Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T05:43:34.588Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Wireless Electronic Medical Record System on the Quality of Patient Documentation by Emergency Field Responders during a Disaster Mass-Casualty Exercise

Published online by Cambridge University Press:  13 October 2011

Theodore C. Chan ,
William G. Griswold ,
Colleen Buono ,
David Kirsh ,
Joachim Lyon ,
James P. Killeen ,
Edward M. Castillo  and
Leslie Lenert
Theodore C. Chan*
Affiliation:
Department of Emergency Medicine, University of California, San Diego, San Diego, California USA
William G. Griswold
Affiliation:
Department of Computer Science and Engineering, University of California, San Diego, San Diego, California USA
Colleen Buono
Affiliation:
Department of Emergency Medicine, University of California, San Diego, San Diego, California USA
David Kirsh
Affiliation:
Department of Cognitive Science, University of California, San Diego, San Diego, San Diego, California USA
Joachim Lyon
Affiliation:
Center for Work, Technology, and Organization, Stanford University, Palo Alto, California USA
James P. Killeen
Affiliation:
Department of Emergency Medicine, University of California, San Diego, San Diego, California USA
Edward M. Castillo
Affiliation:
Department of Emergency Medicine, University of California, San Diego, San Diego, California USA
Leslie Lenert
Affiliation:
Department of Emergency Medicine, University of California, San Diego, San Diego, California USA
*
Correspondence: Theodore Chan, MD UCSD DEM200 West Arbor Drive #8676San Diego, California 92103 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.

Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype (“Wireless Internet Information System for medicAl Response to Disasters” or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher’s Exact Testing of Proportions with differences and 95% confidence intervals reported.

Results: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5–24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9–72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3–17.3%]).

Conclusions: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.

Keywords

disasterselectronic medical recordsinformaticsprehospital emergency care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 26 , Issue 4 , August 2011 , pp. 268 - 275
Copyright
Copyright Chan © World Association for Disaster and Emergency Medicine 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chan, TC, Killeen, J, Griswold, WG, Lenert, L: Information technology and emergency medical care during disasters. Acad Emerg Med 2004;11:1229–1236.CrossRefGoogle ScholarPubMed
Gostin, LO, Hanfling, D: National preparedness for a catastrophic emergency. JAMA 2009;302:2365–2366.CrossRefGoogle ScholarPubMed
Teich, JM, Wagner, MM, Mackenzie, CF, Schafer, KO: The informatics response in disaster, terrorism, and war. J Am Med Inform Assoc 2002;9:97–104.CrossRefGoogle ScholarPubMed
Arisoylu, M, Mishra, R, Rao, R, Lenert, LA: 802.11 wireless infrastructure to enhance medical response to disasters. AMIA Annu Symp Proc 2005:1–5.Google ScholarPubMed
Brown, SW, Griswold, WG, Demchak, B, Lenert, LA: Middleware for reliable mobile medical workflow support in disaster settings. AMIA Annu Symp Proc 2006:309–313.Google ScholarPubMed
Killeen, JP, Chan, TC, Buono, C, Griswold, WG, Lenert, LA: A wireless first responder handheld device for rapid triage, patient assessment and documentation during mass casualty incidents. AMIA Annu Symp Proc 2006:429–33.Google ScholarPubMed
Chan, TC, Buono, CJ, Killeen, JP, Griswold, WG, Haung, R, Lenert, L: Tablet computing for disaster scene managers. AMIA Annu Symp Proc 2006:875.Google ScholarPubMed
Aufderheide, E: Disaster Response: Principles of Preparation and Coordination. First edition: Mosby, St. Louis, 1989. Free online edition: Center for excellence in Disaster Management and Humanitarian Assistance; updated 2002. Available at: http://coe-dmha.org/Publications/default.aspx (accessed August 15, 2011).Google Scholar
Wenger, D, Quaranteill, EL, Dynes, R: Disaster analysis: emergency management office and arrangements, final project report no. 34, Disaster Research Center, University of Delaware, Newark, NJ, 1986.Google Scholar
Jha, AK, Desroches, CM, Campbell, EG, Donelan, K, Rao, SR, Ferris, TG, Shields, A, Rosenbaium, S, Blumenthal, D: Use of electronic health records in US hospitals. N Engl J Med 2009;360:1628–1638.CrossRefGoogle Scholar
Gao, T, White, D: A next generation electronic triage to aid mass casualty emergency medical response. Conf Proc IEEE Eng Med Biol Soc 2006; Suppl:6501–6504.CrossRefGoogle ScholarPubMed
Gao, T, Kim, MI, White, D, Alm, AM: Iterative user-centered design of next generation patient monitoring system for emergency medical response. AMIA Annu Symp Proc 2006;284–288.Google ScholarPubMed
Raytheon Electronic Patient Tracking System. Available at http://www.raytheon.com/capabilities/products/epts/. Accessed 01 March 2010.Google Scholar
Verdasee Solutions, Inc. Available at http://www.verdasee.com/Home.aspx. Accessed 01 March 2010.Google Scholar
EMsystems, Inc.: Available at: http://www.emsystem.com/. Accessed 01 March 2010.Google Scholar
Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL: Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med 2009;54:431–436.CrossRefGoogle Scholar
Briggs, SM: Disaster management teams. Curr Opin Crit Care 2005;11:585–589.CrossRefGoogle ScholarPubMed