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    Estimates of Electronic Medical Records in U.S. Emergency Departments

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    Background: Policymakers advocate universal electronic medical records (EMRs) and propose incentives for meaningful use of EMRs. Though emergency departments (EDs) are particularly sensitive to the benefits and unintended consequences of EMR adoption, surveillance has been limited. We analyze data from a nationally representative sample of US EDs to ascertain the adoption of various EMR functionalities. Methodology/Principal Findings: We analyzed data from the National Hospital Ambulatory Medical Care Survey, after pooling data from 2005 and 2006, reporting proportions with 95% confidence intervals (95% CI). In addition to reporting adoption of various EMR functionalities, we used logistic regression to ascertain patient and hospital characteristics predicting meaningful use, defined as a basic system (managing demographic information, computerized provider order entry, and lab and imaging results). We found that 46% (95% CI 3953%) of US EDs reported having adopted EMRs. Computerized provider order entry was present in 21% (95% CI 1627%), and only 15% (95% CI 1020%) had warnings for drug interactions or contraindications. The basic definition of meaningful use was met by 17% (95% CI 1321%) of EDs. Rural EDs were substantially less likely to have a basic EMR system than urban EDs (odds ratio 0.19, 95% CI 0.060.57, p=0.003), and Midwestern (odds ratio 0.37, 95% CI 0.160.84, p=0.018) and Southern (odds ratio 0.47, 95% CI 0.260.84, p=0.011) EDs were substantially less likely than Northeastern EDs to have a basic system. Conclusions/Significance: EMRs are becoming more prevalent in US EDs, though only a minority use EMRs in a meaningful way, no matter how meaningful is defined. Rural EDs are less likely to have an EMR than metropolitan EDs, and Midwestern and Southern EDs are less likely to have an EMR than Northeastern EDs. We discuss the nuances of how to define meaningful use, and the importance of considering not only adoption, but also full implementation and consequences.

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    Description

    Title : Estimates of Electronic Medical Records in U.S. Emergency Departments
    Author(s) : Benjamin P. Geisler, Jeremiah D. Schuur, Daniel J. Pallin
    Abstract : Background: Policymakers advocate universal electronic medical records (EMRs) and propose incentives for meaningful use of EMRs. Though emergency departments (EDs) are particularly sensitive to the benefits and unintended consequences of EMR adoption, surveillance has been limited. We analyze data from a nationally representative sample of US EDs to ascertain the adoption of various EMR functionalities. Methodology/Principal Findings: We analyzed data from the National Hospital Ambulatory Medical Care Survey, after pooling data from 2005 and 2006, reporting proportions with 95% confidence intervals (95% CI). In addition to reporting adoption of various EMR functionalities, we used logistic regression to ascertain patient and hospital characteristics predicting meaningful use, defined as a basic system (managing demographic information, computerized provider order entry, and lab and imaging results). We found that 46% (95% CI 3953%) of US EDs reported having adopted EMRs. Computerized provider order entry was present in 21% (95% CI 1627%), and only 15% (95% CI 1020%) had warnings for drug interactions or contraindications. The basic definition of meaningful use was met by 17% (95% CI 1321%) of EDs. Rural EDs were substantially less likely to have a basic EMR system than urban EDs (odds ratio 0.19, 95% CI 0.060.57, p=0.003), and Midwestern (odds ratio 0.37, 95% CI 0.160.84, p=0.018) and Southern (odds ratio 0.47, 95% CI 0.260.84, p=0.011) EDs were substantially less likely than Northeastern EDs to have a basic system. Conclusions/Significance: EMRs are becoming more prevalent in US EDs, though only a minority use EMRs in a meaningful way, no matter how meaningful is defined. Rural EDs are less likely to have an EMR than metropolitan EDs, and Midwestern and Southern EDs are less likely to have an EMR than Northeastern EDs. We discuss the nuances of how to define meaningful use, and the importance of considering not only adoption, but also full implementation and consequences.
    Subject : unspecified
    Area : Other
    Language : English
    Year : 2010

    Affiliations Independent researcher
    Editors : Joseph S Ross
    Journal : PLoS ONE
    Volume : 5
    Issue : 2
    Publisher : Public Library of Science
    Pages : e9274 -
    Url : http://dx.plos.org/10.1371/journal.pone.0009274
    Doi : 10.1371/journal.pone.0009274

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