This Just In on EMRs: Workflow Really Matters

A new study carried out by management and computer science researchers at the University of California-Davis is confirming what thought-leaders in healthcare IT have long known on an instinctive level: that the degree to which EMR implementation can help improve physician productivity depends on the level of customization around specific types of workflow demands and working requirements of different medical specialties.

Hemant Bhargava, associate dean and professor of management and computer science at the UC Davis Graduate School of Management, and his colleagues, studied a multi-million-dollar IT project installed at six primary care offices from 2003 to 2006. The offices were part of a large primary care physician network affiliated with an academic medical center. Bhargava and his fellow researchers found, based on data collected from 100 physicians at six clinics, and spread across internal medicine, pediatrics, and family practice, that the initial EMR implementation resulted in a 25 to 33 percent drop in physician productivity. However, recovery of physician productivity following implementation. On the one hand, “internal medicine units adjusted to the new technology and experienced a slight increase in productivity. In contrast,” the study’s authors reported, “pediatricians and family practice doctors did not return to their original productivity levels and experienced a slightly lower productivity rate.”
Bhargava’s conclusion? “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.”

Now, here’s the really interesting part. Bhargava and his colleagues note that there are two different categories of activity when it comes to interacting with an EMR—information review and information entry. Information review includes patient history, notes from previous visits, charts of test data and radiological images; and the USE of an EMR tends to make such tasks more efficient. Further, those features are useful to internists, who tend to see a greater proportion of ill patients. In contrast, pediatricians’ work tends to involve more information entry and documentation, both of which are more time-consuming tasks.
I think more studies like this are needed, as they will continue to provide new insights into some of the specific and particular challenges facing doctors implementing EMRs. The fact that this study uncovered key differences between and among primary care specialties underscores how complex this whole enterprise of EMR implementation really is at the physician office level, and why broad generalizations about doctors’ responses to EMRs tend to be so superficial. I certainly hope consultants working in the physician-office implementation sphere are paying attention.