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Electronic health records may improve financial returns, workflow efficiency
An ophthalmologist reports a financial analysis of EHR implementation over 5 years at a private practice.
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The use of electronic health records may result in significant financial returns and workflow efficiency for practices, according to a report.
The prospective financial analysis, reported in Ophthalmology, evaluated data that affected cash flows relevant to the implementation of EHRs at Asheville Eye Associates, N.C., over a 5-year span. The practice consisted of 10.8 full-time equivalent providers.
“Electronic health record implementation can be a successful venture from a financial perspective, especially with proper planning and training to make for a smooth transition,” study author Robert E. Wiggins Jr., MD, MHA, told Ocular Surgery News. “We show how we did it by process changes to improve workflow.”
Provider schedule and productivity
In the first month of implementation, seven providers started using EHRs, which resulted in a net schedule reduction of 0.41 patients per day over the first year of EHR use.
“It is important that provider productivity not stay down for long as this is a sensitive factor in achieving the best return on investment,” Wiggins said. “Physician and staff training are key factors in maintaining productivity before going live. Staff would backfill charts with past medical histories prior to implementation both for training and to make the transition more efficient as every patient is now ‘new.’”
There were no changes in schedules during years 2 to 4.
In year 5, there was a net annual increase of 1.23 patients per day in productivity for all providers, which was attributed to an increase in EHR familiarity and a greater number of returning patients, which reduced the number of new data entries.
“It was not until the fifth year of implementation that provider productivity actually increased as the staff became familiar with the system and the majority of the patients were in the system where the data could be brought forward from prior visits,” Wiggins said. “It is at this point that an EHR really allows for efficiency over paper records.”
Positive cash flow
The biggest positive cash flow was related to the net reduction in staffing of medical records, transcription, billing, check-out and appointment scheduling, the report said.
“We have simplified the billing process in that charges are posted in the exam room, and follow-up appointments are made without sending the patient to check out, allowing us to lower staff in that area,” Wiggins said. “Copays and deductibles are collected at the front desk, and most patients are able to check out from the exam area. Data is now easily accessible from any location, and reporting of quality measures, using the EHR in conjunction with the American Academy of Ophthalmology’s IRIS Registry, is easily managed.”
Increases in expenses were attributed to information technology staff, EHR maintenance costs, scanning of paper medical records and increased printing costs in the initial phase of implementation, the report said.
“There are still complaints about functionality and cost of an EHR, so improvements in those areas will increase adoption,” Wiggins said. “Clearly we still need interoperability between systems, which will further increase the value of using an EHR.”
Overall, the payback period was 2 years 10 months. The internal rate of return on investment was 41%.
EHR in everyday practice
Studies have shown that large practices are more likely to show a return on investment from EHRs, Wiggins said.
“EHRs will eventually become a part of nearly all practices,” he said. “Health care has been the last major sector of the economy which has relied on paper records. Now things are finally changing.”
As EHRs become used more often in everyday practices, Wiggins recommended staff engagement, training and workflow changes to contribute to success.
“EHRs are here to stay and will increasingly be an important component in quality improvement initiatives,” he said. “Practices should spend time on training staff and think proactively about changing processes in conjunction with their EHR to help improve workflow.” – by Kristie L. Kahl
- Reference:
- Wiggins RE, et al. Ophthalmology. 2015;doi:10.1016/j.ophtha.2015.06.036.
- For more information:
- Robert E. Wiggins Jr., MD, MHA, can be reached at Asheville Eye Associates, 8 Medical Park Drive, Asheville, NC 28803; email: rw@aea1961.com.
Disclosure: Wiggins reports he receives site visit fees from Allscripts.