Effect of an electronic medical record information system on emergency department performance

Objective: To determine whether implementation of the Cerner FirstNet electronic medical record system was associated with any change in emergency department (ED) performance. Design, setting and patients: A retrospective observational study conducted during a 6-month period in 2009 after the introduction of FirstNet and a corresponding 6-month control period in 2008 when the Emergency Department Information System (EDIS) was operational. Data from all patients presenting to the ED during each period were extracted from each system and analysed for changes in key performance indicators (KPIs). Potential confounding variables, including total number of ED presentations, ED occupancy, ED staffing levels and triage category distribution, were also collected. Main outcome measures: Waiting time for all patients; waiting time, treatment time and total time for patients discharged from the ED; proportion of patients who did not wait to be seen by a doctor (DNW rate); and proportion of ambulance offload waiting times longer than 30 minutes. Results: We found a reduction in performance with respect to ED KPIs after implementation of the FirstNet system. There were increases in the waiting time for all patients (median, 40 min v 78 min), and the waiting time (median, 49 min v 87 min), treatment time (median, 128 min v 147 min) and total time (median, 214 min v 280 min) for patients discharged from the ED. There were increases in the DNW rate (8.3% v 15.6%) and the proportion of ambulance offload times longer than 30 minutes (10.5% v 13.3%). All differences were statistically significant (P < 0.05). Conclusion: Implementation of the FirstNet electronic medical record system was associated with deterioration in ED KPIs.