title: The effect of electronic health record implementation on community emergency department operational measures of performance.
abstract: OBJECTIVE
  We study the effect of an emergency department (ED) electronic health record implementation on the operational metrics of a diverse group of community EDs.
  
  
  METHODS
  We performed a retrospective before/after analysis of 23 EDs from a single management group that experienced ED electronic health record implementation (with the majority of electronic health records optimized specifically for ED use). We obtained electronic data for 4 length of stay measures (arrival to provider, admitted, discharged, and overall length of stay) and 4 measures of operational characteristics (left before treatment complete, significant returns, overall patient satisfaction, and provider efficiency). We compared the 6-month "baseline" period immediately before implementation with a "steady-state" period commencing 6 months after implementation for all 8 metrics.
  
  
  RESULTS
  For the length of stay measures, there were no differences in the arrival-to-provider interval (difference of -0.02 hours; 95% confidence interval [CI] of difference -0.12 to 0.08), admitted length of stay (difference of 0.10 hours; 95% CI of difference -0.17 to 0.37), discharged length of stay (difference of 0.07 hours; 95% CI of difference -0.07 to 0.22), and overall length of stay (difference of 0.11 hours; 95% CI of difference -0.04 to 0.27). For operational characteristics, there were no differences in the percentage who left before treatment was complete (difference of 0.24%; 95% CI of difference -0.47% to 0.95%), significant returns (difference of -0.04%; 95% CI of difference -0.48% to 0.39%), overall percentile patient satisfaction (difference of -0.02%; 95% CI of difference -2.35% to 2.30%), and provider efficiency (difference of -0.05 patients/hour; 95% CI of difference -0.11 to 0.02).
  
  
  CONCLUSIONS
  There is no meaningful difference in 8 measures of operational performance for community EDs experiencing optimized ED electronic health record implementation between a baseline and steady-state period.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University, Nashville, TN. Electronic address: mward04@gmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ward
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Landman
authors.affiliation: Emergency Medicine Division, Schumacher Group.
authors.forename: Karen
authors.initials: K
authors.lastname: Case
authors.affiliation: Emergency Medicine Division, Schumacher Group.
authors.forename: Jessica
authors.initials: J
authors.lastname: Berthelot
authors.affiliation: Emergency Medicine Division, Schumacher Group.
authors.forename: Randy L
authors.initials: RL
authors.lastname: Pilgrim
authors.affiliation: Departments of Emergency Medicine and Health Policy, George Washington University Medical Center.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
mesh_terms: D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States