Productivity

The Impact of EHRs on Productivity — Physicians Share Experiences

Productivity can be defined as “the quality, state, or fact of being able to generate, create, enhance, or bring forth goods and services” (Dictionary.com). In a medical office, productivity refers to the number of patients seen and managed during the course of a defined period of work. The implementation of an EHR results in an increase in workload, and therefore can be expected to bring about a corresponding decrease in productivity. What is the net impact on medical practice productivity following EHR implementation and how long should it take for productivity to return to pre-EHR levels?

Loss of productivity is one of the most significant ongoing challenges that practices face following EHR implementation. A selection of EHR satisfaction survey respondents share their experiences regarding this issue:

  • Date of first use: December 2008 — The EHR system was purchased by our local hospital and is maintained through the hospital IT department. The hospital in turn leases it to physicians at a flat monthly rate per physician, with all support, hardware, software, etc. included. This is a great arrangement, and does not involve any inducements for referrals. It took a lot of the risk and hassle out of the equation for our 2-physician practice, and the EHR is very comprehensive. Any system WILL require a lot of physician and staff preparation, but if you are prepared, you can see very little reduction in productivity at your go-live . You and your staff must EMBRACE the concept of doing your work of serving patients in a new way with a new workflow. Some things will be less efficient, and some will be more efficient. Overall, it is probably a wash. In fact, I had an increase in my productivity and earnings in the first year, and I was pleasantly surprised about that! I would recommend this hospital leasing arrangement; especially for small private groups which may not be able to afford all the costs of a comprehensive EHR system with the added bonus of great interfaces with the local hospital’s lab, x-ray, etc. We still maintain a paper chart for paper documents from outside hospitals, although we will probably scan these into the system soon. You need to weigh the cost of personnel to scan vs. file paper. You will discover these issues as you plan and implement.
  • Date of first use: July 2008 — We have experienced a 20% drop in productivity and lost a number of patients due to inability to schedule them in a timely fashion. I would rather go back to a paper chart and submit to the 2% decrease in payment than put up with the difficulties and frustrations associated with EHR. We have looked at 6 additional systems, and none of them impress me.
  • Date of first use: January 2008 — We have had a significant decrease in productivity. The system is cumbersome to use and it is difficult to complete notes in a timely manner. We had SIGNIFICANT issues with our interfaces. Overall the progression to electronic medical records has the possibility to improve access to information, but systems are not efficient to use and could benefit from significant changes.
  • Date of first use: July 2005 — EHR is a difficult transition but makes me more efficient. No one helped defer the cost of EHR, servers, or training. I think that I should be the one to benefit from increased efficiency and productivity. I am very hesitant to share data with Medicare or any others that are looking for ways to pay physicians less for the services they provide.
  • Date of first use: February 2004 — One of the major issues I face is productivity. I do not believe I would ever have reached pre-EHR productivity levels without using a scribe. After a year of getting home at 11 pm and when my spouse threatened to leave me, I began using a scribe real time in the room. She completes 98% of the notes, does all orders, enters the visit code, updates the med list and problem list, sends the prescriptions, prints patient handouts, sends inter-office flags to call for outside reports during the visit, prints the patient summary, and even completes forms such as school physicals in the room while I attend to the patient. In short, she is the major reason that the EHR will deliver meaningful use. A majority of our Medical Assistants are trained as scribes and all of the doctors in our office are now using them. They more than cover their extra expense because visits are more efficient and visit levels are better documented, thus yielding higher reimbursement. If I didn’t have a scribe, I would probably take the day off. It does take a number of days to train a scribe to modest proficiency and months to full productivity.
  • Date of first use: October 2009 — I wish that Medicare had not mandated EHR with the threats of penalties. In fact, I wish that Government would get out of the process of managing patient care. There is not enough time for training and it is expensive… very expensive. Productivity in my office has decreased so far. It takes twice as much time to complete a patient’s visit and I see 75 % of the patients now as compared to before EHR. In my situation, my vendor is 1,000 miles away. I could afford only one onsite visit from a trainer. I would highly recommend a local vendor to my colleagues. I hope to recover the $44,000 incentive otherwise I will be doomed.
  • Date of first use: May 2007 — In my personal opinion, it is a lot more efficient to navigate through a well organized paper chart and dictate using a transcription service. Before EHR I was able to dictate a comprehensive note in less than 5 minutes, now it takes me 10-15 minutes post encounter to complete the note. Physicians are also finding themselves doing more data entry now than in the past. The clicking, closing, opening and scrolling through multiple templates adds a lot of time to the patient visit. The EHR does improve patient safety and practice efficiency but (from my experience) reduces physician productivity and burdens physicians with the need to enter data manually if certain interfaces do not work.
  • Date of first use: October 2006 — My EHR met the needs of a rural health clinic including billing, and accommodated several specialties. The initial training was inadequate. I feel comfortable using it now. It took about 1 year to break even on productivity.
  • Date of first use: March 2010 — Support mechanisms are not appropriate for the needs of such a complex system. I am quite computer savvy and motivated, but the hit we have taken on productivity is unacceptable.
  • Date of first use: September 2009 — The implementation of an EMR has been a huge undertaking heavily involving each member of my staff and myself. We are all now starting to see the rewards of this hard work in multiple ways and I am convinced it will have been well worth the effort in time, energy, money and initial lost productivity.
  • Date of first use: February 2006 — The EHR has increased my workload significantly. I am a young physician and am very comfortable with computers. The EHR makes every aspect of the work involved with patient care take MUCH longer than it did before. It simply takes a long time to click a template multiple times, switch between screens multiple times. In my opinion the EHR reduces productivity — it does not increase it. It did not improve my patient care as I am an extremely detail oriented conscientious person. The EHR is a burden. The other physician in my office who implemented the system with me feels the same way.

Reading these experiences, it is clear that EHR has a variable impact on productivity. Some physicians have found innovative ways to use EHRs without impacting productivity by using scribes. Others have found it difficult to return to pre-EHR levels of productivity despite years of use. Inadequate training appears to be a common issue that negatively impacts productivity. For others, it may be the design and usability of their EHR or a lack of efficiently functioning interfaces to ensure that information flows smoothly between practice, hospital, and labs.

What is your experience? Which are the major factors influencing your productivity and workflow? Is the limitation primarily due to the EHR software and how it functions, or external factors such as interfaces? Share your thoughts below.

Comments:

14 responses to "The Impact of EHRs on Productivity — Physicians Share Experiences"
  • February 9, 2012
    john a steers
    said:

    Notice that the doctors’ comments are not demonstrating a “variable impact,” as you state. On the contrary, almost every doctor on EHR will tell you about the nightmare they have been through. It is inconceivable that the increased complexity, need for expensive hardware and software (from companies that are clearly making a huge profit,) and significant decrease in MD productivity will accomplish anything short of HUGE INCREASES in the cost of health care delivery. This is a classic example of our government getting its nose into something that is should have left to others to improve.

  • February 9, 2012
    Himat K Gorania,MD.
    said:

    Very negative experience with huge drop in productivity and much longer wait for patients, leaving angry due to long wait. Better take penalty, and, go back to old system, due to close to retirement.

  • February 12, 2012
    Arvind Cavale
    said:

    I have a very different experience. I started my new solo practice with an EMR in 2002. One of the reasons I was frustrated with my previous group practice was the inefficiency of paper-based practice. So we started with zero patients, so we had no conversion problems. In 2004, we switched vendors because we quickly realized that our previous vendor was all about itself, not about serving our needs.

    Over the years we have constantly worked to improve our EMR to work better for us. We find something to improve almost every month. Our vendor has been good to respond to our needs.

    We find that our EMR easily replaces 1.5 – 2 FT employees and provides us with a more reliable method of providing better care for our patients. Unfortunately, the current rush towards adopting HIT based on Medicare incentives is exactly opposite of how it should be done. No wonder all the disenchantment.

  • February 28, 2012
    Alan Brookstone, MD
    said:

    An interesting article on scribes was published February 13th by AAPC, one of our content partner organizations – http://www.aapcps.com/news-articles/ProductiveScribes.aspx

  • March 3, 2012
    Barry S. Walters MD FACC
    said:

    Our experience has been the same, loss of productivity. In addition, our IT costs have been astronomical. Our vendor grossly nonsupportive.

    If I knew 2 years ago what I know now, I would have taken the penalty of not complying.

  • March 6, 2012
    Gordon F Green, MD
    said:

    Aside from the rare outlyer, are there any significant numbers of docs out there that prefer EMR over how we have traditionaly documented care? If we all hate it, think it degrades the quality of the patient visit and decreases productivity, why aren’t we banding together and telling the powers that be to “stuff it” and that we aren’t gonna do it any more?

  • March 7, 2012
    Alan Brookstone, MD
    said:

    Another interesting article on scribes from KevinMD.com – http://www.kevinmd.com/blog/2012/03/working-scribe-prepared-medical-school.html

  • September 13, 2012
    Karl Sandberg, MD
    said:

    We tried EMR in my clinic for three months. We lost more than the $40,000 incentive in diminished productivity. We went back to paper.

    The only doctors who don’t suffer massive losses in productivity with EMR are those who aren’t seeing very many patients to begin with.

    Our EMR software could not keep past records plus the current encounter form open simultaneously, therefore we lost the ability to look back in the record while working on the current encounter. Why keep records if you must depend on your memory anyway? Our software had no search function. This made it deficient in the biggest payoff potential of EMR. Pawing through a paper chart is one of the big downsides of paper. Pawing through EMR is even more difficult. Make sure your EMR has a good search function.

    By the way, who likes the way most EMR prints out? I can’t stand the stupid reports of most EMR printouts. What a joke.

  • September 13, 2012
    Karl Sandberg, MD
    said:

    One other thing. EMR doesn’t get along very well with all the non-EMR stuff that gets sent to us from insurance, government, pharmacies, etc. You either have to scan all that stuff in, or leave it out of the record. The stuff you scan cannot be searched.

    I agree with Dr Green. Why do so few people stand up and say how bad this is? When things get crazy, even in the hospital, we revert to paper because it is less time-consuming. This should tell us something but it doesn’t because the government is skewing incentive by bribing us (with our own money) to ignore common sense and do stupid stuff instead.

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  • March 9, 2013
    Josh Frasier, IT Consultant
    said:

    The goal of EHR Technology is not about Productivity or patient satisfaction it’s all about ACCURACY OF PATIENT & PRESCRIPTION INFORMATION WITH GOAL OF REDUCING RISK OF CRITICAL AND EVEN FATAL ERRORS. This leads to a reduction in MALPRACTICE INSURANCE PREMIUMS. This goal is much more important than achieving PRODUCTIVITY GAINS! Again it’s about ACCURACY AND RISK REDUCTION not SPEED! Patients want the CORRECT MEDICINE AND TREATMENT NO MATTER HOW LONG IT TAKES.

  • September 11, 2013
    Joe Davis
    said:

    I disagree with Mr. Frasier. The goal of EHR seems to me to provide info for meaningful use bean counters and insurance auditors. Garbage in garbage out. While the rx function does improve some accuracy, the tendency to click and send 100′s of rx’s entered by another party is a risk in itself.

  • March 21, 2014
    HB, MD
    said:

    With all due respect, Mr Frasier, it does not appear that there is data to back up your claim of increased patient safety. EMR and EHR often DELAYS orders, AMPLIFIES errors, some of which are difficult to reverse, and because systems do not interface well, INCREASES the number of steps to achieve a single event–if it takes ten clicks to place an order, rather than a single stroke, there are 10 points to introduce error. I have used many systems and have not found a single one that does not require workarounds and five times the amount of time. It’s easy to collect data that has been input, generate reports, etc..but filled with errors.

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