Electronic medical records go unused in emergency departments

In spite of the national push for clinicians to improve the quality and efficiency of care by exchanging health information, a study found that data in the electronic medical record are accessed less than half the time in a major urban emergency department, even when emergency physicians are informed of their availability."We found that while old data are accessed often, they are not accessed a majority of the time, even when the clinician is notified that old data are available and when those data are just a single click away in the clinical information system," said lead author Dr. George Hripcsak of the department of biomedical informatics at Columbia University.Hripcsak found that EMR data were accessed only 5% to 30% of time generally and 20% to 50% of the time when emergency physicians were notified of the availability of prior information (J Amer Med Inform Assn 2007;14(2):235-238).Radiology reports were among the data most frequently reviewed (14.4% generally and 25.7% when informed of availability). Radiographs are not available on Columbia's EMR, but they are viewed on the institution's PACS. EMR clinical laboratory reports were accessed the most frequently, 30.5% and 42.5%, respectively.

Hripcsak attributed the low access rates to several factors:

• knowledge that another team will review the data later
• presence of a condition that does not require detailed review of the record
• new data that render review of the previous data irrelevant
• time pressure

Previous studies have evaluated information needs in the emergency department, but few have examined how information actually gets used.

"We analyzed how information from a patient's old electronic records is accessed in the emergency department," Hripcsak said.The researchers used detailed audit logs from over 68,000 ED visits in a six-month period in 2005 to determine how often users in the ED accessed clinical information generated from previous visits. Columbia's longitudinal medical record system, called WebCIS, contains data on over 2,500,000 patients collected over 17 years.Hripcsak concluded that any data exchange initiative should support a relatively broad range of data, and that estimates of how often such data will be used may need to be tempered.