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

Benjamin P Geisler,Jeremiah D Schuur,Daniel J Pallin,Joseph S Ross

doi:10.1371/journal.pone.0009274

Abstract

BackgroundPolicymakers 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 FindingsWe 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 39–53%) of US EDs reported having adopted EMRs. Computerized provider order entry was present in 21% (95% CI 16–27%), and only 15% (95% CI 10–20%) had warnings for drug interactions or contraindications. The “basic” definition of “meaningful use” was met by 17% (95% CI 13–21%) of EDs. Rural EDs were substantially less likely to have a “basic” EMR system than urban EDs (odds ratio 0.19, 95% CI 0.06–0.57, p = 0.003), and Midwestern (odds ratio 0.37, 95% CI 0.16–0.84, p = 0.018) and Southern (odds ratio 0.47, 95% CI 0.26–0.84, p = 0.011) EDs were substantially less likely than Northeastern EDs to have a “basic” system.Conclusions/SignificanceEMRs 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.

Highlights

Electronic medical records may improve patient safety and efficiency of care, and universal adoption is a national goal
Incentivizing healthcare providers to implement electronic medical records (EMRs) can succeed only if policymakers know what is already in place. We provide this information for the emergency departments (EDs) setting, using a large, nationally-representative sample of data collected as part of the National Hospital Ambulatory Medical Care Survey (NHAMCS)
Do we provide objective information about EMR availability in the nation’s EDs; we consider the various ways in which a given ED might be considered to use such technology ‘‘meaningfully.’’ We report the proportion of US EDs that could claim to be ‘‘meaningful users’’ in 2005–2006, under various definitions, including that used by Jha and DesRoches, and consider the validity of various categorization schemes [3,4]

Summary

Introduction

Electronic medical records may improve patient safety and efficiency of care, and universal adoption is a national goal. Physicians and hospitals may receive financial incentives through Medicare and Medicaid if they are ‘‘meaningful users’’ of electronic medical records [1,2]. Recent data found that only 1.5% of US hospitals had a ‘‘comprehensive’’ electronic medical record (EMR), and an additional 7.6% a ‘‘basic’’ system (Jha et al.) [3]. Policymakers advocate universal electronic medical records (EMRs) and propose incentives for ‘‘meaningful use’’ of EMRs. Though emergency departments (EDs) are 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

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