Implementation of an Electronic Medical Record in an Academic Outpatient-Based Multi-Specialty Ophthalmology Practice

Abstract

Purpose: : To quantify the financial impact of implementing an Electronic Medical Record (EMR) in an outpatient setting.

Methods: : Individual faculty data from eleven full-time members was retrospectively collected for the two year period prior to EMR implementation and for the two year period post-implementation. During the "Go Live" period of two weeks post-implementation, clinical appointments were down-scheduled for training. Four metrics which drive profitability were tracked: Gross Charges, RVU, Testing Charge Capture, and Charge Lag

Results: : The data was analyzed using a Autoregressive Integrated Moving Average (ARIMA) model. There was no statistically significant short-term or longer-term decline in total productivity measures following EHR implementation. An initial decline of $52,000 per week of gross charges was noted over the first three weeks. This returned to pre-implementation baseline at week 4. There was no effect of seasonality on data; however physician absenteeism was of significance where each additional provider contributed to a 10% increase in revenue, 95% CI (7 - 13%). In our practice, Gross Charge is a linear function of RVU, therefore the data is identical. Charge lag trended toward a 24% increase, 95% CI (0.98 - 1.57), post-implementation, but the values were not of statistical significance. Notably, testing charge capture increased significantly over the first few months post-implementation prior to reaching a new higher plateau.

Conclusions: : We conclude that this longitudinal study reaffirms that EHR implementation actually enhances productivity and prevents loss of potential revenue generating activities such as diagnostic interpretation. There is a plethora of data available to demonstrate how EHR systems can enhance patient care and patient experiences. With such a paucity of data available on implementation costs, we have helped to quantify the indirect costs of implementation. While the actual direct implementation costs related to hardware/software/training are not quantified in this review, those are far more transparent.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower