This document discusses information management and health IT systems in emergency rooms. It outlines the unique information needs of ERs, including patient history, safety information, treatment details, and patient tracking. Common ER information problems like limited availability and reliability are described. The document then discusses health IT systems that can help, such as electronic health records, order entry tools, clinical decision support systems, and health information exchange. It notes both the values of health IT in areas like safety and efficiency, as well as potential risks like alert fatigue if not implemented correctly. Overall, the document examines how information technology can address ER information problems, but also requires careful management to achieve benefits.

1. IT and Data Management
in the ER
Nawanan Theera-Ampornpunt, MD, PhD
Faculty of Medicine Ramathibodi Hospital

2. Outline
• Healthcare & Health IT
• ER Information Needs
• Information Systems in ER
• Implications for Emergency
Physicians

3. Outline
• Healthcare & Health IT
• ER Information Needs
• Information Systems in ER
• Implications for Emergency
Physicians

4. Manufacturing
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5. Banking
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6. Health care
ER - Image Source: nj.com

7. Why Health care Isn’t Like Any Others?
• Life-or-Death
• Many & varied stakeholders
• Strong professional values
• Evolving standards of care
• Fragmented, poorly-coordinated systems
• Large, ever-growing & changing body of
knowledge
• High volume, low resources, little time

8. Information is Everywhere in Health Care

9. Health IT: What’s In A Word?
Health Goal
Information Value-
Add
Technology Tools

10. Outline
• Healthcare & Health IT
• ER Information Needs
• Information Systems in ER
• Implications for Emergency
Physicians

11. ER Information Needs
• Patient history
– Problem list, comorbidities
– Medication list
– Previous visits
• Patient Safety
– Allergies
• Treatment-Related
– Drug interactions
– Medical references
– Lab & investigation results
• Patient Management
– Progress tracking
– Location tracking

12. Problems with Information Management in ER
• Limited available information
• Often unreliable or incomplete
• Unpredictable presentations
• Urgency - Race against time
• Importance of triage (separate signal from noise)
• Crowded ER, poor operational efficiency

13. To Err Is Human
• Example: Lack of Attention
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14. Value of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making
or process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder

15. Outline
• Healthcare & Health IT
• ER Information Needs
• Information Systems in ER
• Implications for Emergency
Physicians

16. EHRs & HIS
Electronic Health
Records (EHRs)
Hospital
Information
Electronic Medical System (HIS)
Records (EMRs)
Electronic Patient
Records (EPRs)
Clinical
Information
Computer-Based System (CIS)
Patient Records
(CPRs)

17. Functions that Should Be Part of EHR Systems
• Computerized Medication Order Entry
• Computerized Laboratory Order Entry
• Computerized Laboratory Results
• Physician Notes
• Patient Demographics
• Problem Lists
• Medication Lists
• Discharge Summaries
• Diagnostic Test Results
• Radiologic Reports
(IOM, 2003; Blumenthal et al, 2006)

18. Computerized Physician Order Entry (CPOE)

19. Computerized Physician Order Entry (CPOE)
Values
• No handwriting!!!
• Structured data entry: Completeness,
clarity,
fewer mistakes (?)
• No transcription errors!
• Entry point for CDSSs
• Streamlines workflow, increases efficiency

20. Clinical Decision Support Systems
(CDSSs)
• The real place where most of the
values of health IT can be achieved
– Expert systems
• Based on artificial intelligence,
machine learning, rules, or
statistics
• Examples: differential
diagnoses, treatment options

21. Clinical Decision Support Systems
(CDSSs)
– Alerts & reminders
• Examples:
–Drug-allergy checks
–Drug-drug interaction checks
–Reminders for preventive services or
certain actions (e.g. smoking cessation)
–Clinical practice guideline integration

22. Example of “Alerts & Reminders”

23. Clinical Decision Support Systems
(CDSSs)
– Evidence-based knowledge sources e.g.
drug database, literature
– Simple UI designed to help clinical decision
making
• E.g., Abnormal Lab Highlights

24. Health Information Exchange (HIE)
Government
Hospital A Hospital B
Clinic C
Lab Patient at Home

25. People-Process-Technology
Technology
People Process

26. Critical Success Factors
in Health IT Projects
Communications of plans & progresses
Physician & non-physician user involvement
Attention to workflow changes
Well-executed project management
Adequate user training
Organizational learning
Organizational innovativeness
Theera-Ampornpunt (2011)

27. Unintended Consequences of Health IT
Some risks
• Alert fatigue

28. Workarounds

29. Clinical Decision Support Systems
(CDSSs)
– Alerts & reminders
• Examples:
–Drug-allergy checks
–Drug-drug interaction checks
–Reminders for preventive services or
certain actions (e.g. smoking cessation)
–Clinical practice guideline integration

30. Outline
• Healthcare & Health IT
• ER Information Needs
• Information Systems in ER
• Implications for Emergency
Physicians

31. Implications
– ER has unique information needs
– Health IT offers values to EP
– Health IT has some risks (unintended
consequences)
– The “right management” is a
critical success factor

32. Questions?