Friday, April 26, 2013

New South Wales Dislikes Cerner

The grass is clearly greener on the other side for these folks at Nepean Hospital in New South Wales, AUS.  This study details the before-and-after Emergency Department core measures as they transitioned from the EDIS system to Cerner's FirstNet.  As they state in their introduction, "Despite limited literature indicating that FirstNet has decreased performance" and "reports of problems with Cerner programs overseas", FirstNet was foisted upon them – so it's clear they have an agenda with this publication.

And, a retrospective, observational study is the perfect vehicle for an agenda.  You pick the criteria you want to measure, the most favorable time period, and voilĂ !  These authors picked a six month pre-intervention period and a six-month post-intervention period.  Triage categories were similar for that six month period.  And then...they present data on a three-month subset.  Indeed, all their descriptive statistics are of only a three-month subset excepting ambulance offload waiting time – for which they have full six month data.  Why choose a study period fraught with missing data?

Then, yes, by every measure they are less efficient at seeing patients with the Cerner product.  The FirstNet system had been in place for six months by the time they report data – but, it's still not unreasonable to suggest they're somewhat suffering the growing pains of inexperience.  Then, they also understaff the ED by 3.2 resident shifts and 3.5 attending shifts per week.  An under-staffed ED for a relatively new implementation of a product with low physician acceptance?  

As little love I have for Cerner FirstNet, I'm not sure this study gives it a fair shot.

"Effect of an electronic medical record information system on emergency department performance"
www.ncbi.nlm.nih.gov/pubmed/23451963

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