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Emergency Department Information Systems
Katie Marie BoubelColumbia Southern University
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Emergency departments (EDs) are unique to hospitals and are designed to handle patients in life-threatening situations (Davis & LaCour, 2014). Emergency department employees deal with and treat numerous types of patients, situations, and illnesses daily, so it is crucial to have information systems to fit the needs of this hectic, fast-paced environment. Emergency departments are featured in every hospital, and chances are, you’ve visited one some time in your life. When working in an emergency department, it is important to gain knowledge of the information systems you will encounter.
Many hospitals are beginning to recognize that an emergency department information system (EDIS) installed in their emergency room can be a primary strategy to meet Meaningful Use standards and can serve as a launching point for other departments in the hospital (Grossjung, 2012). An EDIS is used when a patient presents to an emergency department to capture key information including patient identity (unique identifier generated or existing in the system) such as date of birth, address, occupation, next of kin, insurance status (Medicare or Private), admission time, mode of arrival (e.g. ambulance, private transport), treating medical professional (e.g. doctor or nurse), primary diagnosis, outcome (i.e. admitted to hospital or discharged), discharge, and departure date (Office of the Auditor General, 2013). This information system is unique to the emergency department and provides health care workers and providers in the department with the tools and resources they need to successfully treat the large intake of patients they see daily.
The Data Elements for Emergency Department Systems (DEEDS) is a uniform data set created by the National Center for Injury Prevention and Control (NCIPC) and Centers for Disease Control and Prevention (CDC) and was released in January 1997. The DEEDS Release
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1.0 was the starting point of this coding and data set. Over time, it has continued to improve, expand, and develop to support the growing needs of the emergency department and advances in information technology. DEEDS is divided into eight sections and contains 156 data elements. This data set supports the uniform collection of data in hospital-based emergency departments to improve the continuity among emergency room records (Davis ; LaCour, 2014). It incorporates national standards for electronic data interchange (EDI), which allows diverse computer systems to exchange information (Davis ; LaCour, 2014). Since time can often be limited in the emergency department, speedy data exchange is a must. The Data Elements for Emergency Department Systems data set supports this need and helps maintain and improve the record system in the emergency department. There are different variations of ways information can be entered into this system, depending on facility. Communication between departments and facilities is important in any hospital, so DEEDS is useful when health care providers need to transfer findings to public health agencies or other departments in the hospital.
The Essential Medical Data Set (EMDS) offers many features that are very beneficial to the emergency department’s fast-paced environment by providing/creating a medical health history for every patient. The EMDS was developed by the National Information Infrastructure Health Information Network Program (NII-HIN). This data set was created to enhance the flow and effectiveness of emergency care and designed to work with the Data Elements for Emergency Department Systems (DEEDS). Since the Essential Medical Data Set (EMDS) complements the Data Elements for Emergency Department System and can provide medical history data on each patient, it improves the overall effectiveness of health care provided to patients in the emergency department (Davis & LaCour, 2014).
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Emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records and contribute to them in numerous ways (Farley et al, 2013). The electronic health records that are marketed and sold to hospitals and providers are all certified for use by the Certification Commission for Heath Information Technology (Farley et al, 2013). Its system function varies and affects physician decision-making, clinician workflow, communication, and, the overall quality of care and patient safety in the emergency room (Farley et al, 2013). Emergency department information systems are a crucial component in a great movement toward improving quality and outcomes with electronic health records (Farley et al, 2013). The perceived advantages of electronic health records, including EDISs, are so significant that Congress allocated nearly $30 billion to build incentive for their universal adoption through the American Recovery and Reinvestment Act (Farley et al, 2013). One interesting feature of emergency department information systems is that they link to other health information systems used in hospitals such as PAS, TOPAS and MediTech, which are patient administration systems (Office of Auditor General, 2013). Together, these systems record each patient’s unique demographics and all patient contacts with the hospital, both outpatient and inpatient (Office of Auditor General, 2013).
There are many factors that cause hospitals and other health facilities to use multiple information systems. These factors depend on the type of facility, the amount of patient intake, funds, and other circumstances and considerations. Some providers use a single electronic health record system, while others can use multiple. These strategies create a mixture of advantages, risks and costs (Payne et al, 2012). A patient that is cared for in the ambulatory and inpatient setting of a health care organization can have electronic record data that is functionally spread
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across more than one electronic medical record (EMR) system, which means practitioners will require access to content or functionality from more than one EMR while delivering care (Payne, Fellner, Dugowson, Liebovitz, & Fletcher, 2012). In a hospital, the laboratory, registration, radiology, and emergency department, among others, will require different types of information systems to suit their specific needs. Different clinics or hospital areas may use electronic health or medical records that are tailored to their specific clinical practice as well (Payne et el, 2012). Affiliated private practice groups may choose an alternative electronic medical record system that, in their opinion, best supports their office-based practices (Payne et al, 2012). Information systems may also be changed or upgraded over time to adapt to higher patient intake and workflow in different areas of a facility. Using more than a single information system in one organization or facility can also be related to the broader topic of information exchange among different healthcare organizations, such as between several hospitals in the same community (Payne et al, 2012). There are many challenges when a facility or health administration uses more than one information system. These challenges include, mitigating risk to patient safety, ease of viewing the patient’s record by health providers and administration, user ability to master multiple information system functionalities and workflows, and institutional costs (Payne et al, 2012).
Emergency departments (Eds) usually fall into one of three workflow categories. There are paper-based emergency departments where clinicians first become aware of new patients from a paper chart being placed in a rack, semi paper-based emergency departments where clinicians first become aware of new patients via an electronic tracking monitor that is linked to their registration system, and fully-electronic emergency departments with an ED information
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system (EDIS) that includes a tracking system (Friedmann, Shapiro, Kannry, Kuperman, 2006). Speedy communication and cooperation among clinicians, administrative staff members, and personnel in other parts of the hospital are needed when it comes to transferring and moving necessary clinical and health administrative data (Raths, 2009). With the increasing amount of uninsured individuals in the United States, the workflow of the emergency department has also increased. Health information systems and specialized emergency department information systems (EDIS) have grown more sophisticated to suit this need and many hospitals are replacing the white boards and paper charts with automated tracking systems and computer displays to speed up patient intake (Raths, 2009). Some systems not only give up-to-the-second information on patient status and location, but also track workflow measures such as time to triage, which emergency departments can use to provide feedback to clinicians if needed (Raths, 2009). Every second counts in the emergency department, so it is essential that every ED utilizes a workflow type that best suits their specific needs.
The emergency department is a fast-paced environment which includes rapid turnover, frequent transitions of care, constant interruptions, large variations in patient volumes, and unfamiliar patients (Farley et al, 2013). With these factors in mind, we can acknowledge that the ED can be prone to many errors in health information collection. Emergency department information system technology is constantly evolving and vendors are adapting to meet new demands by clinicians, health care administrators, the government, and active engagement by front-line clinicians in hopes of improving their function and overall quality (Farley et al, 2013). In addition to enhancing care and the communication about that care, health care providers are
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consistently looking to their EDIS to improve overall emergency department efficiency (Great expectations abound for EDIS, 2011).
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Davis, N., LaCour, M. (2014). Health Information Technology: 3rd Edition. St. Louis, MO: Elsevier/Saunders.
Farley, H. L., Baumlin, K. M., Hamedani, A. G., Cheung, D. S., Edwards, M. R., Fuller, D. C., Pines, J. M. (2013, October). Quality and Safety Implications of Emergency Department Information Systems. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880777/
Friedmann, B. E., Shapiro, J. S., Kannry, J., ; Kuperman, G. (2006). Analyzing Workflow in Emergency Departments to Prepare for Health Information Exchange. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839334/
Great expectations abound for EDIS. (2011). Health Management Technology, 32(12), 15.
Grossjung, T. (2012, September). Emergency Department Information System Plays Important Role in Meeting Meaningful Use Criteria. Retrieved from http://www.veedis.com/article-2012-09.php
Office of the Auditor General. (2013, June 27). Emergency Department Information System – Department of Health. Retrieved from https://audit.wa.gov.au/reports-and-publications/reports/information-systems-application-controls-audits/emergency-department-information-system-department-of-health/Payne, T., Fellner, J., Dugowson, C., Liebovitz, D., ; Fletcher, G. (2012). Use of more than one electronic medical record system within a single health care organization. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613036/
Raths, D. (2009, March 01). Information systems improve hospital emergency departments. Retrieved from http://www.kmworld.com/Articles/Editorial/Features/Information-systems-improve-hospital-emergency-departments-52779.aspx