The electronic medical record plays a key role in improving the emergency department workflow, so this article highlights some clear benefits and key points to be taken into account
- In the ED, in most instances, a patient cannot be left waiting so finding the existing medical record was not an option except in some complex cases where previous information was key for certain decisions.
- The workflow of the transportation of medical records had a delay of 24 hours and the process for immediate transportation was only for emergencies.
I. Unified order platform. All the clinical orders used by a clinician during patient care must able to be managed easily, quickly and intelligently in a unique page screen. This has to include laboratory, radiology, pharmacy and other clinical tests as well as clinical consultations, appointments and other procedures.
II. Access to clinical documentation without barriers. All the clinical documentation must be available to the physicians and nurses regardless of whether the record comes from primary care, ICU, ambulatory visits, surgery area or other areas. It is fundamental not to have islands of information and, today, this is quite common.
III. Integration of diagnostic tests in the EMR. Each test done in the care process has to be integrated with the EMR and this means an online flow of orders and results of the laboratory, radiology, electrocardiogram and other common ED tests. The integration will make it possible to implement alerts that are triggered by important results.
IV. Closed loop medication process. Medication can be a risk for the patient in some cases, due to allergies, interactions between different drugs or errors in the dose administered. Implementing algorithms in the EMR for avoiding these threats adds a level of additional safety to the care process.
V. Different workflows for different pathologies. The admission process must implement a patient triage starting different workflows for different pathologies or types of patients, trying to do the best for each case and introducing clinical pathways and best practices.
A. The unified order platform saves time on ordering and detects duplicity or previous similar tests that the patient has undergone. Through a unified EMR, a hospital or a healthcare system creates a single source of correct information for each patient’s health record. For that reason, it adds efficiency to the process, optimises the care given and improves patient experience. Providers communicate patient care decisions more efficiently and effectively. Nurses and other ancillary caregivers are immediately made aware of patient care decisions. And pharmacists receive clear and precise care decision information. Multiple providers can work simultaneously on the same record, even if they are based in different locations. These efficiencies eliminate time wasting, duplicative processes.
B. More clinical information at the point-of-care improves efficiency as it results in less time for diagnosis but it also increases safety, thanks to the availability of the clinical information from previous contact with the patient.
C. Real-time clinical decision support systems are poor if they do not have online results of laboratory, vitals and other tests. Good algorithms use clinical data to implement the rules. In this case, the clinical decision support system (CDSS) is adding safety and quality in the care process. In addition, the clinical decision support system helps reduce patient safety risks and financial impact due to over-testing, over-prescribing, prescribing expensive drugs when there are low-cost alternatives, and referring without proper work-up.
D. Nowadays, everybody knows that one important cause of clinical errors is the medication administered to patients in hospitals. There are multiple benefits of automating the medication integration process:
- Improved safety through reduction of human error such as errors caused by illegibility of written notes, transcription errors, errors in the Five Rights process (the right patient, the right drug, the right dose, the right route, and the right time).
- Automation of positive patient identification (PPID).
- Verification of the Five Rights.
- Automation of charge capture and improved charging accuracy.
- Improved compliance with standards for patient identification and documentation.
- Consistent messaging at the point-of-care.
- Power at the point-of-care.