Emergency Department Information System Adoption in the United States

Authors

  • Adam B. Landman MD, MS, MIS,

    1. From the Robert Wood Johnson Foundation Clinical Scholars Program (ABL, RAD), Department of Emergency Medicine (ABL, SLB), Department of Pediatric Emergency Medicine (ALH), and School of Public Health (RAD), Yale University, New Haven, CT; and the U.S. Department of Veterans Affairs (ABL, RAD), West Haven, CT.
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  • Steven L. Bernstein MD,

    1. From the Robert Wood Johnson Foundation Clinical Scholars Program (ABL, RAD), Department of Emergency Medicine (ABL, SLB), Department of Pediatric Emergency Medicine (ALH), and School of Public Health (RAD), Yale University, New Haven, CT; and the U.S. Department of Veterans Affairs (ABL, RAD), West Haven, CT.
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  • Allen L. Hsiao MD,

    1. From the Robert Wood Johnson Foundation Clinical Scholars Program (ABL, RAD), Department of Emergency Medicine (ABL, SLB), Department of Pediatric Emergency Medicine (ALH), and School of Public Health (RAD), Yale University, New Haven, CT; and the U.S. Department of Veterans Affairs (ABL, RAD), West Haven, CT.
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  • Rani A. Desai PhD, MPH

    1. From the Robert Wood Johnson Foundation Clinical Scholars Program (ABL, RAD), Department of Emergency Medicine (ABL, SLB), Department of Pediatric Emergency Medicine (ALH), and School of Public Health (RAD), Yale University, New Haven, CT; and the U.S. Department of Veterans Affairs (ABL, RAD), West Haven, CT.
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  • Presented as an abstract at the American College of Emergency Physicians (ACEP) Scientific Assembly, Boston, MA, October 6, 2009; and the Connecticut College of Emergency Physicians (CCEP) Scientific Assembly, Rocky Hill, CT, November 4, 2009.

  • Dr. Landman is a Robert Wood Johnson Foundation Clinical Scholar at Yale University, supported by the U.S. Department of Veterans Affairs and the Robert Wood Johnson Foundation.

  • None of the authors have conflicts of interest to report.

  • A related commentary appears on page 524.

Address for correspondenc and reprints: Adam Landman, MD, MS, MIS; e-mail: adam.landman@yale.edu

Abstract

Objectives:  The American Recovery and Reinvestment Act of 2009 incentivizes adoption of health care information technology (HIT) based on support for specific standards, policies, and features. Limited data have been published on national emergency department information systems (EDIS) adoption, and to our knowledge, no prior studies have considered functionality measures. This study determined current national estimates of EDIS adoption using both single-response rates of EDIS adoption and a novel feature-based definition and also identified emergency department (ED) characteristics associated with EDIS use.

Methods:  The 2006 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits that also surveyed participating EDs on EDIS, was used to estimate EDIS adoption. EDIS adoption rates were calculated using two definitions: 1) single-response—response to a single survey question as to whether the EDIS was complete, partial, or none; and 2) feature-based—based on the reported features supported by the EDIS, systems were categorized as fully functional, basic, other, or none. The relationship of EDIS adoption to specific ED characteristics such as facility type and location was also examined.

Results:  Using the single-response classification, 16.1% of EDs had a complete EDIS, while 30.4% had a partial EDIS, and 53.5% had none. In contrast, using a feature-based categorization, 1.7% EDs had a fully functional EDIS, 12.3% had basic, 32.1% had other, and 53.9% had none. In multivariable analysis, urban EDs were significantly more likely to have a fully functional or basic EDIS than were rural EDs. Pediatric EDs were significantly more likely than general EDs to have other EDIS.

Conclusions:  Despite more optimistic single-response estimates, fewer than 2% of our nation’s EDs have a fully functional EDIS. EDs in urban areas and those specializing in the care of pediatric patients are more likely to support EDIS. Accurate and consistent EDIS adoption estimates are dependent on whether there are standardized EDIS definitions and classifications of features. To realize the potential value of EDIS for improved emergency care, we need to better understand the extent and correlates of the diffusion of this technology and increase emergency medicine engagement in national HIT policy-making.

Academic Emergency Medicine 2010; 17:536–544 © 2010 by the Society for Academic Emergency Medicine

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