2006 EHR WfMS Tutorial Slides 72-79: EMR EHR Workflow Survey: Usability, Revenue, Expense, Time & Quality

(Take me to the beginning of these slides!)

Well, I hope that I have made you interested electronic health record workflow management systems technology. It has a lot promise. But the proof is in the pudding.

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

In a survey of 200 practices using an EHR workflow management system, thirty-six responded. Of these, twenty practices practices had pre-existing operations, so they could compare their before and after experiences. The average practice had been on an EHR WfMS for 2.7 years, had 3.76 physicians, and 17.5 total staff. Their specialties were pediatrics (55%), family medicine and internal medicine (35%), obstetrics/gynecology (5%) and multi-specialty (5%) [CW: which is why the percentages add up to 105 percent]. The survey was a self-assessment survey which covered the categories of usability, revenue, expenses, time and quality.

wfms-usability-ehr-033

Cateories

  • Usability
  • Revenue
  • Expenses
  • Time
  • Quality

Survey questions covered five areas:

  • Usability–operationalized as time to competence, degree of paperlessness, and percent of physicians who use the EMR
  • Revenue–effects on exam rooms, patient volume, charges/visit, billing, denied claims, and total revenue
  • Expenses–staff reduction, staff/provide ratio, transcription costs, ROI
  • Time–waiting, charting, encounter length, to return calls and refill prescriptions
  • Quality–increase immunizations and quality review scores

wfms-usability-ehr-030

wfms-usability-ehr-034

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Usability

Practices achieved competency in five weeks. Of the practices 85% had achieved a paperless office (except for printing paper destined for the outside world or scanning incoming documents). These offices took an average of eleven weeks to achieve this paperless state. Notably, 100% of physicians used the EHR.

wfms-usability-ehr-035

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Expenses (and related figures)

Total staff decreased from 17.5 to 16.7 fulltime equivalents. The staff to physician ratio decreased 12%. (Which is good because physicians generate revenue while staff generate expenses.) Transcription costs decreased 67%. And (in conjunction with the previously described increase in revenue) the estimated pay back period for EHR software and hardware was fifteen months. Visits per day increased 13.5%. Exam rooms increased 34%. Charges per visit increased $17. Billing increased 30%. Denied claims decreased 61%. And revenue increased 24%.

wfms-usability-ehr-036
From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Expenses (and related figures)

Total staff decreased from 17.5 to 16.7 fulltime equivalents. The staff to physician ratio decreased 12%. (Which is good because physicians generate revenue while staff generate expenses.) Transcription costs decreased 67%. And (in conjunction with the previously described increase in revenue) the estimated pay back period for EHR software and hardware was fifteen months.

wfms-usability-ehr-037

From EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale.

Time and Quality

Time and quality have a very interesting relationship. Before the quality management movement, most people assumed that one must increase the amount of time spent on a product or service in order to increase its quality. (This is not necessarily true.) More to the point, patients see timeliness and convenience as an important element of the quality of care. If they do not have to wait or the encounter is shorter and allows them to get back to work on time, this is perceived as increased quality. These practices estimated a 13.5 minute decrease in patient wait, a six minute decrease in charting time, and a 16 minute decrease in overall encounter length. The amount of time to return a phone call to answer a question or to refill a prescription decreased by two hours and 45 minutes and four hours, respectively. Finally, in spite of a higher volume of shorter visits, immunizations increased by 25% (in pediatric practices) and quality review scores increased by 17%.

wfms-usability-ehr-038

To summarize the results of this survey, good things increased, bad things decrease, and the EMR workflow system paid for itself in 15 months. And presumably, next 15 months generated enough to purchase the EMR workflow system again, but since the practices already had on, this flowed directly to the bottom line.

(Take me to the beginning of these slides!)

TEPR 2004 EHR Workflow Management System Slides

Based on the slide deck used for three-hour tutorial at the 2004 TEPR conference in Fort Lauderdale.

TEPR 2006 EHR Workflow Management Systems Slides

Based on the slide deck used for three-hour tutorial at the 2006 TEPR Conference in Baltimore.

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