iCIMS Published in the Annals of Emergency Medicine

The iCIMS report, Efficiency Achievements From a User-Developed Real-Time Modifiable Clinical Information System, has just been published in the Annals of Emergency Medicine.

Study objective

This investigation was initiated after the introduction of a new information system into the Nepean Hospital Emergency Department. A retrospective study determined that the problems introduced by the new system led to reduced efficiency of the clinical staff, demonstrated by deterioration in the emergency department’s (ED’s) performance. This article is an investigation of methods to improve the design and implementation of clinical information systems for an ED by using a process of clinical team–led design and a technology built on a radically new philosophy denoted as emergent clinical information systems.


The specific objectives were to construct a system, the Nepean Emergency Department Information Management System (NEDIMS), using a combination of new design methods; determine whether it provided any reduction in time and click burden on the user in comparison to an enterprise proprietary system, Cerner FirstNet; and design and evaluate a model of the effect that any reduction had on patient throughput in the department.


The methodology for conducting a direct comparison between the 2 systems used the 6 activity centers in the ED of clerking, triage, nursing assessments, fast track, acute care, and nurse unit manager. A quantitative study involved the 2 systems being measured for their efficiency on 17 tasks taken from the activity centers. A total of 332 task instances were measured for duration and number of mouse clicks in live usage on Cerner FirstNet and in reproduction of the same Cerner FirstNet work on NEDIMS as an off-line system. The results showed that NEDIMS is at least 41% more efficient than Cerner FirstNet (95% confidence interval 21.6% to 59.8%). In some cases, the NEDIMS tasks were remodeled to demonstrate the value of feedback to create improvements and the speed and economy of design revision in the emergent clinical information systems approach. The cost of the effort in remodeling the designs showed that the time spent on remodeling is recovered within a few days in time savings to clinicians. An analysis of the differences between Cerner FirstNet and NEDIMS for sequences of patient journeys showed an average difference of 127 seconds and 15.2 clicks. A simulation model of workflows for typical patient journeys for a normal daily attendance of 165 patients showed that NEDIMS saved 23.9 hours of staff time per day compared with Cerner FirstNet.


The results of this investigation show that information systems that are designed by a clinical team using a technology that enables real-time adaptation provides much greater efficiency for the ED. Staff consider that a point-and-click user interface constantly interrupts their train of thought in a way that does not happen when writing on paper. This is partially overcome by the reduction of cognitive load that arises from minimizing the number of clicks to complete a task in the context of global versus local workflow optimization.

DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.05.032

A full report for the project can be downloaded from our Publications page.

iCIMS about to Be Published

We are about to have published our paper on ED-IMS in a leading international journal. This paper will reveal our next generation technology with 40% improved clinical efficiency and 30% reduction in cognitive load for clinical users. This technology enables staff to design their own systems and yet no programming is required to turn it into an operational CIS. At the interface level, staff can create designs exactly conformant to their local needs and change it at will as their environment changes. Yet at the server end, the iCIMS technology enables multiple clinical specialities to run off the one software installation, preventing the siloing of data and lowering the maintenance load on IT Services. Our systems are fully adaptable Best-of-Breed for the clinical users but underneath have enterprise wide software functionalities.

iCIMS at ED Management Conference & Workshop

Professor Jon Patrick is scheduled to present the following topic at the 5th Annual Emergency Department Management Conference:

Testing ED Clinical Information Systems: Case Study Discussing Collaborative Work With The Nepean Hospital

Event Type: Presentation
Date/Time: 22 July 2013, 4:10 pm

Description: Typically an ED Clinical Information System (CIS) is installed without the opportunity to assess either its detailed functionality or its effect and compatibility on the ED’s workflows. Methods for performing detailed evaluations are underdeveloped and comparison between systems in vivo is unheard of.

Discuss collaborative work with the Nepean Hospital to improve the methods and assessment of CISs and discuss the results from their investigation and the implications they have for all EDs.

There will then be a post-conference workshop presented by Jon and Ali Besiso:

Design of an ED Information Management System

Event Type: Workshop
Date/Time: 24 July 2013, 9 am – 12:30 pm

Description: The Emergency Department (ED) is a high risk environment for clinical errors, breaches in patient safety and, staff stress. The design of a clinical information system will have a significant impact on the efficiency of staff work, job satisfaction, and concomitant stress levels let alone the risk they create for patient safety. ED clinical information systems need to suit the particular settings in which they operate in order to achieve the desired staff efficiency and patient safety.

Objectives: This workshop will be an interactive session that will explore the different approaches to the design of an ED information system. Attention will be given to identifying the issues that are created by inefficient systems, the extent to which they increase the demands on staff to be hyper-vigilant and create risky workarounds. Methods for creating effective and efficient information systems that avoid these difficulties will be explored with a software design tool that enables the clinical team to create their own system. The workshop will also discuss successful clinical user testing methods and the importance of system adaptability for continuous clinical work process improvement supported with practical ED examples.

Walk-ins are welcome so please head on over for a demonstration!