Role Playing: Technology in Emergency Medicine

When it comes to healthcare information technology (HIT), emergency medicine physicians are in-the-know—simply because they have to be. In order to maintain accuracy under intense crisis situations, having the best method of tracking patient data is crucial. Naturally, this means using a completely paperless system courtesy of electronic health records (EHRs), and that oftentimes means doling out sensitive patient information to health organizations.

In fact, “emergency departments are often the starting point for Regional Health Information Organizations (RHIOs) and other projects that involve sharing all or part of patients’ records,” according to Government Health IT News senior editor, Nancy Ferris. A RHIO is a “group of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery.” Naturally, this gamble is largely based on the belief that technology—specifically EHRs—will guide emergency medicine into a very profitable future. However, as with any complex issue, there are potential benefits and drawbacks.

Ferris goes on to point out that a good number of patients believe that in an emergency, it is important for the doctors treating them to know their medical histories, and they might be unconscious or otherwise incapable of sharing that information with doctors. EHRs alleviate this worry, particularly with regard to receiving duplicate medication, testing, or other unnecessary measures of care. Additionally, the financial benefits to both patients and doctors is reason enough to implement an EHR in the emergency department setting.

Pros and Cons

It may be common knowledge in the industry that the stability of RHIOs is shaky at best. Yet the difficulty of putting such a system into place—as illustrated in an August Government Health IT News profile of a failed attempt by one Santa Barbara, CA hospital—does not necessarily apply to the majority of organizations. Rather, each hospital’s ability to utilize technology (eg, EHRs) to the advantage of its patients is a better indicator of its overall success.

iHealthBeat reported on the progress of RHIOs despite recent failures, citing former national health IT coordinator David Brailer’s enthusiasm for the concept as a valuable model. Brailer was quoted as saying that “the very presence of RHIOs makes it more likely that positive change will happen, and that change will help RHIOs be sustained.”

Health Management Technology Magazine covered the RHIO business model and examined what qualifies a hospital to become a part of this seemingly growing movement. Brailer remarked that “when you’re in an industry that penalizes efficiency and… quality, if your primary purpose is efficiency and quality, it’s hard to create a business model.” Thus, the complexity involved with maintaining RHIOs, to date.

You Can Lead a Horse to Water…

Although a reliance on technology remains a vital part of the emergency medicine doc’s day-to-day activities, there is budding concern as to any associated learning curves. As one blogger—who goes simply by “EMDoc”—remarked multiple times on his Emergency Medicine Doc page, learning the ins and outs of healthcare technology is a concern among new medical school graduates and young ER physicians. He stated that “working at a facility where in the emergency department we do use all computerized systems, I would find this hard to live without. I can sit at my workstation, see every patient in the department, view their chief complaint and triage note, and their prior visit history—including all the old history and physicals, and lab results. I can order all my tests and view new and old plain x-rays, CT Scan and ultrasounds. I can also access the Internet.” Yet personal negative experiences with emergency department staff gave EMDoc cause for concern.

Why would anyone argue against the use of EHRs, even if it is for the best interests of the business? Clearly improved patient quality of care far outweighs any entrepreneurial ploys, even if it does qualify a hospital for “membership” in a RHIO system.

The Certification Commission for Healthcare Information Technology (CCHIT) and the MITRE Corporation announced a collaborative relationship to begin building a testing resource to evaluate compliance of EHRs and networks with certification criteria for interoperability. The idea was to allow for “HIT companies to add standards-based information exchange capabilities to their products and prepare those products for certification.”

Such measures seem to point to the livelihood of EHRs, not their demise. Will emergency department physicians continue to chomp at the bit, or decide the financial gain of joining RHIOs simply isn’t worth the hassle? We shall see.