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Sarah Read-Brown, Michael F. Chiang, David Sanders, Daniel Tu, Thomas Yackel, Dongseok Choi, Elizabeth Cottle; Implementation Of Electronic Health Record Systems In Ophthalmology: Impact On Outpatient Clinical Volume. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1407.
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Electronic health records (EHRs) have the potential to improve the quality and cost of health care, but only a small percent of ophthalmologists have implemented them. A perceived barrier is that EHRs may decrease the number of patients that can be seen in high-volume specialties such as ophthalmology. We aim to: (1) measure the effect of an EHR system on clinical volume before vs. after implementation; (2) evaluate the clinical volume trend in ophthalmology compared to 5 other medical and surgical specialties within the same academic medical center.
The ophthalmology department at Oregon Health & Science University (OHSU) implemented an institution-wide EHR system (Epic; Madison, WI) in Feb. 2006. The EHR electronic scheduling system was used to gather data on quarterly clinical volume. In the 3-year study period beginning at implementation, stable providers were identified based on having worked in the ophthalmology department for 5 months before and after the study period. Ophthalmology was compared to 5 other medical and surgical specialties at OHSU (internal medicine, family medicine, dermatology, otolaryngology, and plastic surgery) from implementation until Dec. 2010. Regression lines were used to compare ophthalmology divisions and OHSU departments.
23 stable providers (21 ophthalmologists, 2 optometrists) were identified. Compared to the baseline quarterly average clinical volume during the 3 months prior to implementation, the average quarterly clinical volume after implementation was 93% during year 1, 97% in the year 2, and 96% in the year 3. Among individual ophthalmology divisions 4 had a positive regression slope indicating an increasing trend in volume since implementation, while 1 divisions had a negative regression slope indicating a decrease in volume since implementation. When examining overall departmental clinical volume after implementation, ophthalmology had a positive slope (128 patients/quarter) as did all 5 other departments in the study (range 41-241 patients/quarter).
These findings suggest that ophthalmologists can implement EHRs in academic settings without significantly affecting clinical volume, and that ophthalmologists can maintain or increase clinical volume after EHR implementation. Complementary studies involving physician time requirements and clinical documentation quality will be required.
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