- While launching a new EHR implementation may help to reduce hospital spending in the long run, new research suggests labor costs may actually increase for up to six months after healthcare organizations go live with a new system.
A September 2018 study by Scott, MD, et al. published in the Journal of Bone & Joint Surgery used time-driven, activity-based costing methods to assess how a new Epic EHR implementation affected spending and clinical productivity at two outpatient orthopedic arthroplasty clinics part of Duke University Health System.
Researchers focused on providers delivering care for patients undergoing total knee arthroplasties for knee osteoarthritis. The study also assessed provider interactions with patients coming to clinics for intra-articular injections and pre-operative total knee arthroplasties.
“Patients were prospectively timed by hand (with a stopwatch) throughout their entire clinic visit during 1 of 4 data-collection periods, with each group representing a new, unique cohort,” explained researchers in the study report.
Researchers timed 48 patient visits prior to the Epic EHR go-live in 2013. Two and three months after the health system went live with Epic, researchers timed 33 patient visits. Finally, researchers timed 31 patient visits six months after implementation, and 31 patients at two years post-launch. All told, researchers analyzed 143 patient visits before and after implementation.
Using the time-driven, activity-based costing methods, researchers determined total labor costs increased significantly two months after EHR implementation. Specifically, costs jumped from $36.88 to $46.04 per patient visit.
Researchers attributed the spike in labor costs to increases in the length of patient visits.
Two months after implementation, attending surgeons spent about 10.97 minutes per patient, compared to 9.38 minutes before going live with Epic. Medical assistants also spent more time on patient assessments post go-live, with assessment times increasing from 3.4 to 9.1 minutes after go-live.
Combined, surgeons and medical assistants spent 7.6 minutes on clinical documentation during patient encounters after going live with Epic, compared to 3.3 minutes before launching the new system.
While cost savings took a hit two months after go-live, there was no difference in cost at six months and two years. However, the length of time clinicians spent on clinical documentation never returned to pre-implementation levels.
Researchers found “providers spent twice as long documenting encounters at all times after EMR implementation.”
Problems with EHR usability may have contributed to the increased length of patient encounters after implementation.
“Anecdotally, many providers found the new EMR system to be more cumbersome (more windows to click through, etc.) for data entry than the prior system had been,” wrote researchers.
Ultimately, researchers determined healthcare organizations can successfully restore provider labor costs to pre-implementation levels around six months after going live with a new system.
“However, in our study, providers continued to spend almost twice as long documenting patient interactions, even at 2 years post-implementation, as they had before implementation,” the team wrote. “There was also a trend toward decreased time spent reviewing patient records and conducting history and physical examinations as documentation time increased.”
Researchers also found evidence to suggest providers were never able to restore face-time with patients to pre-implementation levels.
“Interestingly, as documentation times fell at the 6-month and 2-year intervals, providers spent more time with patients, although not as much as before implementation,” noted researchers. “This could suggest that providers ultimately were able to spend less time with patients as documentation requirements increased.”
Given these findings, researchers recommended health systems and policymakers keep in mind that the approximate length of the adjustment period that follows a new EHR implementation is six months.
This adjustment period can lead to “substantial disruptions in provider workflows and efficiency and possible to even less clinician time spent with patients,” maintained researchers.