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The Impact of Electronic Health Records on Workflow and Financial Measures in Primary Care Practices
Author(s) -
Fleming Neil S.,
Becker Edmund R.,
Culler Steven D.,
Cheng Dunlei,
McCorkle Russell,
Graca Briget da,
Ballard David J.
Publication year - 2014
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12133
Subject(s) - staffing , payroll , payment , productivity , medicine , electronic health record , net income , workflow , data collection , health informatics , business , operations management , health care , database , finance , accounting , nursing , public health , computer science , economics , statistics , mathematics , macroeconomics , economic growth
Objective To estimate a commercially available ambulatory electronic health record's ( EHR 's) impact on workflow and financial measures. Data Sources/Study Setting Administrative, payroll, and billing data were collected for 26 primary care practices in a fee‐for‐service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. Study Design An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004–2009. Changes were evaluated 1–6, 7–12, and >12 months postimplementation. Data Collection/Extraction Methods Data were accessed through a SQL server database, transformed into SAS ® , and aggregated by practice. Practice‐level data were divided by full‐time physician equivalents for comparisons across practices by month. Principal Findings Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received. Conclusions Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined.