EHRs affect physicians/staffs differently: study

Electronic health record (EHR) systems affect small-practice physicians’ workflows mostly negatively, whereas their staff members’ workflows are generally improved, according to recently published research.

Researchers spent 9 to 14 days over a 4 to 8 week period observing practice workflows, interviewing patients, and collecting documentation at seven community-based primary care practices throughout the northeastern United States. They published their research in the Journal of General Internal Medicine (JGIM)in an article titled “Electronic health record impact on work burden in small, unaffiliated, community-based primary care practices.”

Results of the study indicate that staff clinical and clerical burdens, such as check-in and the rooming of patients, were reduced by EHRs. Communication between staff, patients, and providers also were improved. Investigators also found, however, that although the EHR reduced some of the physicians’ burdens, such as prescribing and lab ordering, those time savings were mitigated by increased documentation and quality reporting requirements.

Researchers found that staff “routine” enabled EHR vendors to develop system workflows that to some degree could enhance and improve primary care practices. The researchers also discovered, however, that a primary care physician’s (PCP’s) clinical workflow is “characteristically more complex and unpredictable,” which makes it difficult to create EHR workflows for PCPs that work well from one practice to the next; the “range of care is diverse, and the sources and types of information may vary widely.”

The study’s authors recommend that EHR developers “focus on supporting clinician charting, disease management, and ordering/reviewing tasks, as these are the main sources of increased EHR-related work burden.” They also concluded that “as EHR vendors develop new systems and the next iteration of existing systems, the complex needs of the primary care clinician should be better understood and considered.”

Authors of the study include Jenna Howard, PhD; Elizabeth C. Clark, MD, MPH; Asia Friedman, PhD; Jesse C. Crosson, PhD; Maria Pellerano, MA, MBA, MPH; Benjamin F. Crabtree, PhD; Ben-Tzion Karsh, PhD; Carlos R. Jaen, MD, PhD; Douglas S. Bell, MD, PhD; and Deborah J. Cohen, PhD. They are from the Department of Family Medicine and Community Health of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset, New Jersey; the University of Wisconsin, Madison; the University of Texas Health Science Center, San Antonio; the RAND Corp.; the University of California, Los Angeles; and the Oregon Health and Science University, Portland.

This latest EHR study mirrors, on a smaller scale, the ongoing Medical Economics EHR Best Practices study, which includes 31 primary care practices and nine EHR vendors from 49 states. The conclusions drawn by authors of the JGIM study strongly support results gathered from the Medical Economics study as well.

The Medical Economics EHR Best Practices study takes a detailed look at what takes place within primary care practices when they implement EHRs. It also includes a related Web seminar series. The study will continue through 2013.

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