As emergency departments are becoming busier and struggling to manage the influx of patients, clinicians and staff say they are hamstrung by inefficient and poorly designed ED information systems.

According to a new survey from Black Book, 72 percent of ED managers and physicians are dissatisfied with the usability and interoperability of their information systems, and 89 percent believe their hospitals rushed to purchase new electronic health record systems between 2010 and 2013 in the pursuit of Meaningful Use dollars, only to see productivity fall, liability rise and connectivity stall.

“The applications that we’re seeing from the enterprises really lean toward what the hospital needed and not the individual physicians that are working in the ER,” says Doug Brown, managing partner of Black Book. “ERs are getting busier and busier so productivity in particular was cited in the survey as the most negative feedback.”

Not surprisingly, the survey reveals that 35 percent of hospitals with more than 150 beds currently or plan to replace their EDIS in 2016, with the majority of replacements (69 percent) represented by those now using enterprise EHR emergency modules and opting for “best-of-breed” systems that can integrate with the hospital’s EHR.

“Most best-of-breed EDIS solutions, not all, are fined tuned for the emergency department environment and workflows,” comments Brown. “In contrast, enterprise EHR solutions have typically been very generic with difficult customization processes and long implementations for emergency departments.”­

Also See: HIE Critical to Emergency Medicine, But Info Lacking in ERs

Black Book surveyed 738 emergency department administrative/nursing managers and 1,104 ED physicians—more than half of whom were members of the American College of Emergency Physicians (ACEP). The Internet survey from crowd sourced members of ACEP and hospital ER directors was conducted between August and October.

In the survey, 39 percent of hospitals with enterprise EHR emergency modules identified themselves as moderately to highly dissatisfied with their current EDIS. “Primarily those are the enterprise systems that were implemented as part of Meaningful Use incentives. Now, as EDs are outsourcing more and more physician services those doctors are coming in and saying ‘we can’t work with your system,’” says Brown.

James Augustine, M.D., an emergency physician based in Ohio and an ACEP board member, says he’s not surprised by the results of the survey. Augustine has hands-on experience with both enterprise-wide and ED-specific EHR systems from multiple vendors.

Augustine asserts that it is typically the enterprise EHR emergency modules that “create trouble” due to poor design and functionality, resulting in staff and patient care issues. “In the emergency department, all of them result in lower productivity and difficulty with staffing and staff retention, as well as difficulty in managing patients that are coming into the ED,” he argues. “We have technology that requires a lot more time and attention than those clinicians want to give it.”

Part of the problem, Augustine says, is that the current enterprise systems are based on billing, laboratory or in-patient care systems and are not designed specifically for the ED. As a result, according to Augustine enterprise EHR emergency modules are simply “bolted on” to “accommodate the work in the ER, but does not facilitate it.” However, he is hopeful that EDs have learned from this experience and vendors are becoming more responsive to their specific needs.

Augustine adds that these issues were a hot topic at last week’s ACEP 2015 Scientific Assembly. “We discussed the problem with user interfaces and complications faced by emergency departments and physicians with implementation of enterprise technology systems,” he says. “It’s a huge issue for our members and the patients that we serve.”

For his part, Brown sees a silver lining. While respondent dissatisfaction with EDIS is at high levels in the survey, he believes clinicians are finally getting a say in decisions about system acquisition.

In 2010, Black Book reported that only 7 percent of ED physicians and 2 percent of ED nursing staff were involved on the EDIS selection teams where enterprise EHRs were given as the only technology option for their respective EDs. But, for 2015 and 2016 pending EDIS selection processes, 70 percent of ED physicians and 16 percent of ED nurses indicated that they have been incorporated into the decision-making.

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