Computers in Emergency Medicine| Volume 41, ISSUE 6, P693-700, December 2011

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Implementation of an Emergency Department Computer System: Design Features That Users Value



      Electronic medical records (EMRs) can potentially improve the efficiency and effectiveness of patient care, especially in the emergency department (ED) setting. Multiple barriers to implementation of EMR have been described. One important barrier is physician resistance. The “ED Dashboard” is an EMR developed in a busy tertiary care hospital ED. Its implementation was exceptionally smooth and successful.

      Study Objectives

      We set out to examine the design features used in the development of the system and assess which of these features played an important role in the successful implementation of the ED Dashboard.


      An anonymous survey of users of the ED Dashboard was conducted in January and February 2009 to evaluate their perceptions of the degree of success of the implementation and the importance of the design features used in that success. Results were analyzed using SPSS software (SPSS Inc., Chicago, IL).


      Of the 188 end-users approached, 175 (93%) completed the survey. Despite minimal training in the use of the system, 163 (93%) perceived the system as easy or extremely easy to use. Users agreed that the design features employed were important contributors to the system's success. Being alerted when new test results were ready, the use of “most common” lists, and the use of color were features that were considered valuable to users.


      Success of a medical information system in a busy ED is, in part, dependent on careful attention to subtle details of system design.


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        • Trzeciak S.
        • Rivers E.P.
        Emergency department overcrowding in the United States: an emerging threat to patient safety and public health.
        Emerg Med J. 2003; 20: 402-405
        • Hoot N.
        • Aronsky D.
        Systematic review of emergency department crowding: causes, effects and solutions.
        Ann Emerg Med. 2008; 52: 126-136
        • Derlet R.W.
        Overcrowding in emergency departments: increased demand and decreased capacity.
        Ann Emerg Med. 2002; 39: 430-432
        • Chuadry B.
        • Wang J.
        • Wu S.
        • et al.
        Systematic review: impact of health information technology on quality, efficiency and costs of medical care.
        Ann Intern Med. 2006; 144: 742-752
        • Ashish K.J.
        • DesRoches C.M.
        • Campbell E.G.
        • et al.
        Use of electronic health records in U.S. hospitals.
        N Engl J Med. 2009; 360: 1628-1638
        • Scott J.T.
        • Rundall T.G.
        • Vogt T.M.
        • Hsu J.
        Kaiser Permanente's experience of implementing an electronic medical record.
        BMJ. 2005; 331: 1313-1316
        • Lapointe L.
        • Rivard S.
        Getting physicians to accept new information technology: insights from case studies.
        CMAJ. 2006; 174: 1573-1578
        • Ford E.W.
        • Manachemi N.
        • Peterson L.T.
        • Huerta T.R.
        Resistance is futile: but it is slowing the pace of EHR adoption nonetheless.
        J Am Med Inform Assoc. 2009; 16: 274-281
        • Likourezos A.
        • Chalfin D.B.
        • Murphy D.G.
        • Sommer B.
        • Darcy K.
        • Davidson S.J.
        Physician and nurse satisfaction with an Electronic Medical Record system.
        J Emerg Med. 2004; 27: 419-424
        • Shelton R.
        The Emergency Severity Index 5-level triage system.
        Dimens Crit Care Nurs. 2009; 28: 9-12
        • Johnson C.W.
        Why did that happen? Exploring the proliferation of barely usable software in healthcare systems.
        Qual Saf Health Care. 2006; 15: i76-i81
      1. Armijo D, McDonnell C, Werner K. Electronic health record usability. Interface design considerations. Agency for Healthcare Research and Quality website. Available at: Accessed February 10, 2010.

        • Miller R.
        • Sim I.
        Physicians' use of electronic medical records: barriers and solutions.
        Health Aff (Millwood). 2004; 23: 116-126
        • Berg M.
        Implementing information systems in health care organizations: myths and challenges.
        Int J Med Inform. 2001; 64: 143-156
        • Kushniruk A.W.
        Evaluation in the design of health information systems: applications of approaches emerging from usability engineering.
        Comput Biol Med. 2002; 32: 141-149
        • Patel V.L.
        • Kushniruk A.W.
        Interface design for health care environments: the role of cognitive science.
        Proc AMIA Symp. 1998; : 29-37