Health information technology in US emergency departments

Information technology may improve patient safety, and is a focus of health care reform. A minority of emergency departments (EDs) in Massachusetts, and in academic EDs throughout the US, have electronic health records.

Assess health information technology adoption in a nationwide sample of EDs.

We surveyed 69 US EDs, asking site investigators about the availability of health information technology in 2005-2006. Using multiple linear regression, we compared adoption of technology by ED type (emergency medicine residency affiliation, annual census, US region) to assess generalizability of the findings.

Sixty-eight EDs (99%) provided information about health information technology; 75% were affiliated with an emergency medicine residency, and all were urban. Most respondents had applications that simply relay information from one place to another, including patient tracking (74%); ordering tests (laboratory 57%, others 62%); and displaying prior visit notes (79%), ECGs (92%), laboratory (97%), and radiology (99%) results. A minority had more-advanced applications, which seek to modify human behavior, including medication ordering (38%), allergy warnings (19%), and medication cross-reaction warnings (13%), and a few used bar coding (20%). There were no significant differences in technology adoption by ED type.

This and prior studies suggest that some applications-particularly those relevant to modifying clinician behavior-are not widespread in US EDs, while others are. The reasons for this are unknown, but might include expense and unintended consequences. The fact that the emergency medicine community has not rushed to adopt certain applications presents challenges and opportunities.