It is no secret that emergency departments are under immense pressure. Rising patient volumes, a national nursing shortage, increased demands for patient safety protocols, and new regulatory compliance measures are placing more demands on an already overburdened channel of patient care.

In our national dialogue on the role of emergency medicine, the importance of a healthy delivery mechanism for emergency medicine is not in question. The realities of an aging population with their higher per capita utilization of EDs, an uninsured population base estimated at 40 million people, and an inpatient capacity squeeze within a shrinking national hospital base, force us to examine how to increase the quality and capacity of our emergency departments. Moreover, the emerging threat of bio-terrorism further expands the breadth of care that distinguishes emergency medicine and reinforces its role as a vital healthcare frontline for our nation.

The mechanics of emergency medicine have evolved little for a field of medicine that now sees more than 35 million additional patients annually compared with just thirty years ago. This is particularly evident in how clinicians track patients and manage patient documentation.

Manual grease-boards are still the prevailing methodology used to identify the location and acuity levels of emergency patients despite the difficulties in keeping the information up-to-date, private and still convenient for viewing. Electronic patient tracking modules have begun to penetrate the marketplace in the past decade, but unless they are linked to electronic documentation solutions, they can add another layer of complexity to patient management.

Patient documentation is often paper-based with clinicians hand writing notes, or using templated charts. These methods are not only time-consuming, but due to illegibility or incompleteness, are inefficient for intra-department communication and for optimization of professional and facility reimbursement. And templates do not address medical decision-making – one of the most important components of charting. Moreover, both handwritten and templated methods are difficult to manage securely and cannot support quality improvement initiatives without cumbersome manual work.

Dictated notes are sometimes presented as the gold standard of charting, but the expense is no longer competitive with more robust electronic charting options. Dictated notes are themselves time-consuming and although structured, are not complaint-specific. Other issues include transcription errors, minimal search capability and the lack of real time TQM reporting capability.

Computerized documentation offers a new paradigm for patient care management. Here are just a few of the many ways that electronic medical records can enhance the efficiency and effectiveness of an emergency department.

In an ED, much time is devoted to coping with documentation tasks which takes time away from attending to patients. Computerized documentation tools offer the potential to complete patient documentation faster than handwriting or dictating charts by expediting data entry and automating repetitive tasks. Time saved charting can assist an emergency department in increasing their capacity with existing staffing levels and physical plant.

When designed optimally, a computerized system can do more than expedite the completion of standard documentation requirements. By embedding diagnostic and medical treatment intelligence into the system, a computerized documentation system can provide powerful clinical support for the emergency physician right at point-of-care. This includes tools such as differential diagnoses generation, automated treatment plans and medication dosing based on a patient’s age and weight and much more. These tools represent real-time risk management support.

Computerized medical records employ electronic security mechanisms to protect access to patient charts using passwords and/or biometric authentication tools (ie. fingerprint readers) Access to the contents of the medical chart can be further governed by role-based (ie. physician, nurse, administrator) and user-based (user-specific) access controls. These measures can help control access to only the protected health information that a given user requires – a key tenet of the Health Insurance Portability and Accountability Act (HIPAA). Additionally, computerizing your medical records can create an automated log of all access to each record to support an ED's need for an accounting to patients of all access to their medical record.

Computerized documentation can incorporate automated patient coding for CPT and ICD- 9 codes as you chart. The system intelligence not only codes accurately but can also alert a physician to check their documentation prior to closing the chart in order to receive the maximum eligible billing. This automated coding feature saves the expense of employing coders to code every chart – an expense that can be in excess of two dollars per chart.

Misheard verbal orders, illegible hand writing, confusion over the status of orders along with tedious, often repetitive documentation, can all contribute to the stress of an emergency department. With a computerized system, caregivers can update each other as they chart, with results appearing in charts and on the electronic tracking boards that are visible at every ED workstation. Verbal orders are minimized as the information is presented clearly and accurately on each workstation. Calls from pharmacies are reduced as automatically-generated prescriptions, capable of being faxed to local pharmacies, eliminate dosage errors and liability problems.

These are just some of the many benefits of computerizing patient tracking and documentation to create electronic medical records within an emergency department. As the national discussion continues regarding solutions for enhancing emergency medical care, the role for computerization of medical records will rise in significance.

Commenting on the National Report Card on the State of Emergency Medicine