Insult to Injury: The Provider Productivity Drain During an EHR Migration
Provider productivity can make or break a healthcare organization. And for good reason: as noted in studies published in the Annals of Family Medicine and Annals of Internal Medicine, physicians spend hours and hours interacting with the EHR – time that could be better spent elsewhere.1,2 Much has been made of the effects of EHR documentation on provider satisfaction and burnout. But it also has significant impact on provider workflow and productivity. The time spent interacting with the EHR could be better allocated to increasing the number of patients seen or lengthening appointments for more challenging medical cases. Over time, those efficiencies can help healthcare organizations improve patient outcomes – and their bottom lines. The productivity situation only worsens when a healthcare organization migrates to a new EHR platform.
“You may as well just bomb productivity for the first few months after any migration component,” says Cathie Biga, RN, president and CEO of Cardiovascular Management of Illinois. “So much depends on how your migration is done. But even with a strong plan in place, you can end up with reduced clinic hours for weeks, even months, after a migration in order to facilitate providers finding the data they need and getting used to the new system.”
Lorren Pettit, vice president of HIMSS, agrees. “EHRs were developed to aid in productivity,” he says. “Ironically, they often present a barrier to physician workflow. And when you add in a migration, it can really be disruptive. It creates inefficiencies for the physician, of course. And that impacts the organization financially. It’s important that organizations take steps, from the beginning, to make sure those productivity speed bumps are minimized.”
Levels of impact
There are many reasons why an organization may need to migrate to a new EHR platform. Pettit says it may involve a merger and acquisition situation, or an organization simply needing a more sophisticated system to help with their documentation, reporting and analytics needs.
“EHR migrations are common,” he said. “But they can be quite a source of frustration for clinicians. Important clinical information may not easily move from one system to another. Clinicians have to spend extra time searching for information or re-documenting it. They may not know the system that well. It adds up to an even bigger drain on productivity.”
More to the point, these “speed bumps” can impact organizations clinically, operationally and financially. Pettit says that, operationally speaking, ensuring patients are seen at their designated times requires clinicians to be very regimented during appointments. When clinical data from the legacy system isn’t where it’s supposed to be in the new EHR, it makes it much more difficult.
“Getting off schedule has a domino effect,” he said. “It leads to patients waiting to be seen. It leads to patients being frustrated with the organization and reporting unsatisfactory patient experiences. And, taken together, these things have a residual effect on patient compliance. Patients are less likely to listen to the provider and manage their conditions. So you see reduced patient outcomes. There really are a lot of downstream effects – unexpected downstream effects – when providers can’t manage their workflows and they really can affect all levels of an organization.”
Minimizing speed bumps, maximizing productivity
Biga said that some of these downstream effects can be mitigated with proper planning. Healthcare organizations that take the time to create a comprehensive migration plan, complete with quality auditing and manual abstraction, may be at a better advantage.
“Manual data abstraction has absolutely proven to be an efficient and cost-effective way to help minimize disruptions,” she said. “It’s indispensable to have that so that your conversions are better and the impact to productivity is minimized.”
She noted that, with a good plan and manual abstraction services in place, her organization was able to return to business as usual after only a single week of reduced clinic hours. Pettit added that it also takes the burdens off providers – before, during and after an EHR migration.
“When you outsource the abstraction to a professional who actually knows what they are doing, they can help to reduce inefficiencies and, ultimately, minimize the impact to your organization,” he said. “It can help minimize errors, increase patient safety and improve provider productivity. And those are all good things for healthcare.”
1. Sinsky, C. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine. 6 December 2016. http://annals.org/aim/article-abstract/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties
2. Arndt BG et al. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Annals of Family Medicine. September/October 2017. http://www.annfammed.org/content/15/5/419.full