The impact of electronic health record implementation on emergency physician efficiency and patient throughput
Introduction
Clinical care in the United States is being impacted by health information technology (HIT), particularly the implementation of electronic health records (EHRs). In 2005, a team of researchers at the RAND Corporation modeled the benefits to be realized by the health system after widespread adoption of health information technology (HIT).1 Included in those projections were $81 billion in annual savings and thousands of deaths averted each year. As part of the American Recovery and Reinvestment Act of 2009, the U.S. Federal Government mandated that all public and private healthcare providers will have implemented “meaningful use” of EHRs by 2014.2
This massive administrative restructuring of the healthcare sector has been expected to affect quality of care, provider and patient satisfaction, productivity, and cost of care. The newly accelerated uptake of HIT spurred by the Recovery and Reinvestment Act has led many to speculate we have reached a tipping point and the gains in reduced mortality, morbidity and expenditures are only a few years off.3 While there have been positive reports of some progress4, 5, many potential gains have remained elusive despite greatly increased uptake of HIT.6, 7, 8, 9 Recent work has highlighted an important discrepancy between the current state of progress and the underlying assumptions of the RAND model: the existence of interconnected and interoperable systems, widely adopted and used effectively.1, 10
Nowhere is it more important to understand the effects of these widespread changes than in the Emergency Department (ED), where patient outcomes hinge on rapid assessment and care. The ED is a high patient volume area within health systems that operates under constant time pressure. Unlike general ambulatory care, where HIT implementation has been studied11, 12, 13, in the ED patients must be quickly and efficiently triaged, stabilized, treated and processed for admission or discharge. HIT has the potential to either disrupt or improve the processes of clinical care, with serious implications for patient outcomes and quality of care.
To date, the impact of HIT changes in the ED setting has been poorly studied. Our aim was to address this gap by studying the effects of introducing HIT into the operations of two busy EDs. Informed by previous work looking at HIT and efficiency in the inpatient setting,14 our driving hypothesis was that the implementation of an EHR in the ED would adversely impact physician efficiency, as measured by physician-patient throughput time.
Section snippets
Study setting and population
We conducted a quasi-experimental, pre and post-intervention study. Data were collected for seven months prior to the intervention and 10 months post-intervention. Our study sites were the EDs in two suburban hospitals. Both hospitals are community hospitals and not referral or trauma centers. SITE A has an overall volume of 60,000 annual visits. It has both adult and pediatric EDs, with 80% of the visits for adults and 20% for children. Twenty-seven percent of adult patients are admitted,
Results
In total, 34 physicians were involved at the two hospitals during the full study period. Median processing times, combined from both sites, increase immediately after implementation and then slowly return to the baseline level, eventually dropping below the initial starting point of August, 2012 (Fig. 1, Fig. 2). Of note, due to the smaller sample, there was larger data variance at Site B than at Site A. In the two months after implementation, processing times increase by an average of 8% (p
Discussion
We have found that implementation of new EHRs in the ED setting at two hospitals was associated with an initial decrease in physician efficiency as indicated by processing time. With physician adaptation, efficiency returned to baseline levels and ultimately surpassed them. While EDs can potentially expect long-term gains from the implementation of EHRs, they should take measures to ensure the initial decreases in efficiency do not affect the quality of patient care. In our study, an additional
Author contributions
NR contributed to the drafting of the manuscript. DA and FB contributed to the data collection and analysis. BG, EW, LP and JMH all contributed to the study design, hypothesis development, implementation and oversight. All authors contributed to the text and revision of the manuscript.
References (21)
Electronic health records, promises promises: experts advise patience for return on investment
Ann Emerg Med
(2013)- et al.
The impact of electronic health records on time efficiency of physicians and nurses: a systematic review
J Am Med Inform Assoc
(2005) - et al.
Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine
Ann Emerg Med
(2009) - et al.
Can electronic medical record systems transform health care? Potential health benefits, savings, and costs
Health Aff
(2005) - United States Congress. American Recovery and Reinvestment Act of 2009. Avail at:...
- et al.
The benefits of health information technology: a review of the recent literature shows predominantly positive results
Health Aff
(2011) - et al.
The effect of health information technology on quality in U.S. hospitals
Health Aff
(2010) - et al.
Barriers to electronic health record use during patient visits
AMIA Annu Symp Proc
(2006) - et al.
What it will take to achieve the as-yet-unfulfilled promises of health information technology
Health Aff
(2013) It ain׳t necessarily so: the electronic health record and the unlikely prospect of reducing health care costs
Health Aff
(2006)
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