EHRs produce no adverse impact on specialty clinics

Use of electronic health records in specialty clinics does not adversely affect workflow as previously feared, according to a June time-motion study.

The paper addresses concern among clinicians that EHRs may take longer for physicians to use than paper-based systems (J Am Med Inform Assoc 2007;14:609-615). Existing time-motion studies, however, had examined the impact only on primary-care physicians.

"Although specialists are beginning to use electronic health records at an increasing rate, there has been little information about the extent to which doing so takes them longer," said Dr. David Bates of the general medicine and primary care Ddivision at Brigham and Women's Hospital in Boston.

Greater adoption is contingent upon addressing barriers such as concerns about time and workflow, he said.

Bates found that using an EHR system in four specialty settings - cardiology, dermatology, endocrine, and pain - took specialists about the same time as using a paper record.

"This suggests that using electronic records need not take a lot of additional provider time, which is an extremely precious commodity," Bates said.

The study monitored attending physicians before and after the switch from paper to a web-based ambulatory EHR. Across all specialties, 15 physicians were observed treating 157 patients while still using paper-based records, and 15 physicians were observed treating 146 patients after EHR adoption.

"Following EHR implementation, the average adjusted total time spent per patient across all specialties increased slightly but not significantly, indicating that implementation of an EHR has little effect on overall visit time in specialty clinics," Bates said.

Controversy remains regarding whether specialists require a different electronic record than primary-care providers. The EHR studied in this specialty clinic evaluation was the same as the record used in primary care, although different views were provided.

"This means that at least for many specialties, the EHR does not have to be specifically designed to accommodate specialists' clinical needs, and that an application used in primary care may also be used in specialty clinics without substantial increases in physician time needed," Bates said.

Bates cautioned that the study has limitations: Only a few specialties were studied, the sample size was modest, and only one EHR was evaluated.

Other barriers to wider EHR adoption remain. A 2003 report by the Center for Information Technology Leadership (Partners Healthcare System, Boston) said that while clinicians often shoulder most of EHR implementation costs, they accrue merely 11.6% of the benefits.