Abstract
The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices. Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members. High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients. This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.
Highlights
Attention to the use of health information technology (HIT) has increased significantly in the United States since The American Recovery and Reinvestment Act (ARRA) of 2009 earmarked an investment of $36 billion to help modernize HIT systems
The percentage of office-based physicians using electronic health records (EHRs) systems rose to an estimated 57% in 2011.2 When EHR systems are interoperable, it becomes possible for health care providers and other stakeholders to share useful information electronically within and between enterprises to care for their patients
To further explore the impact to workflow by EHRs and extend the work to cover forms of interoperability that are becoming more widely available, we modeled workflow effects with a discrete-event simulation (DES) model, which relies upon highly realistic models of workflow, and uses the model to qualify effects of interest such as time spent on tasks
Summary
Attention to the use of health information technology (HIT) has increased significantly in the United States since The American Recovery and Reinvestment Act (ARRA) of 2009 earmarked an investment of $36 billion to help modernize HIT systems. $19 billion of this amount was allotted for incentivizing the meaningful use of electronic health records (EHRs).[1] The percentage of office-based physicians using EHR systems rose to an estimated 57% in 2011.2 When EHR systems are interoperable, it becomes possible for health care providers and other stakeholders to share useful information electronically within and between enterprises to care for their patients. The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. Conclusion This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, overall it appears to improve time efficiency more for administrators than for physicians and nurses
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