title: The impact of electronic health record implementation on emergency physician efficiency and patient throughput.
abstract: BACKGROUND
  In emergency departments (EDs), the implementation of electronic health records (EHRs) has the potential to impact the rapid assessment and management of life threatening conditions. In order to quantify this impact, we studied the implementation of EHRs in the EDs of a two hospital system.
  
  
  METHODS
  using a prospective pre-post study design, patient processing metrics were collected for each ED physician at two hospitals for 7 months prior and 10 months post-EHR implementation. Metrics included median patient workup time, median length of stay, and the composite outcome indicator "processing time."
  
  
  RESULTS
  median processing time increased immediately post-implementation and then returned to, and surpassed, the baseline level over 10 months. Overall, we see significant decreases in processing time as the number of patients treated increases.
  
  
  CONCLUSIONS
  implementation of new EHRs into the ED setting can be expected to cause an initial decrease in efficiency. With adaptation, efficiency should return to baseline levels and may eventually surpass them.
  
  
  CONCLUSIONS
  while EDs can expect long term gains from the implementation of EHRs, they should be prepared for initial decreases in efficiency and take preparatory measures to avert adverse effects on the quality of patient care.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: nicholas.risko@som.umaryland.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Risko
authors.affiliation: Zicklin School of Business, Baruch College, City University of New York, New York, NY, United States; Kogod School of Business, American University, Washington, DC, United States.
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.affiliation: Robert H. Smith School of Business, University of Maryland, College Park, MD, United States.
authors.forename: Bruce
authors.initials: B
authors.lastname: Golden
authors.affiliation: Kogod School of Business, American University, Washington, DC, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Wasil
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Fermin
authors.initials: F
authors.lastname: Barrueto
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Pimentel
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Jon Mark
authors.initials: JM
authors.lastname: Hirshon
keywords: Applied information technology; Efficiency; Electronic health records; Emergency medicine; Health information technology; Quality of care