Computers in emergency medicineAdoption of Information Technology in Massachusetts Emergency Departments
Introduction
Computerized clinical information systems have been shown to improve the quality of care (1). However, cost and the difficulty of implementation are significant barriers to their adoption (2). In 2004, the President of the United States (US) declared that most Americans should have interoperable electronic health records within 10 years, and the National Coordinator for Health Information Technology declared a “Decade of Health Information Technology” (3).
Before 2004, available information suggested that implementation of such technology in US emergency departments (EDs) was quite limited. A study of US academic EDs in 2000 found low rates of implementation, with only 7% of academic EDs reporting fully implemented technology for medication error checking, 18% for computerized medication order entry, and 21% for clinical documentation (4). That study also found that many technologies had been acquired but not implemented fully, evincing the challenges of implementation. For example, although 35% of respondents had acquired information technology for medication order entry, 51% of these described this function as “not fully implemented.” According to a secondary analysis of a national sample of US EDs, during 2001–2003, electronic health information systems had been adopted by a minority, with only 31% of EDs using electronic medical records in any form—and this study did not examine particular technologies such as medication ordering and error checking (5).
The objective of the present study is to describe the state of clinical information systems in all Massachusetts EDs. We hypothesized that implementation of information technology in Massachusetts EDs in 2006 would be similar to that observed in the early 2000s. In particular, we predicted that computerized medication error checking and other technologies known to improve outcomes had been implemented fully in only a minority of EDs.
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Materials and Methods
In early 2006, we mailed an anonymous survey to all non-federal EDs in Massachusetts (n = 74). We repeated mailings at 3-week intervals, for a total of four mailings. We contacted non-respondents by telephone and e-mail. Non-respondents to mailings were given the option of participating in a structured telephone interview conducted by a trained research assistant. Our institutional review board reviewed the study and classified it as exempt.
We designed the survey instrument with input from the
Results
We surveyed the 74 non-federal EDs in Massachusetts, and 61 responded (82%). The median annual visit volume of respondent EDs was 32,578 (interquartile range 28,267–44,828). Among responding EDs, 15% (95% CI 7–26%) were affiliated with an emergency residency program and 90% (95% CI 80–96%) were located in an urban area. Respondent and non-respondent EDs did not differ by annual visit volume, academic status, or location in an urban area (data not shown).
Table 1 shows the state of information
Discussion
We confirmed our hypothesis that the implementation of information technology in Massachusetts had progressed little by mid-decade, relative to nationwide studies at the beginning of the decade (4, 5). This state of affairs persisted despite the fact that, responding to evidence of benefit, several high-profile national committees have called for increased adoption of information technology in health care settings in general and EDs in particular (1, 3, 8).
Implementation of information
Limitations
Our survey is limited by the fact that we relied on key informant report, rather than direct observation; however, respondents were responsible for the systems studied and would be likely to provide correct answers. The response rate was 82%, and we found that responding and non-responding EDs were similar, suggesting that our results are likely to provide an accurate description of the information technology resources of EDs throughout Massachusetts. Important obstacles to successful
Conclusion
Information technologies that have been recommended forcefully are not in place in the majority of Massachusetts EDs, just as they were not in place in the majority of US academic EDs in 2000 (3, 4, 8, 10). When present, these technologies are often implemented incompletely.
ED directors may be isolated in their efforts to understand the available tools, and there is enormous duplication of effort as each new ED sets out to learn the options. Centralization of this effort might facilitate
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