One of the challenges of any major change is a potential loss of productivity. Paper-based practices have for years optimized workflow in order to achieve maximum productivity in individual settings. As these practices transition to EMRs, some of the major challenges they face are the workflow changes necessary to implement and use the technology in clinical practice settings. This is not helped by the fact that there is limited ability at this time to exchange data with other providers and pharmacies through eReferrals and ePrescribing.
Even with these limitations, the majority of physicians who use EMRs would not change and go back to paper. There are additional advantages, such as the ability to remotely access the EMR, implement reminder and notification systems, and generate reports that provide an instant view of a patient’s status or identify patients who may be on a certain drug that has been recalled.
What is the net impact on medical practice productivity following EMR implementation and how long should it take for productivity to return to pre-EMR levels? The loss of productivity is not unique to the Canadian setting and colleagues in the U.S. are facing similar problems as they transition to EMRs.
As a general rule of thumb, practices suffer a loss in productivity for 2–3 months following implementation of an EMR; however, the productivity loss can extend for longer periods and in some cases never returns to pre-EMR levels. Whether a practice returns to pre-EMR productivity levels can be a function of the EMR that is being used (a limitation of the technology) or can be due to a lack of workflow redesign in the practice. In this situation, practices continue to run as they did prior to EMR without taking advantage of the new capabilities offered by the technology. For example, the management of incoming documents can be a significant bottleneck for practices if the reports and consult letters have to be reviewed by physicians before being scanned into the EMR, particularly if they are personally not well organized.
Some U.S. physicians are using scribes to assist with documentation while they focus on examining patients and deciding on diagnostic investigations and treatment options. This is probably not practical in a fast-paced GP practice. Some Canadian specialists may have added scribes in their practices, although it does increase practice overhead.
What has been your experience with productivity loss and the return to pre-EMR levels of efficiency? Have you developed innovative ways to improve productivity? What advice would you provide to colleagues going through an EMR implementation?
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