EDECS: the Emergency Department Expert Charting System

EDECS, the Emergency Department Expert Charting System, integrates clinical guidelines into the everyday practice of medicine. By generating the medical record and patient aftercare instructions, it facilitates patient care. For this reason, doctors are willing to use it. While using it, the doctors are continually presented with advice regarding documentation, testing, and treatment. Unlike guidelines that attempt to modify behavior through traditional educational methods, these computerized guidelines are seen by the physician every time she sees a patient. We have demonstrated this by directly integrating the guidelines into the process of patient care; we can increase compliance with the guidelines [1]. At present EDECS exists for the chief complaints of occupational exposure to body fluids, acute low back pain, recurrent seizure, fever in children, and males with penile discharge or dysuria. Upon examining the patient, the physician proceeds to the computer, which prompts him for essential information regarding the history and physical examination. Certain items are required for all patients with the chief complaint, others are required based on the answers to these items. Data is analyzed by the computer, which provides advice regarding testing and treatment. Once testing is completed, the system suggests a probable diagnosis and aids in patient disposition and discharge planning. Finally, EDECS prints the medical record as well as patient-specific aftercare instructions. EDECS is a user friendly system; most data is entered via mouse. It is written in the OS-based expert system shell AM(TM) and can be run on an IBM compatible PC or PC network. Rules are generally written in an "if...then" format, but more sophisticated rule structures, including Bayesian models, are used when needed. Each module contains separate subroutines for the history, physical, laboratory ordering, treatment, and disposition. These modules call each other in a dynamic fashion. The system is currently being evaluated for its effect on documentation, appropriateness of use of ancillary tests, appropriateness of use of treatments, physician satisfaction, patient satisfaction, and patient outcomes. Initial results of the system's effect on documentation and use of ancillary tests and treatments show much promise [1]. The Occupational Exposure to Body Fluids module has shown a statistically significant, and sometimes rather dramatic, increase in the level of documentation for nearly all items. Further, the advice given by EDECS has caused an increase in the appropriate use of testing and treatments. For example, unnecessary ancillary tests dropped from 1.5 per patient without the computer to 0.1 per patient with the computer's aid. EDECS facilitates quality management activities and research since it collects standardized information and stores it in an easily retrievable database format. It can also be used to educate medical students and residents about the proper care of patients with a given chief complaint. At this session, EDECS will be demonstrated, and issues regarding the development of guidelines, the encoding of guidelines in rules, and the organizational structure of the software will be presented and discussed.