Only advanced electronic medical records reduce ER time

In an Aug. 18 Health Blog from The Wall Street Journal, reporter Katherine Hobson discusses a new study from the W. P. Carey School of Business. The research by Assistant Professor Michael Furukawa shows you're likely to spend significantly less time in the emergency room, if your hospital's E.R. has advanced electronic medical records.

Here's an excerpt:

The study, published online earlier this summer and set to appear in a future print edition of Medical Care Research and Review, found that if you end up at a hospital with the most fully digitized form of records, your total length of stay was likely to be more than 22% shorter than at ERs with minimal or no electronic medical record systems, while treatment time was likely to be about 13% shorter.

However — and it’s a big “however” — only 1.7% of the ERs covered by the data, from 2006, fit this “fully functional” definition. Some 10.8% of ERs in the study had a basic level of electronic medical records, and if you ended up at one of those, your wait time was actually likely to be longer than at the nearly 88% of hospitals that had minimal or no EMR systems when the study was conducted. There was an especially large (negative) impact on patients with urgent or semi-urgent problems; their wait time at semi-digitized ERs was more than 47% longer than at ones with little or no digitization.

To some extent, the discrepancy may reflect the learning curve — hospitals with more advanced systems may have been using records for longer, while facilities with more basic systems may be just at the beginning of the whole process. “We couldn’t rule that out,” Michael Furukawa, author of the study and an assistant professor at W.P. Carey. But, he says, mixed systems in general, even with experienced users, are likely to “actually increase the time spent on a computer — a doctor might be looking for a paper chart containing one piece of information and logging on for another — so the process is not optimal,” he says. “People with a minimally functional system will never be as efficient.”

It’s also possible that the better wait times in fully digitized ERs may reflect not the technology, but the fact that those hospitals were more likely to be in “large urban and affluent areas,” the study finds.

Furukawa says this study, taken with another study he and colleagues recently published on the impact of EMRs on costs, nurse staffing levels and some outcomes, suggests the message for hospitals is that “if you’re going to take it slow as you move through the different stages” of EMR implementation, “you really need to temper expectations.”

He says he’s optimistic that systems designed and implemented with the input and acceptance of physicians, will pay off in the long term in quality and, hopefully, costs. “If [administrators and physicians] can agree on the technology and how to use it, it can be successful.”