Information management in the emergency department.

Information system planning for the ED is complex and new to emergency medicine, despite being used in other industries for many years. It has been estimated that less than 15% of EDs have comprehensive EDIS currently in place. The manner in which administration is approached in large part determines the success in obtaining appropriate institutional support for an EDIS. Active physician and nurse involvement is essential in the process if the new system is to be accepted at the user level. In the ED, large volumes of information are collected, collated,interpreted, and acted on immediately. Effective information management therefore is key to the successful operation of any ED. Although computerized information systems have tremendous potential for improving information management, such systems are often underused or implemented in such a way that they increase the workload on caregivers and staff. This is counter productive and should be avoided. In developing and implementing EDIS one should be careful not to automate poorly designed manual processes. Examples are ED tracking systems that require staff to manually relocate patients in the system. This task probably is completed only when the ED volume is low and "worked around" when the department is busy. Information from such a system is, therefore, flawed; at best useless and at worst counter productive. Alternatively, systems are available that can track patients automatically through the ED by way of infrared sensors similar to those used in baggage-tracking systems that have been in place in airports for years. In the automated (computerized) ED, we must have zero-fault-tolerant,enterprise-wide, hospital information networked systems that prevent unnecessary duplication of tasks, assist in tracking and entering data, and ultimately help analyze the information on a minute-to-minute basis. Such systems only reach their potential when they are fully integrated, including legacy systems, rather than stand alone proprietary EDIS. Further,a modular approach in which individual components are connected to a flexible computer backbone is ideal.Finally, good clinical content is key to virtually every aspect of the EDIS. Much of this content is yet to be developed and what is available still needs to be adapted to the EDIS environment. Daunting as it may be, an EDIS implementation properly accomplished results in better patient care, improved staff productivity, and a satisfying work environment (Box 3).