Study: EMR functionality matters in the ER

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Patients receiving care from hospitals with the most advanced type of EMRs spend 22.4 percent less time in the emergency room (ER) than at other hospitals, but providers with basic EMRs were associated with longer wait times on average, especially for patients arriving at the ER with truly urgent medical needs, according to research published online in Medical Care Research and Review.

Michael F. Furukawa, PhD, from the W.P. Carey School of Business at Arizona State University in Phoenix, examined the relationship between EMR sophistication and the efficiency of U.S. hospital emergency departments. Using data from the 2006 National Hospital Ambulatory Medical Care Survey (which includes records from more than 30,000 patient visits to 364 hospitals across the U.S.), he used survey-weighted ordinary least squares regressions to estimate the association of EMR sophistication with ED throughput and probability a patient left without treatment.

He examined three categories: hospital ERs with little or no EMRs; those with only basic EMRs, which lack more advanced functions like online access to certain test results; and ERs with the best, fully functional type of EMR systems.

“If you choose a hospital with the best type of fully functional EMR, you will probably have a shorter treatment time and a much shorter overall stay in the ER,” said Furukawa. “However, the research shows if your hospital has just a basic EMR system, efficiency could actually be worse than at ERs with no EMR at all.”

Instrumental variables were used to test for the presence of endogeneity and reverse causality. Greater EMR sophistication had a mixed association with ER efficiency. Hospital ERs with the best EMRs had 13.1 percent shorter treatment times, 23.5 percent shorter stays in the ER for patients eventually admitted to the hospital and 21.3 percent shorter stays in the ER for patients who were treated and discharged without being admitted, the research found.

Surprisingly, ERs with basic EMR were not more efficient on average, and basic EMR had a nonlinear relationship with efficiency that varied with the number of EMR functions used, the research found. For example, hospital ER with only a basic EMR had a 47.3 percent longer wait time for patients specifically dealing with urgent or semi-urgent medical issues.

“The sophistication of health IT systems is important,” wrote Furuwaka. “Some hospitals may just plan to do the minimum necessary to get federal funding, and that may have unintended, negative consequences.”

Furukawa concluded that efficiency may improve over time as hospital staffers and others become more familiar with the basic systems. “This could be a learning curve situation where the benefits vary depending on the number and type of functions used by hospitals," the author stated. “For now, people [should] have realistic expectations for EMRs.”