More Efficient, But Not Always Better

SWITCH TO ELECTRONIC HEALTH RECORDS SOMETIMES REQUIRES DOCTORS TO SPEND MORE TIME WITH COMPUTERS, LESS WITH PATIENTS

By Bruce Golden

RAND Corporation researchers painted a rosy picture in 2005 when looking forward to the widespread adoption of health information technology. They projected $81 billion in annual savings and thousands of deaths averted each year. The U.S. government responded in 2009, mandating that all health care providers implement electronic records systems by 2014.

Despite the optimistic projections, health care improvements have been slow to develop. In many cases, doctors are spending more time focused on their computer screens and less time with patients as hospitals scramble to improve efficiency. The quality of health care sometimes suffers as a result — even as patient processing times improve.

Yet if efficiency is the goal, new research shows promise in emergency room settings where outcomes most often hinge on rapid assessment and treatment. The study, which I co-authored with Smith School Ph.D. graduate David Anderson and other colleagues at the University of Maryland Medical Center, shows that emergency department efficiency gets worse initially but then improves following the transition to electronic health records.

We base our assessment on observations at two suburban hospital emergency departments during a 17-month transition period. We collected baseline data for seven months prior to implementation of electronic health records, and then measured changes in patient processing times in the 10 months that followed.

As expected, the shock of switching from paper to digital records caused initial delays in patient admit/discharge decisions and led to longer overall stays. Processing times slowed by an average of 8 percent during the first two months

After this initial setback, however, processing times started improving. Within six months after implementation, the losses were erased and processing times had returned to baseline levels. By the end of our observation period, processing times had improved by an average of 5 percent from the baseline.

We saw no evidence of the efficiency trend diminishing toward the end of the study, leading us to predict a continuing but small long-term improvement. Emergency departments will likely reach a point of diminishing returns, but this did not occur within 10 months at the hospitals we observed.

We also saw something reassuring for hospitals worried about the ability of older, more experienced doctors to adapt to change. Although the new technology initially hindered these doctors more than their younger counterparts, the differences disappeared by the end of the study.

While hospitals facing the transition to electronic health records can find positive things in these results, they should take precautions to ensure that the initial disruption does not affect the quality of patient care. The hospitals we observed added an eight-hour shift of daily provider coverage for the first week after the switch, which might not be enough for a transition that can last months.

We tested and recommend several measures for emergency department administrators to consider for offsetting the immediate negative effects of switching to electronic health records. These strategies include:

• Adding two or three staff hours in overnight shifts.
• Opening an additional triage unit for eight hours a day.
• Strategically placing or moving scribe programs around  the department.
• Adding as many as six hours of physician assistant coverage to daily schedules.

These moves might increase costs in the short run, but they also can work to ensure patient care quality while protecting staff morale and reinforcing the investment in new technology. Most importantly, hospitals should remember that greater efficiency does not always translate to improved quality in health care.

Bruce Golden, PhD, is the France-Merrick Chair in Management Science at the University of Maryland’s Robert H. Smith School of Business.

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“The Impact of Electronic Health Record Implementation on Emergency Physician Efficiency and Patient Throughput,” co-authored by Bruce Golden, appears in the September 2014 issue of Healthcare.