Advocates for Evidence-Based Health Policy Speakers
EHR’s & Physician Productivity
A majority of doctors are dissatisfied with EHRs citing productivity losses. But a new study debunks their feelings.
The 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 and their HIT infrastructure. From a provider standpoint, the most visible change has been the widespread adoption of (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
3 Replies to “EHR’s & Physician Productivity”
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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.
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?