title: Electronic medical records and mortality in trauma patients.
abstract: BACKGROUND
  The Electronic Medical Record (EMR) has been proposed as a way to reduce medical errors. It can also be used to document clinician involvement, which may affect outcomes. We sought to determine whether the EMR could be used to improve attending involvement in daily care, enhance surgical revenue, and lower mortality of patients with trauma.
  
  
  METHODS
  In 2004, the Trauma Division adopted a software program (CARE, Miami, FL) for creating an EMR and implemented a weekly report that was distributed to all members of the division and also to Departmental decision makers. Before initiation, explicit instructions were given to all surgeons that daily notes in the EMR were expected and would be followed by weekly reports. Before this, most notes were recorded in the paper chart and were difficult to track. Differences among proportions were determined with z test or chi, where appropriate with significance defined as p < 0.05.
  
  
  RESULTS
  With implementation of the EMR, daily and weekly reports were immediately available. Both attending surgeon documented notes and divisional annual revenue increased. A reduction in mortality was also observed.
  
  
  CONCLUSIONS
  The EMR can be used to change attending surgeon involvement in patient care and procedures. The increase in attending involvement was associated with an increase in revenue. Use of the EMR was associated with a significant reduction in hospital mortality.
authors.affiliation: Ryder Trauma Center, University of Miami, Miami, Florida 33101, USA. ddeckelbaum@med.miami.edu
authors.forename: Dan L
authors.initials: DL
authors.lastname: Deckelbaum
authors.forename: Ara J
authors.initials: AJ
authors.lastname: Feinstein
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Augenstein
authors.forename: Mary F
authors.initials: MF
authors.lastname: Murtha
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Mark G
authors.initials: MG
authors.lastname: McKenney
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D016347:Medical Records Systems, Computerized / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy; D055815:Young Adult