Physician Productivity and the EMR - What is the Latest?

This report popped up a few days ago.

EMRs have varying effects on productivity: UC Davis study

By Joseph Conn

Posted: December 17, 2010 - 12:01 am ET

A study of about 100 primary-care physicians found that using an electronic health-record system yielded mixed results in physician productivity after the doctors had climbed the learning curve and become fully acclimated to the systems.

The bottom line of the study by Hemant Bhargava, associate dean and professor of management and computer science at the University of California Davis Graduate School of Management, and his colleagues is that EHR system specialization by medical specialty matters in that the differing needs of internists, pediatricians and family practitioners in an EHR made a difference in whether the systems helped or hindered workflow.

The study was conducted from 2003 to 2006 following the rollout of an electronic health-record system across six care sites of a large primary-care network affiliated with an academic medical center.

“Our research suggests that a ‘one-size-fits-all' design does not work—the ideal technology design should vary by physicians' requirements and work-flow demands,” Bhargava said in a news release.

More here:

http://www.modernhealthcare.com/article/20101217/NEWS/312179998/

I thought it would be worth chasing down the original study, but am told (Hi Joanne) that it will be a little while before the details are released. Here is the UC Davis press release

UC Davis study finds e-medical records have varying effects on productivity

December 16, 2010

The introduction of electronic medical records in hospitals and clinics — dubbed the “silver bullet” of health care reform — appears to have varying effects on different types of primary care physicians, a UC Davis study has found.

“Our research suggests that a ‘one-size-fits-all’ design does not work — the ideal technology design should vary by physicians’ requirements and work-flow demands,” said Hemant Bhargava, associate dean and professor of management and computer science at the UC Davis Graduate School of Management.

Bhargava and his research colleagues recently completed a study of a multimillion-dollar information technology project installed at six primary care offices from 2003 to 2006. The offices were part of a large primary care physician network affiliated with an academic medical center.

The study, one of the first to measure the impact of electronic medical record-keeping on doctors’ productivity, was conducted with 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.

The system that was studied digitized patient records and allowed for electronic prescriptions and messaging.

The federal government has shown its support for developing electronic health records by setting aside $19.2 billion in stimulus funds to help pay for such conversions across the country.

“Prior to our study,” Bhargava said, “there was controversy regarding the benefits of health care IT investments. In fact, there was some anecdotal evidence that these technologies reduced physician productivity.”

For the study, researchers analyzed the impact the technology had on physician productivity, collecting data on work hours and output before and after the introduction of EMR technology. The data was collected for about 100 physicians spread across three primary care categories — internal medicine, pediatrics and family practice — and six clinics.

The researchers found that the initial implementation of the EMR system resulted in a 25 percent to 33 percent drop in physician productivity. While significant, the drop was anticipated, Bhargava said.

“Initially, physicians and their staff had to learn the system,” he explained. “After a month of utilization, physicians and their staff became more comfortable with the technology and productivity overall increased to just below starting levels, with interesting variations by unit.”

Over the next few months, the researchers found that the impact of the new technology on productivity varied by physician group. Internal medicine units adjusted to the new technology and experienced a slight increase in productivity. In contrast, pediatricians and family practice doctors did not return to their original productivity levels and experienced a slightly lower productivity rate.

“These differences by unit suggest that there is a mismatch between technology design and the work-flow requirements and health administration expectations for individual care units,” Bhargava said.

The findings, he explained, can be more easily understood by breaking EMR technology use into two categories — information review and information entry.

The use of electronic medical records makes information review — patient history, notes from previous visits, charts of test data and radiological images — more efficient. These features are useful to internal medicine doctors, who tend to see a greater proportion of ill patients.

In contrast, pediatricians’ work tends to involve more information entry and documentation for which EMR technology can be more time-consuming.

Bhargava suggests vendors and medical centers consider implementing different versions of electronic record keeping systems, tailoring the user interface, information entry and visualization features for different groups of physicians.

About UC Davis

For more than 100 years, UC Davis has engaged in teaching, research and public service that matter to California and transform the world. Located close to the state capital, UC Davis has more than 32,000 students, more than 2,500 faculty and more than 21,000 staff, an annual research budget that exceeds $679 million, a comprehensive health system and 13 specialized research centers. The university offers interdisciplinary graduate study and more than 100 undergraduate majors in four colleges — Agricultural and Environmental Sciences, Biological Sciences, Engineering, and Letters and Science. It also houses six professional schools — Education, Law, Management, Medicine, Veterinary Medicine and the Betty Irene Moore School of Nursing.

Media contact(s):

* Hemant Bhargava, Graduate School of Management, (530) 754-5961, hemantb@ucdavis.edu

* Jim Sweeney, UC Davis News Service, (530) 752-6101, jpsweeney@ucdavis.edu

The release source is here:

http://www.news.ucdavis.edu/search/news_detail.lasso?id=9665

What to say. Some of the results are pretty obvious such as suggesting that using the EMR for looking up information is a more useful activity than data entry. Hard to argue!

The finding that different specialities get different outcomes is interesting.

It is a bit sad the data being reported on (2003-2006) is so old!

The study shows clearly that EMR usability and work flow support is vital and good training is critical, as well as also indicating the need for some much more modern studies reported much more quickly!

David.