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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
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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:
1. Blumenthal D. Launching HITECH. N Engl J Med. 2010;362(5):382-385.

2. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-504.

3. DesRoches CM, Campbell EG, Rao SR, et al. Electronic health  records in ambulatory care—a national survey of physicians. N Engl J Med. 2008;359(1):50-60.

4. Miller RH, West C, Brown TM, Sim I, Ganchoff C. The value of electronic health records in solo or small group practices. Health Aff (Millwood). 2005;24(5):1127-1137.

5. Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc. 2005;12(5):505-516.

6. Dobson G, Pinker E, Van Horn RL. Division of labor in medical office practices. Manufacturing & Service Operations Management. 2009;11(3):525-537.

7. Adler-Milstein J, Jha AK. Organizational complements to electronic health records in ambulatory physician performance: the role of support staff. J Am Med Inform Assoc. 2012;19(4):537-540.

8. Reinhardt UE. Manpower substitution and productivity in medical practice: review of research. Health Serv Res. 1973;8(3):200-227.

9. Reinhardt U. A production function for physician services. Rev Econ Stat. 1972;54:55-66.

10. Furukawa M. Electronic medical records and efficiency and productivity during office visits. Am J Manag Care. 2011;17(4):296-303.

11. Roos NP. Impact of the organization of practice on quality of care and physician productivity. Med Care. 1980;18(4):347-359.

12. Record JC, McCally M, Schweitzer SO, Blomquist RM, Berger BD. New health professions after a decade and a half: delegation, productivity and costs in primary care. J Health Polit Policy Law. 1980;5(3): 470-497.

13. Kimbell LJ, Lorant JH. Physician productivity and returns to scale. Health Serv Res. 1977;12(4):367-379.

14. Glenn JK, Goldman J. Strategies for productivity with physician extenders. West J Med. 1976;124(3):249-257.

15. Smith KR, Miller M, Golladay FL. An analysis of the optimal use of inputs in the production of medical services. J Hum Resources. 1972; 7:208-225.

16. Yankauer A, Connelly JP, Feldman JJ. Physician productivity in the delivery of ambulatory care: some findings from a survey of pediatricians. Med Care. 1970;8(1):35-46.

17. Straub D, Limayem M, Karahanna-Evaristo E. Measuring system usage: implications for IS theory testing. Manage Sci. 1995;41: 1328-1342.

18. Simon SR, Soran CS, Kaushal R, et al. Physicians’ usage of key functions in electronic health records from 2005 to 2007: a statewide survey. J Am Med Inform Assoc. 2009;16(4):465-470.

19. Lanham HJ, Leykum LK, McDaniel RR Jr. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting. J Am Med Inform Assoc.2012;19(3):382-391.

20. Valentine MA, Edmondson AC. Team Scaffolds: How Minimal In-Group Structures Support Fast-Paced Teaming. Technology and Operations Management, Harvard Business School. Working Paper 12-062. Published January 2012. Accessed September 4, 2013.

21. Pizziferri L, Kittler AF, Volk LA, et al. Primary care physician time utilization before and after implementation of an electronic health record: a time-motion study. J Biomed Inform. 2005;38(3):176-188.

22. Cheriff AD, Kapur AG, Qiu M, Cole CL. Physician productivity and the ambulatory EHR in a large academic multi-specialty physician group. Int J Med Inform. 2010;79(7):492-500.

23. De Leon S, Connelly-Flores A, Mostashari F, Shih SC. The business end of health information technology: can a fully integrated electronic health record increase provider productivity in a large community practice? J Med Pract Manage. 2010;25(6):342-349.

24.Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations: effects on resource utilization. JAMA. 1993;269(3):379-383.

25. Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8(4):361-371.

26. Adler-Milstein J, Green CE, Bates DW. A survey analysis suggests that electronic health records will yield revenue gains for some practices and losses for many. Health Aff (Millwood). 2013;32:562-570.
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