In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) act was passed. This provided an incentive for all US hospitals to demonstrate “meaningful use” of the EHR. For those of you interested in the details, check out the related post link at the end of this article.

Hospitals rushed to comply, shelling out lots of money to try to recoup some of it through these incentives. In theory, using an EHR should allow better record sharing, increase patient satisfaction, reduce unnecessary testing and medical errors, and ideally, improve billing. But does it work?

A community hospital with a medium-sized ED looked at physician productivity in the ED while using an EHR. In this case, the software product was McKesson, and 16 clinicians were monitored prospectively over a 30 hour period.

Here are the factoids:

• The group consisted of attending physicians, residents, and nurse practitioners / physician assistants
• The distribution of how they spent their time is shown below:
  

• In order to complete an assessment in the EMR, it took an average of 160 mouse clicks
• On average, clinicians saw 2.12 patients per hour, requiring nearly 4000 mouse clicks to complete their charting

Bottom line: Overall, this is not a very good or coherent or even well-designed study. But it does show us one thing. Clinicians spent only 28% percent of their time seeing patients, and 56% of their time reviewing or entering data into the EHR! Note the blue and green wedges in the pie chart. How can they possibly earn their salaries? Other studies have confirmed that using an EHR does decrease throughput slightly, yet reimbursements increase anyway.

How can this be? EHRs were originally designed to facilitate billing, and it looks like they still do, making up for the fact that fewer patients can be seen. But this seems like a perverse incentive to me. Adopt the EHR, see fewer patients, get paid more!?

Related posts:

• The trauma flow sheet and CMS “meaningful use”

Reference: 4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED. Am J E Med 31:1591-1594, 2013.

The EHR has been around longer than you think. Even before the current desktop style microcomputers existed, a few hospitals implemented early versions of this product. One of the first was the Latter Day Saints Hospital in Salt Lake City. It installed what it called the HELP system, an acronym for Health Evaluation through Logical Programming.

As computing power increased and the size of the computer box and its cost decreased, a series of advances in medical software systems began to occur. In 1983, a software product geared toward resource scheduling was introduced, and became one of the leading applications of its kind. Most people recognize the name Cadence, but few realize that this was one of the earliest product releases from Epic Systems Corporation.

In 1988, the US government contracted out to develop an electronic record system for the military, much of which is still in use today. On a smaller scale, PC type computers were almost 10 years old in 1990 when Microsoft introduced what I consider the first real version of Windows, version 3.0. Epic was once again an innovator, and it released a product called EpicCare for Windows.

Beginning in 2004, there was a move within the government to emphasize implementation of EHRs across the US, spearheaded by President George W. Bush. And as expected, this led to a number of products developed by a variety of software makers. The push to roll out an EHR universally continues to this day, with no end in sight.

Is this a good thing or a bad one? Although much maligned, the EHR can certainly offer benefits. However, like anything touted as a miracle drug or device, there are always downsides. I’ll review both over the course of the week, but my focus will be on one very specific trauma problem: use of the EHR during trauma resuscitation. Many trauma programs either voluntarily adopted the use of an electronic trauma flow sheet (eTFS), or were forced into it by their hospital administration or IT department. Good idea or not?

We shall see…