The results of a recently released UC Davis study on the effect of EMR adoption on physician productivity say a lot about the impracticality of trying to impose one EHR solution on an entire healthcare delivery system. Although this study was limited in its focus—primary-care providers within an academic medical center—its implications are even greater when applied to specialists, and magnified exponentially when extended to community-based, private-practice physicians.
The researchers at UC Davis were not surprised with their findings that the initial implementation of EMR technology resulted in a 25% to 33% decline in physician productivity, but what they did find surprising was that the results varied widely by medical discipline. While internal medicine physicians regained—and slightly increased—their prior productivity over time, pediatricians and family practice physicians did not, “even after they had climbed the learning curve.” The study’s conclusion was that inherent differences in workflows create varied needs for EHR technology and that “One size does not fit all.”
If one EHR cannot satisfy the needs of different types of primary-care physicians, clearly that EHR cannot be expected to meet the needs of specialists whose workflow is very different, driven by different types of patients and care. It is foolish to expect that a hospital can impose on its physicians the EHR that meets its needs and expect that it will also meet theirs. This is particularly true with community-based, private-practice physicians, whose incomes are tied to their productivity. Physicians understand the productivity impact of the wrong EHR and will resist.
An anticipated positive outcome of the government’s goal of interoperability, which it is trying to achieve through the establishment of EHR standards, should be that providers will be able to adopt the software that best meets their needs and not have to conform to another provider’s preference. One size will no longer be expected to fit all.