hours; 95% CI of difference -0.07 to 0.22), and overall length of stay (difference of 0.11 hours; 95% CI of difference -0.04 to 0.27). For operational characteristics, there were no differences in the percentage who left before treatment was complete (difference of 0.24%; 95% CI of difference -0.47% to 0.95%), significant returns (difference of -0.04%; 95% CI of difference -0.48% to 0.39%), overall percentile patient satisfaction (difference of -0.02%; 95% CI of difference -2.35% to 2.30%), and provider efficiency (difference of -0.05 patients/hour; 95% CI of difference -0.11 to 0.02).

Conclusion: There is no meaningful difference in 8 measures of operational performance for community EDs experiencing optimized ED electronic health record implementation between a baseline and steady-state period.

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Figures

Figure 1
Figure 1
Length of stay for door-to-provider, admitted, discharged and overall by month for one year before and one year after EHR implementation. The numbers along the x-axis represent the midpoint of each month's performance before (negative) and after (positive) implementation. The dashed line indicates the month of EHR implementation. Note: EHR, electronic health record.
Figure 2
Figure 2
Operational metrics relative to time (in months) from EHR implementation. The numbers along the x-axis represent the midpoint of each month's performance before (negative) and after (positive) implementation. The dashed line indicates the month of EHR implementation.
Figure 3
Figure 3
Standardized performance by facility before and after EHR implementation for 4 operational metrics. A positive value represents superior performance relative to the other facilities whereas a negative value represents inferior performance. For example, superior performance for length of stay would be a reduction in time, but for patient satisfaction would represent an increase is percent satisfied. Note: EHR, electronic health record.
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