An inventory of emergency department information systems (EDIS) in Canada: Benchmarking system functionality and...

Emergency Department Information Systems (EDIS) are essential digital technology used in Emergency Departments (ED). Modern EDIS provide electronic patient tracking, documentation, order entry and decision support, and are crucial for enabling data analytics and Artificial-Intelligence (AI)-based tools to improve patient care. However, Canada's adoption of digital-health technology is slow, and the digital functions of current Canadian EDIS are unknown. This study presents an inventory of current Canadian EDIS functions. The primary outcome is a categorization of ED-centers as either 'mostly-digital', 'hybrid-digital & handwritten' or 'mostly-handwritten.' We hypothesized that < 50% of Canadian ED-centers are mostly-digital.

A national electronic survey aiming to sample the 739 total Canadian ED-centers was conducted from Jan-Sept 2024. One response representing each center was recorded. The primary outcome was EDIS functions based on an adapted version of the electronic health record system functional model (EHR-S FM). Secondary outcomes include respondent and hospital demographics, and the ED-centers' current and future-planned EDIS use.

Data from 99 individuals representing 545 (74%) of the target ED-centers was obtained. The most used EDIS brands include MEDITECH (31%), EPIC Systems (21%) and Allscripts (15%). Overall, 52.4% ED-centers are mostly-digital, 47.4% are hybrid-digital & handwritten, and 0.2% are mostly handwritten. Paper-based health provider ED documentation and order entry were reported in 19.7% and 46.2% of responses. Tracking medication administration and patient vitals are paper-based in 45.6% and 21.8% of responses.

Despite national expansion in digital-health technology, there is widespread use of paper-based processes for Canadian ED patient care. These findings affect strategic planning for use of electronic care supports and AI. Further infrastructure changes are needed in order for Canadian patients to equitably and practically benefit from AI and data analytics innovations in the ED. Large portions of the information these technologies use are in difficult to access formats.