Impact of Health Information Technology on Primary Care Workflow and Financial Measures

Several frequently cited barriers to the adoption of electronic health records (EHR) include potentially high implementation costs and uncertainty regarding its impact on workflow, productivity, and post-implementation revenue. The data in the literature on these barriers are based on expert opinion and the experience of academic centers using "home-grown" health information technology. "Real-world" data for commercial EHRs implemented in a relatively short time frame are not readily available. This research sought to estimate the cost and workflow impact of rapid implementation for 26 primary care practices within a fee-for-service ambulatory care physician network that adopted an EHR between July 2006 and December 2008.

The study identified "hidden" costs, i.e. resources and staff time, that provider practices and health care organizations must consider when planning for EHR implementation. The three main types of hidden costs are: the time spent by the corporate implementation team in guidance, planning, and overall support; time spent at the practice level in planning, training, and workflow redesign; and the time spent by end-users in activities such as pre-loading charts.

The main objectives of this study were to:

1. Estimate the effect of the EHR on workflow outcome measures.
2. Estimate the effect of the EHR on financial measures.
3. Quantify financial and non-financial costs of implementation and maintenance, providing information on perceived barriers and facilitators in the adoption and implementation of the EHR.

Overall, the team estimated that the EHR and practice teams spent a total of 611 hours per practice for implementation. End-users spent 134 hours per physician. For a five physician practice, hardware and software implementation costs were estimated as $162,000, with $85,500 in maintenance expenses during the first year. The study found that a variety of people were needed for pre-implementation planning, including IT staff, management, clinicians, and leadership. There were short-term decreases found in productivity with substantial recovery in both work flow and financial measures 12 months after implementation. The results observed in this study compare to other reports in the literature suggesting that the effects a practice sees following EHR implementation may depend on the roles played by support staff (and how these can be redefined to reflect new workflow activities created by the EHR), and costs of ongoing EHR maintenance.