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Emergency Department Information Technology/CEDR

Main Points:

  • ACEP supports advances in health information to improve patient care, patient safety and efficiency.[1]
  • Information technology is changing the way today’s emergency departments operate.
  • Consistent, user-friendly electronic health records are vital in a medical emergency, because physicians may not have ready access to patients’ medical information.
  • While significant progress has been made in regard to electronic health records, sharing information across regions continues to be a challenge.
  • ACEP in 2016 launched the first emergency medicine specialty-wide registry at a national level in an effort to design and promote health care quality and outcomes — the Clinical Emergency Data Registry (CEDR).

What are the benefits of information technology in the emergency department?

  • New technologies are developing every day to improve patient care — from ensuring correct doses of medications to tracking pain levels of patients. By automating processes, medical staffs spend less time looking for information (e.g., tracking lab results, x-rays, past medial history) and entering duplicate data.  Information technology is helping change the way today’s emergency departments operate by eliminating redundant patient records and allowing medical information to be accessed instantly and simultaneously at multiple sites.
  • Examples of beneficial technologies include tablet computers, which allow physicians and nurses to access and enter medical information at the bedside. In addition, bedside ultrasound and laboratory testing help with rapid diagnosis and treatment. Telemedicine (remote access via the internet) is increasingly being used to extend the reach of specialists into emergency departments that would otherwise not be available. For example, a remote neurologist can help an emergency department assess a stoke patient, when time is critical. Applied to pre-hospital care, telemedicine can include real-time video and data links between emergency departments and ambulances that allow remote patient assessment and full integration of automatic crash notification systems with public safety dispatch systems.

What steps are being taken to promote electronic health records?

  • ACEP is committed to promoting development of electronic health records and other health information technologies, such as a nationwide health information network.

In 2009, the HITECH Act[2] provided nearly $20 billion in incentives for physicians (up to $40,000 per physician) and hospitals (several million dollars) to adopt electronic health records by 2014 and  hospitals and physicians could be penalized if they do not go digital by 2015. 

  • While emergency physicians are exempt from the requirements and financial incentives, many hospitals are deploying these systems in the emergency department as a roadmap to meeting “meaningful use” necessary to qualify for these incentives. Further, with time, emergency department patients will benefit from increased availability of outpatient and other data previously not readily accessible in an emergency.
  • HITECH also provided for the continuation (initiated by executive order in 2004) of The Office of the National Coordinator (ONC) for Health Information Technology (a staff division of the HHS Secretary) whose mission is coordination of nationwide efforts to implement and use health information technology and the electronic exchange of health information.
  • There are multiple private and other publically funded HIT projects, including several efforts to establish robust Regional Health Information Exchanges[3].

What are the challenges to implementing electronic health records?

  • A survey of 3,000 hospitals in 2008 found that most of the nation’s hospitals did not have electronic health records (only 9 percent). (NEJM 2008). By 2011 it was a much different story. American Hospital Association reported that the percentage of US hospitals that had adopted EHRs more than doubled from 16 to 35 percent between 2009 and 2011. Eighty-five percent of hospitals reported in 2015 that they intend to take advantage of the incentive payments made available through the Medicare and Medicaid EHR Incentive Programs.[4]
  • Similar to hospital general EHR adoption, Emergency Department Information System (EDIS) adoption remains anemic. A 2010 study showed fewer than 2 percent of our nation’s emergency departments have a fully functional EDIS, 16.1 percent a complete EDIS, 30.4 percent a partial EDIS, and 53.5 percent none.[5]
  • Despite major initiatives, the true effectiveness of EHRs remains unclear.[6],[7][8] Some studies indicate that they may not save money,[9] reduce medical errors[10] or even improve patient care.[11] Other concerns center on the usability and increasing data entry “IT overhead” associated with electronic systems.[12] This is particularly true in fast-paced ERs, where some employ medical scribes to help mitigate that impact.[13],[14],[15]
  •  Security and privacy of health information will always be an issue. While in many ways EHRs improve security (unauthorized access), privacy (misuse of authorized access) becomes challenging with broader access (e.g. HIE). Nevertheless, privacy must be balanced with the need for ready access, especially in an emergency. The real value of EHRs cannot be achieved without aggregated broadly available data at the point of care. Many state privacy laws have yet to catch up to this modern technology.
  • Cost:  Despite financial incentives (and avoidance of future penalties), EHR adoption remains expensive.  In addition, efforts to meet regulatory requirements (i.e. “meaningful use”) have had some negative consequences. Related to efforts made to comply with regulations, emergency department technology needs are often neglected. Worse, well-adopted and functional “best-in-breed” EDISs are being replaced by less functional EMR emergency department modules under the guise of vendor consolidation and interoperability. For example, in an effort to meet meaningful use, it may be easier to implement CPOE in the ER with the hospital-wide EMR module vs. doing a “one-off” CPOE with a “best-of-“breed EDIS. There also intangible costs, which include productivity losses, additional staff and technology “work-arounds.”
  • The ACEP Section for Emergency Medicine Informatics (EMI) is a special interest group of physician IT advocates that help ACEP monitor, promote, guide and advocate for HIT advancement. The Section collaborated with the Quality Improvement and Patient Safety (QIPS) Section and published “Quality and Safety Implications of Emergency Department Information Systems”[16]  The leaders of the EMI section have authored a white paper on Health Information Exchanges (publication pending).

What is a clinical data registry?

  • The Clinical Emergency Data Registry (CEDR) will promote the highest quality of emergency care for patients as well as demonstrate the value of emergency care. For more information: http://www.acep.org/cedr/
  • The 2012 American Taxpayer Relief Act authorized a new standard for individual eligible professionals (EPs) to satisfy Physician Quality Reporting System (PQRS) reporting requirements beginning in 2014.
  • This new mechanism recognizes satisfactory participation in a qualified clinical data registry (QCDR) in lieu of reporting traditional PQRS measures to CMS. QCDRs may submit information on both PQRS measures and up to 30 additional non-PQRS specialty specific measures.
  • QCDRs give a better picture of the overall quality of care provided, because QCDRs collect and report quality information on patients from all payers, not just Medicare patients.
  • It also will provide data to identify practice patterns, trends and outcomes in emergency care.

For more information on this and other topics, visit www.acep.org and www.acep.org/cedr.


[1] Health Information Technology, ACEP Policy Statement, August 2008.

[2] Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009.

[3] http://www.healthit.gov/policy-researchers-implementers/state-health-information-exchange.

[4] http://www.healthit.gov/media/pdf/ONC_Data_Brief_AHA_2011.pdf.

[5] Landman AB, Bernstein SL, Hsiao AL, Desai RA. Emergency Department Information System Adoption in the United States. ACA EM 2010; 17:536–544.

[6] Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005 Mar 9;293(10):1223-38.

[7] Wears RL, Berg M: Computer technology and clinical work: still waiting for Godot. JAMA. 2005 Mar 9;293(10):1261-3.

[8] It Ain’t Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs. Health Affairs 25, no. 4 (2006): 1079–1085.

[9] Himmelstein DU, Wright A, Woolhandler S. Hospital Computing and the Costs and Quality of Care: A

National Study. The American Journal of Medicine (2009)

[10] Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL: Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005 Mar 9;293(10):1197-203.

[11]Jury still out on whether EMRs improve patient care. American Medical News. Feb 14, 2013.

[12] EMR not boosting productivity? It could be a mismatch between system and specialty. American Medical News. Jan. 17, 2011.

[13] Use of Scribes, an Information Paper. ACEP June 2011.

[14] Arya R, Salovich DM, Ohman-Strickland P, Merlin MA. Impact of Scribes on Performance Indicators in the Emergency Department. ACA EM 2010; 17:490–494.

[15] One answer to EMR data entry - Hire a scribe to do it - AM News - July 14, 2008.

[16] Farley et al. Quality and Safety Implications of Emergency Department Information Systems. Ann Emerg Med. Jun 21, 2013. 


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