Mixing Electronic and Non-Electronic Health Records Limits Physician Productivity - The Arizona Experience

Abstract

Objective: Estimate the effects of electronic health records (EHRs) on physician productivity in day-to-day practice by including the combinations of EHRs with nonelectronic records that typify current practice. Study Design: Cross section of 7,725 physicians representing 70% of physicians who provided patient care in 2012-2014 in Arizona. The sample was divided into office based (OFB) and non-office based (NOFB) physicians. Methods: Information from licensing applications was combined with a survey of the uses of electronic and nonelectronic health records. Productivity was measured as patient visits per hour in a typical work week. The effects of EHRs on productivity were estimated from a regression model that compared users to non-users and an model that included combinations of electronic, paper and scanned records. The results are compared to the physicians’ rankings of the effect of each combination of records on staff and physician productivity. Results: The productivity of OFB physicians is increased by the use of e-prescribing (+17.4%, p<0.001) and intervention reminders (+5.7%, p=0.03). There are no significant effects of the different mixes of health records. Among NOFB physicians, e-prescribing is the only contributor to productivity (+7.7%, p=0.069). Physicians rank EHR-only as more productive than any combinations of EHRs with non-electronic records. Conclusion: The potential productivity of EHRs is severly limited by the typical practice of combining EHRs with non-electronic records. Reducing the number of different types of records used in a practice will increase the positive effects of EHRs on productivity. One requirement for such reductions is an increased availability of health information exchanges.