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The American Journal of Managed Care Special Issue: Health Information Technology - Guest Editor: Farzad Mostashari, MD, ScM
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The Impact of Electronic Health Record Use on Physician Productivity
Julia Adler-Milstein, PhD; and Robert S. Huckman, PhD
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The Impact of Electronic Health Record Use on Physician Productivity

Julia Adler-Milstein, PhD; and Robert S. Huckman, PhD
Although increasing electronic health record use and delegating the related work improve physician productivity, these 2 strategies interact differently based on practice size.
Third, our measure of EHR use did not distinguish more intensive use from inefficient use (eg, re-entering incorrect vital signs would appear as more intensive use). However, inefficient use should result in a negative relationship with productivity and therefore work against our observation of a positive, significant relationship between greater system use and productivity. Fourth, observed productivity gains may, in fact, have been improvements in charge capture (ie, more accurate documentation of services provided toensure full payment).4,26 Though increased EHR use may lead to better documentation that facilitates higher coding without improved underlying productivity, this possibility would not explain our findings related to delegation. Finally, there are limitations related to the generalizability of our findings. The practices in our sample are early adopters and our analytic period predates meaningful use. In addition, all practices used the same EHR system, which was designed to adapt to an array of physician preferences about how to document clinical data. This may limit generalizability, but also holds the advantage of ensuring that our results are not driven by differences in the underlying EHR system.

Even with these limitations, our study advances understanding of the relationship between the use of EHRs—the predominant type of health information technology tied to billions of dollars in new federal incentives—and productivity outcomes of great concern to physicians. We found that both increased EHR use and delegation result in meaningful productivity gains, but that practice size influences the extent to which they operate as complements or substitutes in their joint impact on productivity. Deeper investigation of these issues is a fruitful avenue for future research to bolster understanding of the organizational factors that shape the productivity implications of EHR use. 

Author Affiliations: From University of Michigan School of Information and School of Public Health (JA-M), Ann Arbor, MI; Harvard Business School, Technology and Operations Management and National Bureau of Economic Research (RSH), Boston, MA.

Funding Source: None.

Author Disclosures: The authors (JA-M, RSH) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JA-M, RSH); acquisition of data (JA-M, RSH); analysis and interpretation of data (JA-M); drafting of the manuscript (JA-M); critical revision of the manuscript for important intellectual content (JA-M, RSH); statistical analysis (JA-M); and supervision (RSH).

Address correspondence to: Julia Adler-Milstein, PhD, University of Michigan, School of Information, 4376 North Quad, Ann Arbor, MI 48109. E-mail: juliaam@umich.edu.
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