Abstract
OBJECTIVES: This study aimed to investigate electronic medical record (EMR) implementation in a busy urban academic emergency department (ED) and to determine the frequency, duration, and predictors of EMR downtime episodes. MATERIALS AND METHODS: This study retrospectively analyzed data collected real time by the EMR and by the operations group at the study ED from May 2016 to December 2017. The study center has used the First Net Millennium EMR (Cerner Corporation, Kansas City, Missouri, USA). The ED operations data have been downloaded weekly from the EMR and transferred to the analytics software Stata (version 15MP, StataCorp, College Station, Texas, USA). RESULTS: During the study period, 12 episodes of EMRD occurred, with a total of 58 hours and a mean of 4.8 ± 2.7 hours. The occurrence of EMRD event has not been associated with on-duty physician coverage levels (p = 0.831), month (p = 0.850), or clinical shift (morning, evening, or night shift) (p = 0.423). However, EMRD occurrence has been statistically significantly associated with weekdays (p = 0.020). DISCUSSION: In a real-world implementation of EMR in a busy ED, EMRD episodes averaging approximately 5 hours occurred at unpredictable intervals, with a frequency that remained unchanged over the first 20 months of the EMR deployment. CONCLUSION: The study could define downtime characteristics at the study center. The EMRD episodes have been associated with inaccuracies in hourly census reporting, with a rebound phenomenon of over-reporting in the first hour or two after restoration of EMR operations.