Prospective Assessment of Electronic Health Record (EHR) Implementation on Community Based GI Practice

Abstract

Purpose: EHRs are increasingly utilized in GI practices with the promise of increased practice efficiency, improved safety, and decreased cost. There is limited data on the ability of EHRs to achieve these intended endpoints. This abstract compares the impact of EHR implementation on two community based GI practices. Methods: Huron Gastro (HG) is an 18 provider practice in Michigan that installed the NextGen EHR in 2004 and was fully implemented in 2006. The Center for Digestive and Liver Health (CDLH) is a 15 provider practice in Georgia that implemented the Allscripts EHR in 2005. Clinical outcomes and costs pre and post implementation were assessed. Results: Prior to implementation, the average time for a referring doctor to receive a dictated consultation was 14 days (range 7–28 days). Post implementation, this time decreased to hours after completion of the consultation at both practices. HG medical records FTE preimplementation was 1 per 3 providers, post implementation 1 per 4 providers. CDLH medical records FTE preimplementation was 5 per 6 providers, post implementation 3 per 8 providers. HG annualized pre-implementation transcription costs were 112K compared to 12K post implementation. CDLH annualized pre-implementation transcription costs were 71K compared to 29K post implementation. HG postage costs decreased from $20K to $6.5 during the same comparative period. When the drug Zelnorm was withdrawn from the market due to safety concerns, all patients using Zelnorm at both practices were identified within 24 hours and contacted by mail or phone to discontinue the drug. Similar efforts to identify patients when Cisapride was withdrawn took over a week in 2000 at HG. Conclusion: Community based GI practice EHR implementation resulted in reduction in the time for referring physician to receive consultation notes by an average of 2 weeks at both practices, decreased medical record FTEs, decreased transcription costs, and decreased postage costs. These finding suggest EHR implementation improves the efficiency of communication and decreases practice costs. Allowing easy database searches to identify patients at risk for drug toxicity may enhance patient safety. The cost savings achieved by EHRs are countered by the significant cost associated with implementation and the hiring of dedicated IT staff.