EHR’s and the Productivity Paradox

One of the main complaints of using electronic health records (EHR)s is they make delivery of health care less productive. In a survey of primary care physicians from Medical Economics, one-third said the greatest challenge of an EHR was the disruption to their practice and only one in ten said it was the cost. The same article recommended that users should plan for a 30% reduction in productivity, but it could be as high as 50%.

Meaningful Use (MU) was a federal government initiative begun several years ago. MU was established to improve quality, safety, efficiency, and reduce health disparities. It provided funds for software and hardware to accomplish these goals. To qualify for the funds from MU, you had to demonstrate your system improved quality, safety, but there were no criteria to improve efficiency.

When electricity moved into the industrial sector, most steam engines were replaced with electrical engines. When installing the electric engines, they put them in the same place the steam engines were originally. The steam engines were all aligned in a row because it was easier to connect the steam pipes, so the new electric engines were all placed in a row. The expected increases in productivity never occurred. It wasn’t until someone figured out they could easily place the engines in different areas of the factory that productivity increased.

The same can be said for EHRs. Just dropping in an electronic record to mimic a paper record may not increase productivity. In fact, as cited above it will likely decrease it. A focus on using the capabilities of computers to improve efficiency should be encouraged. For example, documenting redundant and repetitious information should be automated. Improving interfaces allowing greater ease of entry of information. Automating coding for billing purposes would also help improve efficacy.

A large effort, in the form of money and man-hours, has been made to try to achieve the goals of MU. Quite a few criteria used to measure the results of MU have quality, safety, and reduction in health disparities, but very little has done to improve or measure the improvement in efficiency.