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

Introduction: Emergency departments (EDs) face escalating pressures from rising patient volumes, workforce shortages, and documentation burdens. Digital health technologies have shown promise individually, but most are implemented in isolation, limiting their collective impact. This narrative review synthesizes evidence for six digital health technologies applicable to the ED and proposes a three-pillar framework for their coordinated implementation, positioning the ED as a convergence point for health system digital transformation.

Methods: We searched PubMed and Google Scholar for peer-reviewed literature published from 2018 through July 2026 on ambient artificial intelligence (AI) documentation, telehospitalist programs, virtual nursing, remote patient monitoring, virtual specialty consultation, and postdischarge transitional care, prioritizing systematic reviews and meta-analyses. Fifty-one sources met inclusion criteria and were synthesized. We organized the technologies into three functional pillars: streamlining clinical workflows; expanding workforce capacity; and extending continuity of care. Outcomes included clinical, operational, and implementation measures. Experience from Houston Methodist, a nine-hospital health system, is presented as an illustrative example separate from the literature synthesis.

Results: Of the 51 sources, 23 (45.1%) addressed streamlining clinical workflows, 16 (31.4%) expanding workforce capacity, and 12 (23.5%) extending continuity of care. Overall, 22 (43.1%) were ED-specific: 10, five, and seven within the respective pillars. Ambient AI documentation included 13 sources (seven ED-specific); telestroke included one ED-specific source. Evidence maturity varied by technology and setting. In non-ED settings, meta-analyses reported shorter documentation time with ambient AI documentation (standardized mean difference, -0.72; 95% CI, -0.99 to -0.45), lower hospital mortality with tele-intensive care (risk ratio, 0.74; 95% CI, 0.58-0.96), and lower odds of 30-day readmission with low-complexity post-discharge interventions (odds ratio [OR], 0.78; 95% CI, 0.66-0.92). Emergency department-specific evidence remained largely observational; one meta-analysis showed no mortality difference with telestroke (OR, 1.16; 95% CI, 0.94-1.43), while one systematic review found no demonstrable benefits from telephone follow-up post-ED discharge.

Conclusion: Current evidence supports individual digital health technologies in and around the ED. Based on implementation science principles and institutional experience, we propose that coordinated implementation across the three pillars may offer advantages over isolated deployments, a hypothesis warranting prospective comparative evaluation.