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In an article in the New England Journal of Medicine, Senate Majority Leader William H.Several pilot studies of RFID tracking in the ED offer insight regarding the potential of this technology to improve the quality, timeliness, and efficiency of emergency care.Goldsmith J, Blumenthal D, Rishel W. 2003. Federal health information policy: A case of arrested development.The ADM maintains an audit trail that records which provider had access to each medication, facilitating investigation of adverse events.The information was updated manually when the staff noticed a change and had the time to update the board.While the barriers to IT adoption are significant, research demonstrates that they are hardly insurmountable.A number of hospital IT tools have been demonstrated to be effective in improving patient flow and efficiency, and to have a direct and substantial impact on ED crowding and the quality of emergency care.Rapid diagnostic tests are available for an increasing number of conditions seen in the emergency setting, including Streptococcus pneumoniae infection, meningitis, bloody diarrhea, and septicemia.

Six key areas of emergency care could immediately benefit from an infusion of IT.At least initially, most molecular tests that will impact the ED will be offered through centralized molecular diagnostics laboratories.Today, it is estimated that fewer than one-third of hospitals and one-fifth of private physicians use EHRs.Appendix B Biographical Information for Main Committee and Hospital- Based Emergency Care Subcommittee.A recent IOM study, Quality Through Collaboration: The Future of Rural Health, highlighted the growing application of telemedicine to emergency and trauma care (IOM, 2004b).Providing emergency physicians with an updated display of the status of laboratory tests has been shown to improve their perceptions of efficiency and communication with patients (Marinakis and Zwemer, 2003).

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Dr. Thompson clicks on a Web page for the Eastern Hospital Emergency call-in program.An added benefit is that rapid diagnostics can be used to determine whether a patient is a carrier of a disease that could potentially harm other patients and health care workers.

Teich JM, Wagner MM, Mackenzie CF, Schafer KO. 2002. The informatics response in disaster, terrorism, and war.As a result, test turnaround times were reduced by 87 percent, ED lengths of stay declined by 41 minutes per patient, and ED diversions decreased.The IOM report Health Literacy: A Prescription to End Confusion documented the poor state of health literacy, even among English-speaking patients, and the serious consequences this can have for health outcomes (IOM, 2004a).ED clinicians are frequently called upon to make crucial decisions under pressure with limited data while maintaining continual readiness for new arrivals, stressing available resources.Bertling CJ, Simpson DE, Hayes AM, Torre D, Brown DL, Schubot DB. 2003. Personal digital assistants herald new approaches to teaching and evaluation in medical education.However they are configured, electronic dashboards allow providers to see the most recent information without the need for manual input.

Baumann MR, Strout TD. 2005. Evaluation of the emergency severity index (version 3) triage algorithm in pediatric patients.Clinical documentation —Electronic documentation of emergency services can facilitate the timely, accurate collection and storage of information regarding the course of patient care, serving as proof of services rendered for reimbursement purposes and supporting public health and research functions, among other benefits.Providers participating in the Massachusetts Healthcare Data Consortium, for example, have access to pharmacy prescription databases for treatment purposes.For example, strategically locating advanced imaging equipment in the ED would shorten patient wait times and improve throughput by accelerating diagnosis.All of the common medical tasks performed by doctors involve information processing: taking a history, examining a patient, ordering and interpreting test results, considering diagnoses, devising a treatment plan, and communicating with other providers about the appropriateness of admission or discharge.Information is generated when procedures are performed, and simply by the presence and flow of patients.For example, the Veterans Health Administration routinely shares its health information and health IT resources—including software and staff expertise—through the Health Information Technology Sharing Program at no or minimal cost.

IOM. 2003. Patient Safety: Achieving a New Standard for Care.IOM. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century.Several examples can be found to demonstrate the inefficiencies and reductions in patient safety that accompany poor implementation of health care IT (Ash et al., 2004). As noted earlier, for example, Cedars-Sinai Medical Center removed its CPOE system after less than 6 months as a result of significant resistance by doctors and nurses who claimed the system was difficult to use.

A key factor inhibiting the rate of adoption of new health care technologies is the lack of development of common health care IT standards (Goldsmith et al., 2003). Data communication standards are sets of rules that allow disparate computer systems to exchange information without requiring custom programming for each new connection.

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Clinical decision support —As stand-alone units or part of a broader system, CDSSs can help guide clinicians in choosing the optimal and most economical therapy and can enhance the safety and efficiency of triage.The condition on which they demand their uew deals is their assertions., De Wat, June SJ, 1SS. Ed.It has been prospectively validated and found to have a high level of interrater reliability (Dong et al., 2005). Existing computer triage systems can also be modified to support syndromic surveillance.The early application of health care IT was limited almost exclusively to hospital accounting systems.Wellwood J, Johannessen S, Spiegelhalter DJ. 1992. How does computer-aided diagnosis improve the management of acute abdominal pain.Currently at most facilities, ED registration represents a significant bottleneck in what should be a serial process.Among the IT tools currently available to assist with the management and coordination of emergency care are those described below.

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The committee therefore recommends that hos pitals adopt robust information and communications systems to improve the safety and quality of emergency care and enhance hospital efficiency (5.1).Register for a free account to start saving and receiving special member only perks.Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. 2004. Reliability and validity of scores on the emergency severity index version 3.

Thus even if the triage staff is unable to match the paper referral to the appropriate patient chart, clinical staff can still see and act on the information via the dashboard display.

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Clinical documentation programs are the next logical choice for many hospitals and health care systems seeking to improve patient flow and enhance quality and safety.Computerized systems provide an excellent overview of the ED and patient flow for both clinicians in the ED and administrators in their offices.The San Francisco Community Clinic Consortium, for example, brings together primary care, specialty care, and EDs in a planning and communications network that closely coordinates the care of safety net patients throughout the city.Brillman JC, Doezema D, Tandberg D, Sklar DP, Davis KD, Simms S, Skipper BJ. 1996. Triage: Limitations in predicting need for emergent care and hospital admission.Moreover, such leadership is needed today to ensure that IT advances are made in a coordinated way that facilitates the necessary interoperability and communication.In its next-generation system, HealtheVet, VistA also implements standard functions for health data repository systems, registration systems, provider systems, management and financial systems, and information and educational systems.

A regional health information organization blazes a trail in upstate New York.Data reveal, however, that the expected level of investment simply has not occurred.Chang P, Hsu YS, Tzeng YM, Sang YY, Hou IC, Kao WF. 2004. The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.The goal of outbreak detection is to generate an alert whenever observed data depart sufficiently from an expected baseline.