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EMR Productivity Effects Vary By Primary Care Specialty

Healthcare systems should choose electronic medical records systems that reflect physician workflow demands to minimize decreases in efficiency, finds study.

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Electronic medical records (EMRs) are not a panacea and have varying effects on different types of primary care physicians, reports a study conducted by the University of California, Davis.

The report found that the impact of EMRs 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.

Hemant Bhargava, associate dean and professor of management and computer science at the UC Davis Graduate School of Management, declared in a statement last week that: "Our research suggests that a 'one-size-fits-all' design does not work -- the ideal technology design should vary by physicians' requirements and workflow demands."

"These differences by unit suggest that there is a mismatch between technology design and the workflow requirements and health administration expectations for individual care units," Bhargava added.

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 EMRs 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 sick 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 recordkeeping systems, tailoring the user interface, information entry, and visualization features for different groups of physicians.

Bhargava said the report, "Do Electronic Medical Records Make Physicians More Productive? Empirical Analysis and Design Implications," will be released in January. He said that, prior to the study, there was controversy regarding the benefits of healthcare IT investments, as well as anecdotal evidence that these technologies reduced physician productivity.

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 from about 100 physicians spread across three primary care categories -- internal medicine, pediatrics, and family practice -- and six clinics. The system that was studied digitized patient records and allowed for electronic prescriptions and messaging.

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

"Initially, physicians and their staff had to learn the system. 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," Bhargava said.

The study is one of the first to measure the impact of EMRs on doctors' productivity since the federal government set aside $19.2 billion in stimulus funds to help pay for EMR implementations across the country.

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