The Consequences of Electronic Health Record Adoption for Physician Productivity and Birth Outcomes

Abstract

The authors use a mixed-methods approach to investigate how the integration of electronic health records between ambulatory and hospital practices affected physician productivity and birth outcomes at a large health network. Physicians and staff were interviewed during a five-year staged integration of electronic health records, and a direct measure of physician productivity, relative value units, was analyzed concurrently with several measures of birth outcomes. The regression analyses show an 11% reduction in total productivity following the installation of the new system at primary-care sites. The qualitative findings indicate the reduction is attributable to the additional time physicians and staff needed to learn new processes, adopt work practice changes, and develop coordination. Nevertheless, users value the additional integration, especially as information flows back to the ambulatory practices from the hospital. This is supported by increases in treatment intensity over time and a 37% reduction in the severity of adverse birth events.

Electronic medical records and medical procedure choice: Evidence from cesarean sections

“…The most similar study to ours, Meyerhoefer et al (), finds that the exchange of electronic information between the outpatient and inpatient setting at a large, regional provider organization reduced C‐section rates. Our study complements this work by exploring large‐scale data on EMR use within hospitals across 29 states and additional functionalities such as decision support.…”

Data breach remediation efforts and their implications for hospital quality

“…Enhanced security measures in response to a data breach are likely to worsen the usability of the HIT system, which not only diminishes the effectiveness of its intended function but also spawns new errors that worsen the quality of care provided to patients. Installation of new health IT requires clinicians and staff to learn new processes, procedures, and ways to coordinate their workflow . Clinicians adjusting to new processes and systems do so in the presence of patients, which detracts from time spent communicating with the patient and diminishes the patient experience and satisfaction …”

“…Remediation activity may introduce changes that delay, complicate, or disrupt HIT and patient care processes. [12][13][14][15] Furthermore, changes in HIT systems are associated with learning, training, and support costs that may raise usability challenges and unexpected errors. 16 Remediation efforts to repair the damage from a data breach and improve security incur financial costs.…”

“…Figure B shows a conceptual model that hypothesizes the relationship between breach remediation and hospital quality. Remediation activity may introduce changes that delay, complicate, or disrupt HIT and patient care processes . Furthermore, changes in HIT systems are associated with learning, training, and support costs that may raise usability challenges and unexpected errors .…”