Physician productivity is a key determinant of physician compensation (1). This holds true in both small practices and in larger organizations. Fear of increased time for patient encounters, and subsequent loss of productivity is a major concern in terms of adoption of electronic medical records (2,3). Another study (4) showed that financial compensation for the educational time required to learn to use and become proficient with the system had the greatest impact on behavior.
A complex relationship
A study by Cheriff et al (5) analyzed the changes in physician productivity after the implementation of a commercially available ambulatory electronic medical record (EMR) system (EPIC) in a large academic multi-specialty physician group (Cornell). Provider productivity, as measured by patient visit volume, charges, and wRVUs modestly increased for a cohort of multi-specialty providers that adopted the EMR. After the ‘ramp-up’ period, the productivity gain appeared to become even more pronounced after several months of experience with the system. It is to be noted that there were baseline differences in productivity metrics between the adopters and non-adopters in the study suggesting that there were fundamental differences in these groups.
A report from the Medical Group Management Association (MGMA) (6) that was based on a survey of 1,324 primary care and specialty practice members, found significant financial benefits to using an electronic health records system. In another study, during the initial phase in a large integrated health care system, there was approximate net decrease of 10% below average pre-implementation productivity levels as assessed by wRVUs (7). The same study concluded that the biggest barrier was the initial period of reduced productivity. In a study by MGMA (8) that included 285 practices where EMR implementation was in process or was fully implemented, respondents described increased operating costs, reduced productivity, and other surprises and challenges during the first 6 to 24 months of the implementation. However, after the first 6 to 24 months, the benefits of EMR adoption exceeded costs.
Potential factors leading to decreased physician productivity
- Increased time for patient encounter
- Lack of adequate physician (and ancillary staff) training
- Disruption of clinical workflow
- Electronic Health record downtime for maintenance and upgrades
- “Ramp up” phase when all the above factors might likely be significant contributors
- Inadequate keyboarding skills
Increased physician productivity
- Potentially decreased time for patient encounter
- Increase in data capture leading to better coding and billing
- Improved documentation
Steps to avoid decreased productivity
- Doing your research with vendor
- Understanding workflow
- Implementation in a phased manner
- Adequate planning with regards to costs/savings
- Potentially get the meaningful dollars! (and factor that into productivity)
- Planning for the training period
- Training ancillary staff to work at the top of their license
Clearly, there appears to be incremental costs, and consequent loss in productivity during the initial phase that might last for up to 24 months. However, this is likely not a significant issue after this initial period - adequate research, meticulous planning and a well thought out implementation would offset and make up for most of these transition costs. Allocating adequate time for installation and clearly understanding the changes in the processes and workflow will likely lead to greater revenue, decreased expenses, and more profit over the long-term.
- Productivity still king in physician comp, but impact of resource utilization growing. Capitation rates & data 11, 19-21 (2006).
- Tierney, W. M., Miller, M. E., Overhage, J. M. & McDonald, C. J. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA : the journal of the American Medical Association 269, 379-383 (1993).
- Shu, K. et al. Comparison of time spent writing orders on paper with computerized physician order entry. Studies in health technology and informatics 84, 1207-1211 (2001).
- Levick, D., Lukens, H. F. & Stillman, P. L. You've led the horse to water, now how do you get him to drink: managing change and increasing utilization of computerized provider order entry. Journal of healthcare information management : JHIM 19, 70-75 (2005).
- Cheriff, A. D., Kapur, A. G., Qiu, M. & Cole, C. L. Physician productivity and the ambulatory EHR in a large academic multi-specialty physician group. International journal of medical informatics 79, 492-500, doi:10.1016/j.ijmedinf.2010.04.006 (2010).
- Electronic Health Records Impacts on Revenue, Costs, and Staffing 2010 Report Based on 2009 Data
- Clayton, P. D. et al. Physician use of electronic medical records: issues and successes with direct data entry and physician productivity. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 141-145 (2005).
- Impact of Electronic Health Records on the Financial Performance of Medical Group Practices—Track 1: EHR Implementation and Adoption.
Submitted by Mini Spoorthi Sushma Velagapalli MD