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Doing More with Less in a Difficult Environment

Emergency medicine is a complex, information-intensive endeavor with a body of knowledge that is rapidly exceeding the ability for any single practitioner to keep track of all necessary variables. This process is further complicated when put in the context of treating patients while also tracking necessary operational information. Efforts to treat the 120 million patients per year with a shortage of certified emergency physicians1 in overcrowded emergency departments (EDs) has pushed the national emergency care system to the breaking point.2 Health information technology (HIT) promises to increase efficiencies in care, improve quality, and reduce costs in emergency care.

Rapid Expansion of ED Information System Implementation

With the passage of the American Recovery and Reinvestment Act (ARRA) in 2009, Congress made a $19 billion bet that the universal implementation of HIT (including computers, software, and network connections throughout the healthcare system) would improve the quality and efficiency of healthcare in the United States—the Health Information Technology for Economic and Clinical Health (HITECH) Act. In order to encourage hospitals and physicians to use electronic health record (EHR) systems, HITECH provides incentives to adopt and use a certified EHR in a meaningful way—meaningful use (MU). The incentives include extra Medicare and Medicaid payments in the first years. After 2016 penalties will begin to accrue. While not directly incentivized to adopt ED information systems, every ED in the United States is affected by this legislation. Hospitals continue to update or replace their EHR and community physicians continue to demand better communication with the ED. This chapter discusses the ED-specific components of the EHR known as the emergency department information system (EDIS) and the process of selecting and implementing an EDIS.

Chapter Outline and Learning Objectives

This chapter describes EHR systems and the EDIS, reflects on the implications of the HITECH Act, outlines the issues in selecting and implementing a system, and emphasizes the importance of continued support and evolution of the EDIS as part of the ED. In addition, this chapter describes the features of a fully realized EDIS, the considerations for selection of an EDIS, and pearls and pitfalls in implementation of an EDIS.

The goal of this chapter is to aid the reader to

  1. Define and describe an EDIS and its associated functionality

  2. Understand the role of the EDIS in meeting HITECH MU requirements

  3. Know the steps and issues in the selection and implementation of an EDIS

  4. Recognize the importance of integration of the EDIS into the larger health information infrastructure

  5. Become familiar with evolving uses and requirements for healthcare information systems


Extensive reports concerning decreased quality, excess costs, and avoidable errors demonstrate the need to adopt new tools and methods to manage healthcare processes and knowledge.3 Individual practitioners find themselves unable to keep track of ...

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