News Ticker

EHR’s & Physician Productivity

A majority of doctors are dissatisfied with EHRs citing productivity losses. But a new study debunks their feelings.

400px-Doctor_and_librarian_working_with_PDQThe revolution in health information technology (HIT) holds the promise of improving patient care. Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, the nation’s hospitals and medical practices have scrambled to upgrade their HIT infrastructure. From a provider standpoint, the most visible change has been the widespread adoption of electronic health records (EHR). Yet, the impact on physician productivity during the transition from paper to electronic records remains unknown. A recent article investigated “The Impact of Electronic Health Record Use on Physician Productivity.”

In the article, the authors used EHR task-log data from 40 primary care physicians to characterize the relationship between physician productivity and the degree of EHR use and delegation of EHR tasks. The main outcome for productivity was relative value units (RVUs). Beyond main effects, they tested for interactions between delegation and EHR use – thus looking for synergistic or otherwise joint effects on productivity. The analytic approach used an ordinary least squares regression model. The authors also stratified by practice size (1-3 clinicians vs. 4+) to see if the effects differed between small and large practices.

Results showed that increased delegation and EHR use were both independently associated with greater productivity. For instance, an increase by 1 standard deviation (SD) in EHR use (i.e. an additional 178 tasks per appointment) from the average (370 tasks) was associated with an increase of 0.9 RVUs per day. This equated to being able to have an additional 20-minute new patient visit. Similarly, an increase by 1 SD in delegation to support staff (from an average of 16% of EHR tasks to 37%) resulted in an increase of 1.9 RVUs per day (equivalent to a 40-minute established patient visit). In context, the magnitude of these increases was sizable because the average physician worked 17.5 RVUs per day (equivalent to six one-hour new complex patients).

Commentary

This study is particularly timely in light of the nation’s policy of moving the health care delivery system toward electronic health records (EHR). Many clinicians, especially the ones who have been in practice for decades have concerns that EHRs will disrupt their current workflow and thus decrease their productivity. This study provides evidence that these fears may be overstated.

Furthermore, the dataset used was particularly valuable because of the level of granularity it offered. For instance the data included information on when and by whom each vital sign was entered. Additional studies using similar methods may consider also analyzing whether the gains in productivity seen by using EHRs and the liberal delegation of tasks to non-physician support staff are modified by important provider characteristics such as age, digital-literacy, typing speed, etc.

Adler-Milstein, J and Huckman, RS. Am J Manag Care. 2013; 19 (11 Spec No. 10): SP345-352.

by

Andrew A. Gonzalez, MD, JD, MPH 

About Andrew A. Gonzalez , MD, JD, MPH

Andrew A. Gonzalez, MD, JD, MPH is a general surgery resident at the University of Illinois Hospital and Health Sciences System in Chicago and a lecturer in health policy at the University of Illinois at Chicago (UIC) College of Medicine. He is currently conducting health services research at the University of Michigan’s Center for Healthcare Outcomes and Policy (CHOP). In 2006, Dr. Gonzalez earned his juris doctor from Chicago’s John Marshall Law School. He was a member of the Law Review and on the Elected Board of the Black Law Students Association. He went on to receive his medical degree and masters of public health in health care policy and administration from UIC in 2010. More Posts

  • Andrew Gonzalez

    I do not believe that the study was designed to address either question. Specifically, they did not look at number of patients seen per day. However, the whole idea behind RVUs was to adjust for patient complexity, thus looking at total patients per day may have been misleading. To answer the question of more “true” productivity vs. better billing; the study would have to (at a minimum) examine the MD notes+labs/imaging vs. EHR productivity data. Regarding whether or not patient health was improved by using EHR, I would guess this study would be underpowered to find these differences, especially in the context of primary care.

  • Cedric Dark

    I am under the impression that the practices with improvements in productivity (as measured by RVUs) probably just extracted better billing out of their current patients. Did they actually see more patients per day? Did the health of their patients improve relative to those practices without as much EHR use?

%d bloggers like this: