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clinical decisions in constrained timeframes and
under high degree of uncertainty.
In order to address this issue, we have conducted
a field study to examine the impact of KMS in an
emergency room (ER) at a major hospital in the
United States. Specifically; we investigated the
following research questions:
Research Question 1: How does the use
knowledge management system change the clinical
decision-making behaviors by medical
professionals?
Research Question 2: What are the impacts of the
use of knowledge management system on cost and
efficiency in clinical decision-making?
2 A FIELD STUDY OF KMS USE
IN AN EMERGENCY ROOM
Lately, the popularity and deployment of EMR
(electronic medical records) have been on the rise in
the U.S. EMR systems are integrated IT systems for
healthcare information management and process
support. We anticipate that the eventual ubiquitous
availability of EMR systems in the U.S. will create
the necessary “backbone” that serves as the
infrastructure for knowledge codification, storage,
search, and delivery for clinical decision-making.
This in turn creates a need for conducting studies
that provide the necessary insights and
understanding for development and deployment of
knowledge management systems (KMS) for
effective and efficient delivery of patient care.
The effectiveness and outcomes of the decisions
made in an emergency room depend on timely and
accurate diagnosis and delivery of appropriate
treatments to patients. These decisions are in turn
impacted by the timely availability of the requisite
knowledge such as the knowledge of diagnostic tests
and their outcomes, treatment protocols, and
accurate presentation of the patient’s condition and
symptoms. As such, clinical decisions in emergency
rooms can benefit from the codification,
accumulation, and delivery of knowledge to
augment physicians’ judgment and know-how.
We investigated the impact of the use of a KMS
by emergency room physicians on the rate of
admission of emergency room patients to the
hospital, emergency room charges, and patient time
spent in the ER. The emergency room under
investigation serves the 573-bed university hospital
and is staffed by 38 physicians, working between
one to fifteen 8-hour shifts per month. The ER
treated approximately 93 patients per day and in
2009, a total of about 34,000 patients were treated at
this facility.
The emergency room in our field study routinely
collects and maintains patient records in a data
warehouse. The records of all adult patients (18
years and older) who visited the ER in a 321 day
period between January 2009 and November 2009
were used in this study (the precise dates were
masked to protect patient anonymity). For the
purpose of this study, we analyzed the records of ER
patients who complained of abdominal pain as their
primary symptom. We chose to focus on abdominal
pain complaints because they represent relatively
ambiguous cases and can potentially benefit the
most from the use of a KMS. Considering patient
privacy issues, we used a de-identified data sample.
This was accomplished by creating new data sets
from the warehouse patient records by excluding all
identifying fields, assigning appropriate aliases, and
copying the remaining data fields. The data fields
used in our analyses are described in Table 1.
The IT infrastructure in the ER consisted of an
EMR system, FirstNet, by Cerner Corporation in
Kansas City, Missouri. FirstNet functionalities
include electronic records and notes, results
management (e.g., lab and radiology reports),
clinical provider order entry (e.g., test orders), and a
KMS for decision support (e.g., standard diagnostic
orders and clinical guidelines and protocols). The
KMS module provides physicians with
recommended diagnostic tests and medication order
sets, based on the patient’s symptoms. As such, this
module can enhance the accuracy of diagnosis and
delivery of appropriate patient care. The standard
order sets (the codified knowledge embedded in the
system) are developed by expert physicians based on
the best available evidence of their efficacy.
Physicians and nurses, however, can choose not to
use the KMS recommendation and place their own
orders.
We focused our investigation on the impact of
the use of diagnostic order sets placed through the
KMS on patient care outcomes.
In order to control for the exogenous impact of the
severity of the conditions that affect the outcome of
the ER visit, we only focused on two most prevalent
acuity levels (urgent and emergent), resulting in a
sample of 2238 emergency department visits. A
small number of immediate, stable, and non-urgent
cases were dropped. Table 2 shows basic descriptive
statistics and the correlations between variables. All
correlations with an absolute value of 0.07 or greater
are significant at the p <0.05 levels.
AN INVESTIGATION OF THE USE OF KMS ON CLINICAL PERFORMANCE
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