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Area of Science:

  • Health Informatics
  • Healthcare Operations Research
  • Clinical Data Management

Background:

  • Operational data quality is crucial for real-time system adjustments.
  • Electronic Health Record (EHR) implementation can introduce transient data errors.
  • The impact of EHRs on emergency department (ED) operational data quality is not well understood.

Purpose of the Study:

  • To assess the operational data quality in an ED before and after EHR implementation.
  • To quantify the frequency and magnitude of transient data errors during EHR transition.

Main Methods:

  • Direct observation of ED timestamps (arrival, bed placement, clinician evaluation, disposition, exit) over 8 weeks (4 pre-EHR, 4 post-EHR).
  • Comparison of observed timestamps with electronic timestamps to evaluate data accuracy.
  • Statistical analysis using proportions and medians with 95% confidence intervals (CIs) to determine the magnitude of discrepancies.

Main Results:

  • Post-EHR implementation, more systematic data errors were observed.
  • The proportion of disposition timestamp discrepancies over 10 minutes decreased (29.3% to 16.1%).
  • Clinician evaluation timestamp accuracy decreased (median difference of 3 minutes earlier), and multiple service intervals became less accurate.

Conclusions:

  • EHR implementation in EDs can negatively affect operational data quality.
  • Reliance on electronic timestamps for operational assessment post-implementation requires careful consideration of error magnitude and compounding.
  • Further research is needed to understand peri-implementation data quality challenges.