Efficiency achievements from a user-developed real-time modifiable clinical information system

Area of Science:

• Health Informatics
• Clinical Information Systems
• Human-Computer Interaction

Background:

• Introduction of a new information system in Nepean Hospital Emergency Department (ED) led to reduced clinical staff efficiency and ED performance.
• Existing proprietary systems may not be optimized for ED workflows, causing inefficiencies.
• Need for improved design and implementation of clinical information systems in EDs.

Purpose of the Study:

• To construct the Nepean Emergency Department Information Management System (NEDIMS) using novel design methods.
• To compare NEDIMS efficiency (time and click burden) against Cerner FirstNet.
• To model the impact of efficiency gains on patient throughput in the ED.

Main Methods:

• Quantitative comparison of NEDIMS and Cerner FirstNet across 6 ED activity centers and 17 tasks.
• Measurement of task duration and mouse clicks for 332 task instances in live and simulated environments.
• Development of a simulation model to assess patient throughput based on workflow differences.

Main Results:

• NEDIMS demonstrated at least 41% greater efficiency than Cerner FirstNet (95% CI: 21.6%–59.8%).
• Patient journeys showed an average difference of 127 seconds and 15.2 clicks favoring NEDIMS.
• Simulation indicated NEDIMS could save 23.9 hours of staff time daily for 165 patients.

Conclusions:

• Clinical team-led design and adaptive technology in emergent clinical information systems significantly enhance ED efficiency.
• Minimizing clicks reduces cognitive load and interrupts clinicians less than traditional paper-based methods.
• Optimizing global workflow through efficient system design improves overall ED performance and staff experience.