How Electronic Records Can Slow Doctor’s Productivity

Digital record-keeping is slowly but inevitably replacing paper records everywhere from the pilot’s cockpit to the register of motor vehicle But if implemented without proper consideration of how work gets done, the results can make productivity worse, not better. That’s one of the lessons from a new study of physician offices transitioning to electronic health records used in managing patient care. In general, larger offices in the study that employed EHRs recorded productivity gains, but certain types of smaller practices lost productivity. “You should be aware of the subtle way that you might be changing existing communication patterns among staff” One likely reason for the decline: processing electronic records can change the way staff members communicate with one another, clogging up what had been a well-oiled machine. “When you adopt EHRs, you should be aware of the subtle way that you might be changing existing communication patterns among staff,” says Harvard Business School Professor Robert Huckman. The digital doctor In recent years, many physicians have put away pen-and-paper and taken up the keyboard or tablet to maintain patient health records. One motivation was the 2009 Health Information Technology for Economic and Clinical Health Act, which allows for $27 billion in incentives for health care providers who demonstrate “meaningful use” of digital records. The legislation came from the belief that EHRs used in certain ways-such as medication order entry that would alert a clinician about drug-to-drug interactions-could ultimately make patient care safer, more effective, and more efficient. However, several studies indicated that when physicians spent extra time entering data themselves, it cut down time spent with patients and stretched out their workday – hardly what was intended. So many practices realized that it made sense for clinicians – mostly physicians, but also nurse practitioners and physician assistants – to delegate some EHR-related tasks to clinical support staff, including registered nurses, licensed practical nurses, and medical assistants. Huckman, the Albert J. Weatherhead III Professor of Business Administration and faculty cochair of the HBS Healthcare Initiative, set out with Adler-Milstein to discover what happens to productivity when doctors delegated their data entry. Did it free up their time and increase office productivity? After all, delegating these tasks can cost physicians extra coordination time, plus doctors still need to review and authorize orders in an EHR before they are submitted. The study examined the relationship between physician productivity, the degree of digital health records use, and the delegation of EHR tasks. And it explored whether these relationships differed by practice size. Huckman and Adler-Milstein researched monthly EHR task-log data between 2006 and 2009 from more than 40 primary care and internal medicine practices throughout the United States. Practices had a range of one to 14 clinicians, with an average of four. All the practices had used digital records for a minimum of six months, with an average of 17 months. All practices in the sample employed at least one clinical support staff member, allowing clinicians to delegate EHR tasks. Productivity increase Overall, the findings suggest that increased use of electronic health records and greater delegation were independently associated with higher levels of production. That is, practices that increased the number of tasks performed using EHR saw an increase in clinician productivity, and practices that increased the extent to which EHR tasks were performed by clinical support staff, as opposed to clinicians, saw an independent increase in productivity as well. “We rely on physicians’ penmanship in making some pretty important decisions” But there was one important caveat: Increasing both EHR use and delegation gave large practices with four or more clinicians a productivity boost, while the same dual increase led to a productivity loss among small practices with high levels of delegation. Bigger practices may benefit more from EHRs by allowing a larger group to communicate more effectively, Huckman hypothesizes. In smaller practices, where informal but highly effective relationships may exist, introducing an EHR system might generate formal processes that, at a certain level, become counterproductive. Source:hbswk.hbs.edu