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.