Transient and Sustained Changes in Operational Performance, Patient Evaluation, and Medication Administration During Electronic Health Record Implementation in the Emergency Department

Study objective: Little is known about the transient and sustained operational effects of electronic health records on emergency department (ED) performance. We quantify how the implementation of a comprehensive electronic health record was associated with metrics of operational performance, test ordering, and medication administration at a single-center ED. Methods: We performed a longitudinal analysis of electronic data from a single, suburban, academic ED during 28 weeks between May 2011 and November 2011. We assessed length of stay, use of diagnostic testing, medication administration, radiologic imaging, and patient satisfaction during a 4-week baseline measurement period and then tracked changes in these variables during the 24 weeks after implementation of the electronic health record. Results: Median length of stay increased and patient satisfaction was reduced transiently, returning to baseline after 4 to 8 weeks. Rates of laboratory testing, medication administration, overall radiologic imaging, radiographs, computed tomography scans, and ECG ordering all showed sustained increases throughout the 24 weeks after electronic health record implementation. Conclusion: Electronic health record implementation in this single-center study was associated with both transient and sustained changes in metrics of ED performance, as well as laboratory and medication ordering. Understanding ways in which an ED can be affected by electronic health record implementation is critical to providing insight about ways to mitigate transient disruption and to maximize potential benefits of the technology.