Emergency Department Access to a Longitudinal Medical Record
Emergency Department Access to a Longitudinal Medical Record George Hripcsack, MD, MS, Soumitra Sengupta, PhD, Adam Wilcox, PhD, Robert Green, MD Journal of the American Medical Informatics Association Vol 14 Number 2 Mar/Apr 2007
This study is a report of information seeking behavior in The NewYork-Presbyterian Hospital/Columbia University Medical Center. The aim was to study the use of the MRS system WebCIS that was in use at the health system and available at the ED. Previous studies have shown that there are unmet information needs in the ED that could be met by an EHR.
The NewYork-Presbyterian Hospital/Columbia University Medical Center ED is a busy center with residents and staff. While the study stated that the WebCIS was available in the "normal workflow" There was only about 1 terminal for each 3 beds. Viewing of the information was sometimes a summary by the resident on the chart and sometimes a printed report placed on the chart by the ward-clerk. The majority of notes were done on paper and not through the WebCIS.
For the study period of June 1, 2005 to December 31, 2005 there were 68,337 ED visits. The number of visits that had any access of the WebCIS within 24hrs of was 40,818. Remember this includes access by the ward clerks and residents. The top three areas reviewed were lab, radiology and clinician notes. Access rates were 30%, 14% and 10% for those data types. If the ED physician was made aware that "old data" was available the viewing rates went to 42%, 26%, 47% respectively.
The authors posed several reasons for a lack of access to the data, feeling that others would review data, data irrelevant to current problem, new data more relevant, lack of time. In the case description and again in the discussion they comment on how the majority of visits are done on paper. I can't reconcile the fact that the majority of visits were on paper and 1 terminal to three beds with their claim that the data display was integrated into their workflow. A similar study done in an ED that is 100% electronic visits might be a good follow-up to this study.
--Hamricr 15:36, 16 May 2007 (CDT)