A Survey of EHR Workflow Management Productivity: Process-Aware HIT

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In a survey of 200 practices using an EHR workflow management system, thirty-six responded. Of these, twenty practices had pre-existing operations, so they could compare their before and after experiences. The average practice had been on an EHR WfMS for 2.7 years, had 3.76 physicians, and 17.5 total staff. Their specialties were pediatrics (55%), family medicine and internal medicine (35%), obstetrics/gynecology (5%) and multi- specialty (5%).

The survey was a self-assessment survey which covered the categories of usability, revenue, expenses, time and quality.

Usability

Practices achieved competency in five weeks. Of the practices 85% had achieved a paperless office (except for printing paper destined for the outside world or scanning incoming documents). These offices took an average of eleven weeks to achieve this paperless state. Notably, 100% of physicians used the EHR.

Revenue (and related figures)

Visits per day increased 13.5%. Exam rooms increased 34%. Charges per visit increased $17. Billing increased 30%. Denied claims decreased 61%. And revenue increased 24%.

Expenses (and related figures)

Total staff decreased from 17.5 to 16.7 fulltime equivalents. The staff to physician ratio decreased 12%. (Which is good because physicians generate revenue while staff generate expenses.) Transcription costs decreased 67%. And (in conjunction with the previously described increase in revenue) the estimated pay back period for EHR software and hardware was fifteen months.

Time and Quality

Time and quality have a very interesting relationship. Before the quality management movement, most people assumed that one must increase the amount of time spent on a product or service in order to increase its quality. (This is not necessarily true.) More to the point, patients see timeliness and convenience as an important element of the quality of care. If they do not have to wait or the encounter is shorter and allows them to get back to work on time, this is perceived as increased quality. These practices estimated a 13.5 minute decrease in patient wait, a six minute decrease in charting time, and a 16 minute decrease in overall encounter length. The amount of time to return a phone call to answer a question or to refill a prescription decreased by two hours and 45 minutes and four hours, respectively. Finally, in spite of a higher volume of shorter visits, immunizations increased by 25% (in pediatric practices) and quality review scores increased by 17%.


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Take me to the next blog post in this series! EHR Productivity Survey Discussion: Process-Aware Health IT.

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