Electronic medical information systems and timeliness of care in the emergency department: a scoping review

Background Although many emergency department (ED) settings have implemented an electronic medical information system (EMIS) and EMIS tools in an effort to improve timeliness of care outcomes, there remains a paucity of scientific information on this topic. We therefore performed a scoping review to describe the range of EMIS interventions and their impacts on time-based outcomes in the ED. Methods We searched four bibliographic databases to identify potentially relevant records published after 2014 in English. Two reviewers assessed records for eligibility using a two-step screening process. We then extracted data on the type of EMIS, outcomes assessed, and reported results. Findings were summarized in tabular form and grouped by time-based outcome. Results Twenty-five studies met the eligibility criteria, with approximately half being retrospective studies. Interventions varied among studies; they generally included a new or updated EMIS, EMIS tools related to disease diagnosis and/or management, triage tools, or health information exchange platforms. Included studies compared interventions with relevant comparator groups, such as prior versions of an EMIS, absence of an EMIS, pen-and-paper documentation, and/or communication via telephone and fax. The most common outcomes reported were length of stay (n = 17 studies) and time to medication (n = 6 studies), followed by time to order, time to provider, and time from result to disposition. Reported effects of the interventions were generally inconsistent, showing either improvements, delays, or no change in examined outcomes. Conclusions Additional research is needed to determine how electronic medical information may be used in the ED to improve timeliness of care. Findings from this review can be used to inform future systematic reviews that evaluate the impact of these systems and tools on specific quality of care measures.