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?