Electronic Health Record Implementation in the Emergency Department

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Electronic health records are meant to reduce the healthcare costs, decrease the volume of unnecessary testing and improve operational performance of an health system. This particular article by Ward et al shows how implementation of EHR is crucial and how initial stages will disrupt the workflow of an Emergency Department, increase test ordering, medication administration and length of stay.


The study was done on a 24-bed,suburban,academic ED in Cincinnati, OH. The annual volume of patients was approximately 34,000. The data of the study was collected from between May 15, 2011 and November 26, 2011. Participants were Emergency physicians, emergency medicine and internal medicine residents, and physician assistants and nurse practitioners. Study was done for total 28 weeks. 4 weeks before implementation of EHR and 24 weeks after the implementation. The variable of study were length of stay, use of diagnostic tests, medication administration, radiology imaging and patient satisfaction.


Transient changes:

  • Workflow disruptions:

Temporary operational disruption due to getting to know about the new system - a learning curve. Adopting to fully automated system from paper based system. Examples such as using Voice recognition system for physicians to enter patient info.

  • Length of stay:

Median length of stay increased for admitted and discharged patients. This change that lasted approximately 8 weeks.

Persistent Changes:

Laboratory testing, medication administration,radiologic imaging, radiographs and CT scan, ECG orderings went up throughout 24 weeks after EHR implementation. all these test orders seems to be a click of a button.


TO maximize the potential usages of EHR technology in ED it is important to know its temporary and permanent changes that will occur in the process of its implementation.