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Technology and specifically comprehensive electronic health record (EHR) systems are transforming processes and practices in the emergency department (ED). It is critical that nurse and physician directors are as knowledgeable about informatics, EHR regulations, and have the requisite knowledge and skills to understand EHR design implementation and maintenance of their systems and the clinical content. The goal of Section 5 “Operations—Informatics” is to provide ED leaders with the clinical resources and skills necessary to understand, operationalize, and measure the success of information technology implementation in the ED.

Case: As the ED medical director and the ED nurse manager, you are invited to a briefing with the hospital administrative team regarding the comprehensive EHR selected for use hospital-wide. The plan is for the system to roll out in the ED within the next 6 months in order to meet federal “meaningful use” mandates. The hospital executive team has made the project a priority. The EHR vendor promises that the ED will become “paperless” and that patient information will seamlessly integrate with inpatient services. They also promise patient safety will be enhanced by sophisticated computerized physician order entry (CPOE) and computerized clinical decision support (CCDS) applications.

As you listen to the presentation, you ponder the impact of the EHR on the ED team and patients. Your questions and concerns can be summarized as follows.

Project Management and Leadership

  • Who is the resource and who has the expertise within the physician group to support this transition?
  • With ED staffing in the 25th percentile, how will you involve nurses and other support staff?
  • Who will help you keep track of all of the project management activities, issues, and risks?
  • What will be the impact of the use of the EHR on staff productivity?
  • How can the information and reporting tools produced by the EHR improve the management of processes, patient quality, and service utilization?

Adoption, Change Management

  • How will the ED concerns and priorities be integrated into an enterprise EHR? Specifically workflows, clinical content, reports, and so on.
  • The physicians and nurses have a diversity of ages and computer expertise.
  • Does the EHR have a high degree of usability? How will the new system be configured to enhance usability, rather than increase the potential for errors?
  • There is a significant degree of physician and nurse practice variability, but the implementation of the system requires process standardization. How will you engage all the stakeholders and obtain agreement or consensus?
  • The nursing turnover remains in the double digits. How will training be delivered and how can you ensure that staff is proficient in the use of the new EHR?
  • What staff or processes will be needed to manage and update the clinical content?

Operational Impact

  • How will the EHR work within the design of the current ED?
  • What devices ...

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