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Implementation of electronic charting is not associated with significant change in physician productivity in an
Dusadee Sarangarm1, Gregory Lamb1, Steven Weiss1
1Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Insights
Electronic charting in academic emergency departments showed no overall decrease in physician productivity or billing. However, critical care encounters increased while observational stays decreased post-implementation.
Area of Science:
- Emergency Medicine
- Health Informatics
- Healthcare Management
Background:
- Electronic charting systems are increasingly adopted in healthcare settings.
- Assessing the impact of these systems on physician productivity and billing is crucial for resource management.
- Academic emergency departments (EDs) face unique challenges in adopting new technologies.
Purpose of the Study:
- To evaluate the effect of electronic charting implementation on physician productivity and billing in an academic ED.
- To compare key performance indicators before and after the transition to electronic documentation.
Main Methods:
- A retrospective, blinded, observational study design was employed.
- Data from 31 ED physicians were analyzed for 6 months pre- and 6 months post-implementation.
- Physician productivity was measured using total encounters and a productivity index (relative value units per clinical full-time equivalent).
Main Results:
- No significant difference was observed in the overall monthly productivity index (758 vs. 756; P = 0.30).
- A 9% decrease in total monthly encounters was noted (138 vs. 125; P = 0.01).
- Significant increases in critical care encounters and decreases in observational stay encounters were observed, with no change in total charges.
Conclusions:
- Electronic charting implementation did not negatively impact overall physician productivity or billing in this academic ED.
- The transition was associated with a shift in encounter types, favoring critical care over observational stays.
- Findings suggest that electronic documentation can be implemented with minimal disruption to physician workflow and financial performance.
Objectives:
To compare physician productivity and billing before and after implementation of electronic charting in an academic emergency department (ED).
Materials And Methods:
This retrospective, blinded, observational study compared the 6 months pre-implementation (January to June 2012) with the 6 months post-implementation 1 year later (January to June 2013). Thirty-one ED physicians were recruited, with each physician acting as his/her own control in a before-after design. Productivity was measured via total number of encounters and "productivity index" defined as worked relative value units divided by the clinical full-time equivalent. Values for charges, encounters, and productivity index were determined during each study period and separately for procedures, observational stays, and critical care.
Results:
No differences were found for total productivity index per month (758 [623-876] pre-group vs. 756 [673-886] post-group; P = 0.30). There was, however, a 9% decrease in total encounters per month (138 [101-163] pre-group vs. 125 [99-159] post-group; P = 0.01). Significant decreases were seen across all observation stay categories. Conversely, significant increases were seen across all critical care categories. There was no difference in total charges per month.
Discussion:
This is one of few studies to demonstrate minimal disruption in physician productivity after transitioning to electronic documentation. The reasons for these findings are likely multi-factorial.
Conclusion:
In this study, implementation of electronic charting was not associated with decreases in productivity or billing for total ED care, but may be associated with increases for critical care and decreases for observational stays.
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