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Travis Redd, Sarah Read-Brown, Anne Kitzmiller, Thomas Yackel, Dongseok Choi, Michael Chiang; Implementation of electronic health record systems in ophthalmology: impact on clinical volume compared to other medical fields. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4426.
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© ARVO (1962-2015); The Authors (2016-present)
Electronic health records (EHRs) have the potential to improve efficiency and quality of ophthalmic care. However, concerns have been raised about a possible negative impact on patient volume in ophthalmology due to unique documentation requirements, high clinical volume, and relatively limited attention from vendors. This study aims to compare the impact of EHR implementation on patient volume in ophthalmology to 7 other specialty and primary care fields (orthopedics, dermatology, hematologic malignancies, hematology/oncology, cardiology, family medicine, and pediatrics).
An institution-wide EHR system (Epic; Madison, WI) was implemented at Oregon Health & Science University from 2006-2008. Stable clinical providers were identified from among the 8 departments listed above, and quarterly patient volume recorded for each via query of the EHR system. Data for each department was collected from 9 months before to 36 months after EHR implementation. Provider characteristics were recorded, including gender, age, department, and patient volume. Descriptive statistics and paired t-tests were used to evaluate the data.
86 stable providers were identified, including 23 from ophthalmology and 4-12 from each of the other departments. Ophthalmology showed a small non-significant decrease in volume (Table 1) following implementation (range: 93-97% of baseline, p 0.52-0.81). The 5 other specialties combined experienced an increase in volume (surgical group range: 107-124%; medical group range: 110-121%). This change was significant only for dermatology (p 0.03), hematology/oncology (p 0.04-0.27), and cardiology (p 0.01-0.02). Primary care departments trended toward decreased volume (range: 88-90%, p 0.18-0.28). Provider characteristics associated with increased volume included low pre-implementation clinical volume (p 0.04-0.12), female gender (p 0.21-0.57), and younger age (p 0.12-0.60, Table 1).
At this medical center, EHR implementation did not have a significant negative impact on clinical volume in ophthalmology. In comparison, other specialty fields had significantly increased volume, while primary care fields trended toward decreased volume. This suggests that EHR may not have a negative impact on volume in ophthalmology or other specialty fields, but further research is needed to determine the generalizability of these findings.
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