title: Does an integrated Emergency Department Information System change the sequence of clinical work? A mixed-method cross-site study.
abstract: OBJECTIVE
  (1) to describe Emergency Department (ED) physicians' and nurses' perceptions about the sequence of work related to patient management with use of an integrated Emergency Department Information System (EDIS), and (2) to measure changes in the sequence of clinician access to patient information.
  
  
  METHODS
  A mixed method study was conducted in four metropolitan EDs. Each used the same EDIS which is a module of the hospitals' enterprise-wide clinical information system composed of many components of an electronic medical record. This enabled access to clinical and management information relating to patients attending all hospitals in the region. Phase one - data were collected from ED physicians and nurses (n=97) by 69 in-depth interviews, five focus groups (28 participants), and 26 h of observations. Phase two - physicians (n=34) in one ED were observed over 2 weeks. Data included whether and what type of information was accessed from the EDIS prior to first examination of the patient.
  
  
  RESULTS
  Clinicians reported, and phase 2 observations confirmed, that the integrated EDIS led to changes to the order of information access, which held implications for when tests were ordered and results accessed. Most physicians accessed patient information using EDIS prior to taking the patients' first medical history (77/116; 66.4%, 95% CI: 57.8-75.0%). Previous discharge summaries (74%) and past test results (61%) were most frequently accessed and junior doctors were more likely to access electronic past history information than their senior colleagues (χ(2)=20.717, d.f.=1, p<0.001).
  
  
  CONCLUSIONS
  The integrated EDIS created new ways of working for ED clinicians. Such changes could hold positive implications for: time taken to reach a diagnosis and deliver treatments; length of stay; patient outcomes and experiences.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia. Electronic address: j.callen@unsw.edu.au.
authors.forename: Joanne
authors.initials: J
authors.lastname: Callen
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Director of Emergency Medicine, Concord Repatriation and General Hospital, Concord, Sydney, NSW 2139, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.affiliation: Rheumatology Department, Liverpool Hospital, Sydney, NSW 1871, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Gibson
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Li
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D006751:Hospital Information Systems / Q000706:statistics & numerical data*; D006801:Humans; D009726:Nurses; D017063:Outcome Assessment, Health Care; D010465:Perception; D010820:Physicians; D011787:Quality of Health Care; D057188:Workflow
keywords: Emergency care information systems; Evaluation studies; Hospital information systems; Information seeking behaviour; Medical history taking