I have posted several notes about decreased physician productivity and efficiency experienced in ambulatory practices as a result of the introduction of an EHR (see: Some of the Details Behind the Maine Medical Center/Epic EHR Meltdown; Nursing Union Demand Delay of Hospital EHR Go-Live in Massilon, Ohio; Who Says a Hospital CIO Can't Get Fired for Picking the Epic EHR?). There has been a tendency for hospital executives to blame these changes on the learning curve of the new system and assume it will rebound after some short period of time. I personally believe that much of this decrease in physician productivity is gone forever and attributable to EHR workflow (i.e., workslow) design. Here's an excerpt from an article on this same topic (see: Docs blame EHRs for lost productivity):
Nearly 60 percent of ambulatory providers surveyed for a new...report say they're unsatisfied with their electronic health records, citing frustrations with usability and workflow...[The study was the result of a poll of] 212 ambulatory and hospital-based providers. It found that while the adoption of EHRs is widespread, the experience of most who use them "is one of dissatisfaction." According to results, 58 percent of ambulatory providers surveyed were dissatisfied, very dissatisfied, or neutral about their experience with ambulatory EHRs. Issues affecting EHR productivity include poor usability, inappropriate form factors and user interfaces, access to mobile technology, workflow tools and configurations, inadequate training, inadequate staffing and support, inefficient processes and application uptime and availability, according to the report. "Despite achieving meaningful use, most office-based providers find themselves at lower productivity levels than before the implementation of EHR," said [one of the authors of the report]. "Usability, productivity and supplier quality issues continue to drive dissatisfaction and need to be addressed by suppliers and practices....The top three goals for providers implementing EHR include regulatory compliance (56 percent), improving the quality of care (43 percent) and qualifying for meaningful use incentives (40 percent). The two most frequent reasons for EHR dissatisfaction involved lost productivity – spending more time on documentation (85 percent) and seeing fewer patients (66 percent). Providers who were satisfied with EHRs cited the top reasons were a reduction in the number of lost or missing charts (82 percent), the ability to access medical records and work remotely (75 percent) and incentive payments (56 percent).
I have firsthand knowledge about three physicians working in outpatient settings in a large academic hospital that recently deployed a new EHR in the outpatient setting. None of them have been unable to complete their patient documentation duties during their normal work days whereas this was not a problem with the previous system. They are spending some two additional hours or more completing them at night and at home. They attribute this additional work to poorly designed EHR user-interfaces and workflow such that multiple mouse clicks to execute simple tasks. They also question some of the data that is now being collected. These inefficiencies are compounded by hospital requirements to care for about the same number of patients, or even more, than prior to the deployment of the new EHR software.
I don't think that hospital executives are appropriately addressing this emerging EHR problem for a number of reasons. The first reason is that they have painted themselves into a corner with the new software. Backing out is not a reasonable option and they have only limited means of forcing their EHR vendor to execute major design changes of the software. Hiring physician extenders such a EHR scribes adds to personnel expenses and introduces additional inefficiencies (see: Greater Adoption of the Scribe Model for EMR Data Input). It also calls into question the commonly accepted idea that EHR automation increases efficiency. They are also facing budgetary problems because of the high initial cost of the new EHR system (see: Who Says a Hospital CIO Can't Get Fired for Picking the Epic EHR?). All of this is also in the face of reimbursement cuts associated with healthcare reform. No enterprise has ever been able to thrive if the productivity of key employees is being throttled without offsetting gains.