Specialty-Specific Productivity Differences with EHR Implementation

The results of a study conducted by Abhay Mishra, an assistant professor of health administration at Georgia State University, and research assistant Shuang Liu, a Ph.D. student in applied mathematics at UC Davis raise some interesting questions about specialty-specific work flow and the effect that EHRs have on productivity. The researchers collected data on productivity pre/post EHR implementation in 6 clinics involving 100 physicians in the specialties of internal medicine, family medicine and pediatrics. Consistent with other studies, there was an initial drop in productivity of between 25–33%. What is more interesting is that over the ensuing months, the researchers noted a difference — by specialty — in how well productivity moved closer to baseline. Evidently internal medicine physicians actually improved productivity (slightly) over baseline after a few months while family physicians and pediatricians improved, but did not return to pre-EHR implementation productivity.

The researchers hypothesize that the results might be due to differences in workflow requirements between the three specialties. They suggest that EHRs make information review more efficient but information entry less efficient. Their hypothesis is that efficiency of information review is more beneficial to internists than pediatricians and that the less efficient information entry features of EHRs tend to disadvantage pediatricians because their workflow likely relies on more information entry and documentation.

If this is true, then the implication is that the user interface and specific features/functions of EHRs might need to be tailored to specialty-specific needs. This is somewhat obvious for specialties such as dermatology, ophthalmology, and otolaryngology — but before this study, might not have been as obvious for less procedurally-oriented specialties.

Question: Do you agree with the findings of this study? If so, what specific changes would you recommend that EHR vendors consider for your specialty?

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.


2 responses to "Specialty-Specific Productivity Differences with EHR Implementation"
  • January 14, 2011

    The eBusiness community (ie. eBay, Amazon, etc) have devoted significant resources to U/I conception, design, testing, implementation, testing, etc.
    Engaging these stakeholders to develop standards (or conventions, or guidelines), “best practices” and “lessons learned” seems helpful.
    Consider windowing systems: Linux, Apple and Microsoft products all offer comparable visual models, layouts, widgets and behaviors. After all, there’s only so many ways to write a document processor, spreadsheet or database manager.
    Same, same for EMR demographics, medications, scheduling, etc.
    Has anyone called Jeff Bezos, Bill Gates, Steve Jobs, Linus Torvald or Larry Ellison?

  • January 16, 2011
    Dr. Alan Brookstone (Cientis)

    As part of the NHS National Program for IT, Microsoft launched the Microsoft Health Common User Interface (MSCUI) providing User Interface Design Guidance and Toolkit controls – http://www.mscui.net
    Because of the complexity of integrating technology into a clinical setting, I am not sure one can take standard business processes and apply them to healthcare. Microsoft has been at this for some time with slow progress.

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