Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

The HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009 galvanized the universal adoption of electronic health record (EHR) systems to improve the quality, delivery, and coordination of patient care.¹ Initial results demonstrated improvement in population health outcomes and increased transparency.^2-3 Through the HITECH Act’s Meaningful Use (MU) incentives, EHR adoption also promised shorter hospital stays, reduced costs and improved access to healthcare data.⁴ These promises, however, never materialized; studies have demonstrated that EHR adoption causes decreased rates of patients seen per hour, highly variable documentation times, and increased order entry times.⁵

The unintended consequences of the HITECH Act are exacerbated in the emergency department (ED). While the few studies examining practical limitations of ED EHR use are limited to single-site studies with variable, non-validated outcomes, they suggest that MU obstructs ED best customs and practices and is potentially dangerous. ^6-7 For instance, real-time computerized charting is difficult because it requires a bedside computer and Internet access, but installing the required hardware is limited by cost and regulations governing the use and renovation of hospital facilities.⁸ MU requirements also stipulate a transition to computerized physician order entry (CPOE); however, prior studies have demonstrated that CPOE increases order entry times, exacerbating the well-documented issue of ED crowding and boarding.^1,5,9 In emergent situations, CPOE forces physicians to leave the deteriorating patient’s bedside to access a computer before treatment can be rendered.