Department of Emergency Medicine, Yale University, New Haven, CT, USA.
Acad Emerg Med. 2010 May;17(5):536-44. doi: 10.1111/j.1553-2712.2010.00722.x.
The American Recovery and Reinvestment Act of 2009 incentivizes adoption of health care information technology (HIT) based on support for specific standards, policies, and features. Limited data have been published on national emergency department information systems (EDIS) adoption, and to our knowledge, no prior studies have considered functionality measures. This study determined current national estimates of EDIS adoption using both single-response rates of EDIS adoption and a novel feature-based definition and also identified emergency department (ED) characteristics associated with EDIS use.
The 2006 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits that also surveyed participating EDs on EDIS, was used to estimate EDIS adoption. EDIS adoption rates were calculated using two definitions: 1) single-response-response to a single survey question as to whether the EDIS was complete, partial, or none; and 2) feature-based-based on the reported features supported by the EDIS, systems were categorized as fully functional, basic, other, or none. The relationship of EDIS adoption to specific ED characteristics such as facility type and location was also examined.
Using the single-response classification, 16.1% of EDs had a complete EDIS, while 30.4% had a partial EDIS, and 53.5% had none. In contrast, using a feature-based categorization, 1.7% EDs had a fully functional EDIS, 12.3% had basic, 32.1% had other, and 53.9% had none. In multivariable analysis, urban EDs were significantly more likely to have a fully functional or basic EDIS than were rural EDs. Pediatric EDs were significantly more likely than general EDs to have other EDIS.
Despite more optimistic single-response estimates, fewer than 2% of our nation's EDs have a fully functional EDIS. EDs in urban areas and those specializing in the care of pediatric patients are more likely to support EDIS. Accurate and consistent EDIS adoption estimates are dependent on whether there are standardized EDIS definitions and classifications of features. To realize the potential value of EDIS for improved emergency care, we need to better understand the extent and correlates of the diffusion of this technology and increase emergency medicine engagement in national HIT policy-making.
2009 年美国复苏与再投资法案激励采用基于特定标准、政策和功能的医疗保健信息技术（HIT）。关于国家急诊信息系统（EDIS）的采用，发表的数据有限，据我们所知，以前的研究都没有考虑过功能措施。本研究使用 EDIS 采用的单一响应率和一种新颖的基于功能的定义来确定当前全国 EDIS 采用的估计值，并确定与 EDIS 使用相关的急诊部门（ED）特征。
使用全国代表性的急诊就诊样本——2006 年全国医院门诊医疗保健调查，该调查还调查了参与 EDIS 的参与 ED，以估计 EDIS 的采用情况。使用两种定义计算 EDIS 采用率：1）单一响应-对 EDIS 是否完整、部分或无的单一调查问题的响应；2）基于 EDIS 支持的报告功能的基于功能的-系统被归类为功能齐全、基本、其他或无。还检查了 EDIS 采用与特定 ED 特征（如设施类型和位置）的关系。
使用单一响应分类，16.1%的 ED 具有完整的 EDIS，30.4%的 ED 具有部分 EDIS，53.5%的 ED 没有 EDIS。相比之下，使用基于功能的分类，1.7%的 ED 具有功能齐全的 EDIS，12.3%的 ED 具有基本功能，32.1%的 ED 具有其他功能，53.9%的 ED 没有 EDIS。在多变量分析中，城市 ED 比农村 ED 更有可能拥有功能齐全或基本的 EDIS。儿科 ED 比普通 ED 更有可能拥有其他 EDIS。
尽管有更乐观的单一响应估计，但全国不到 2%的 ED 拥有功能齐全的 EDIS。城市地区的 ED 和专门从事儿科患者护理的 ED 更有可能支持 EDIS。准确和一致的 EDIS 采用估计取决于是否有标准化的 EDIS 定义和功能分类。为了实现 EDIS 在改善紧急护理方面的潜在价值，我们需要更好地了解这项技术的扩散程度和相关性，并增加急诊医学在国家 HIT 决策制定中的参与度。
