Does EHR Software Save Time?

The question every doctor wants to ask is, will the EHR save me time?

The answer is an obvious: depends.

Here’s a nice little way to break it down into an EHR’s functions (started by gchiu on EMR Update with a few of my own changes):
Takes Less Time

  • Finding and Retrieving Notes (milliseconds)
  • Doing Refills (minutes)
  • Faxing Off Prescriptions (seconds)
  • Making Appointments (seconds)
  • Looking Up Results (milliseconds)
  • Doing Calculations (DAS28, Framingham) (seconds)
  • Drug Interactions (seconds)
  • Reporting to Recall Patients (minutes)
  • Reprinting Letters (seconds)
  • Looking Up ICD9s (seconds)

Takes More Time

  • Documenting an Encounter (Level of Documentation Is Now Higher than Before?)
  • Entering Initial Diagnosis List
  • Writing Prescriptions

Please feel free to add to this list in the comments and I’ll update the post. I also started a page on the EMR and EHR wiki of the above EMR and EHR time savings and also started the list of EHR benefits and costs. I certainly encourage more people to contribute there as well.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

23 Comments

  • It is nice to break down the functions but the bottom line is “will it take more time or less time to see the patient, document the note and do everything else you need to do with and for the patient (write scripts, check labs, give notes, etc)?

    If I was selling an EMR and it could “save time”, this would be my main selling point and I think this is what doctors want from their EMR. They want a tool which helps them work more efficiently so they can provide better care (and get home to their family for dinner and the kids activities).

    So far, most EMRs, don’t save time because they are too busy making doctors enter data in a granular manner. The granular data entry must be kept to a minimum so that the key data (health maintenance and chronic problem data) is captured in a granular manner and the other data can be entered in a flexible efficient way.

  • Many doctors cite writing a prescription as a more time consuming task. It used to be a doc could merely scribble some words & numbers on a sheet of paper, hand it to the patient, and be off. With an electronic system, you first sign into the computer system, click on the appropriate tool, do the prescription lookup hoping that the system stores the prescription under the name you use (a decent system will store all common names for a drug), second guess yourself after the default dosage is different than what you would have otherwise prescribed, click through the warnings of possible drug interactions, and finally submit. The number and placement of computer terminals is also a factor. A doctor can get used to this, but there’s no question that it takes longer than writing it on a readily accessible slip of paper. In a situation like this, efficiency is the price you pay for effectiveness. Quality of care goes up (CPOE has been shown to improve care across the board) but doctor efficiency falls.

  • Jon,
    I’m with you on that one. I’ve added writing prescriptions to the list of things that take longer with an EMR. Refills can be faster and faxing them to the pharmacy can be faster with an EMR, but the actual writing of the prescription does take longer most of the time. Only exception might be drugs you don’t prescribe regularly where you’d have to go to your palm pilot or something to look it up. Now you can hopefully do something similar in your EMR.

  • Jon Payne, if your EMR makes writing prescriptions less efficient, then you don’t have a very good EMR. Writing prescriptions is one of the easiest things for an EMR to do! It is very “low hanging fruit” when you talk about how EMRs can help doctors be more efficient. It definitely needs to be added to John’s list but it “should be” in the “takes less time”! Just my opinion.

  • Jeff,
    I have to disagree with you and agree with Jon. Just the time spent opening the EMR is longer that scribbling on a piece of paper. Most will have it open already, but you add in the other things that Jon mentions like the default values and the drug to drug and drug to allergy checking and it just takes longer. Certainly is worth it, but takes longer.

    Although, most EMR do provide some nice “macro” packages for standard things that can save time in this area as well and make prescribing faster. However, I’d say that overall most would say that prescription writing takes longer.

  • “Click through the warnings of possible drug interactions” — Jon Payne

    The clinical support tools need to be “on demand” and not “demanding”. They CAN’T be intrusive. This distinquishes a good EMR from a BAD EMR!

    There is something called “alert fatigue”. This is when the provider ignores all alerts because he or she gets so many!

  • Jeff,
    Even if they’re appropriate alerts they still take more time than writing on a paper. It’s time you want them spending as a patient, but still takes more time.

    Plus, there are too many cases where alerts are appropriate, but it’s also appropriate to click through them on certain cases. Still takes time.

  • John,

    If prescription writing takes longer with an EMR, then the EMR is not properly designed! I am a doctor, I wrote prescriptions by hand and I currently write prescriptions using an EMR. I have seen EMRs that make prescription writing an onerous and time consuming task. These annoying type of EMRs are usually designed by computer guys rather than doctors.

  • The current alert systems in most EMRs are poorly designed and ineffective because providers just ignore them. It is like the boy crying wolf! The alerts must be designed so that only clinically significant alerts get through to the doctor. Remember, doctors are very smart and well trained. They don’t need to be reminded about every little thing. The doctor should have the option to choose his or her level of alert function. This would include being alerted about everything or being alerted about nothing (having the option to turn off the alerts). The best option is probably somewhere inbetween these two extremes. Remember, we want to save time and avoid “alert fatigue”.

  • Great comments. The design of the interface and the process can have a significant effect on amount of time required. Process management is just important in a computer program as it is in the flow of human resources or paper files in a clinic. It would be possible, for example, to display non-critical drug interactions on the screen in a way that is not intrusive and does not require a click, then reserve the warning box for serious interactions. You might also install biometric scanners to reduce login time (i.e. swipe your finger instead of type). But, even with the best of all possible designs, you would be hard pressed to beat (or even match) the amount of time it takes to scribble a prescription on paper. The exception to this would be when the doctor needs to look up information about the drug, in which case, the computerized version could definitely speed up the process.

    Also, while this is not a clinical task per se, most administrative reporting is completed much quicker.

  • Something to think about: is it JUST implementing an EMR that saves time\cost or is it also implementing not only an EMR but also implementing some process improvements\changes\updates that saves time\cost … ?

  • Sam,
    Definitely could be an important time saving factor, but that’s dependent on a the specific processes that a clinic uses. The other issue I’ve seen is that rarely does a poorly run office become a well run office thanks to an EMR. I usually see well run offices get even better.

  • Jeff, I’m really curious to know what EMR you use? As someone who has been a vendor, consultant and healthcare provider who has implemented hundreds of systems of various types (namely the top 8-10 that instantly come to mind), my observation is that there are very few people who save time when creating a net new eRx. I’ll ignore the statement about developers vs. physicians but as a side note many EMR companies employ quite a number of physicians (practicing and non) to help design and provide feedback into the product functionality and design, so in fact most of the cumbersome products your refer to are created with ALOT of direct input throughout the development process from physicians.

    Alerts and reminders would require artificial intelligence to flag/not flag appropriately which would only increase the cost of already expensive systems. Clinical relevance to a resident for example is likely different to clinical relevance to the Attending doctor, from the perspective of understanding, retaining and applying knowledge on interactions and potential adverse events. Either an adverse event is likely at some severity level or it’s not, therefore creating basic boolean logic is a must as a system requirement. Asking a physician to determine whether they choose to ignore it or not is simply good practice.

    Bottom line is that EMR implementation is not about the technology it’s about the process of change and applying reasonable workflows to the technology (many do it the other way around and fail miserably) that aid providers and their staff as opposed to hindering. However, new eRxs are not a time saver, although refills are without question.

  • “Many EMR companies employ quite a number of physicians (practicing and non) to help design and provide feedback into the product functionality and design, so in fact most of the cumbersome products your refer to are created with ALOT of direct input throughout the development process from physicians”

    John W., I think you are correct in your assertion that most EMR companies use a great deal of physician input into their systems. The problem is that most physicians (incluiding those physicians that these companies rely on) are not very good at designing EMRs.

    So, what is the answer? Computer designers are not very good at it, business people are not very good at it and most doctors are not very good at it! This is the reason that 9 out of 10 or 99 out of 100 EMRs are not very good!

    You get a truly good EMR when you combine a great doc with a great programer with a great business guy. Sometimes you find all 3 attributes in the same person and sometimes you find this in a team of people. The magic does not occur often, hence the paucity of truly good EMRs.

  • “Bottom line is that EMR implementation is not about the technology it’s about the process of change and applying reasonable workflows to the technology (many do it the other way around and fail miserably) that aid providers and their staff as opposed to hindering.”

    John W., EMR implementation IS about the technology! If you have crappy technology, no process will make things work well! You need very good technology and then you apply workflow and process change. The technology is critical!

  • “However, new eRxs are not a time saver, although refills are without question.”

    John W., new prescriptions using a good EMRs should save time!

    You are in the patients chart, you click on prescription writer, you type ampicillin, you are given choices of dose, frequency, etc (and possible the program is “smart” and it gives you your most commonly prescribed doses first), you click on the dose, frequency and click on send or print. The patient’s demographics are added, your information is added and you just send or print! This should save time.

    If you are an internist and you write new presciptions AND you do refills, it saves A LOT of TIME!!!

  • Jeff,
    I think you are conflating time and value. There are plenty of reasons to implement and EMR, of which time savings for the physician is only one. Others are improved quality of care (including fewer errors), less redundancy in care, and increased efficiency for the entire system to name a few. I agree with John W that good process optimization and change management are more important than EMR. EMR, in fact, is an optional component of the latter.

    Jeff, you continually refer to a “good EMR”. That “good EMRs should save time”. That is quite impossible to say in categorical terms. “Good” is defined differently in each environment. In fact, there is still no standardized definition for EMR. An EMR in a rural clinic would have a very different definition of good than one implemented in a hospital. Among the primary drivers for EMR are facilitating billing, reducing administrative overhead for accounting and reporting requirements, and electronic prescribing. These all save time for the system as a whole, and may even save money in the long-run, but very few features in an EMR actually save time for the doctor, except in the case of task-shifting. If the use of an EMR (through simple automation or intelligent UIs) can shift a task away from the physician and move it to a less trained and less expensive employee, then everyone wins. This has been a big focus of EMR systems abroad, but has not worked quite as effectively in the US.

  • “There are plenty of reasons to implement and EMR, of which time savings for the physician is only one.”

    John Payne, if the EMR does not save me time (or is not time neutral), I am not interested in using it. If it takes 2 minutes extra per patient, it adds an extra HOUR to my day, each and every day, if I am seeing 30 patients per day. “Time Savings” is THE critical issue here. Period!

    I agree that there are lots of reasons to implement an EMR (and I love EMRs), but don’t “blow off” the time saving aspect because you are telling ME that I have to work an extra hour or two each day without additional compensation!

    Ask doctors what is important to them and they will tell you “time”, “quality of care”, “job satisfaction”, “patient satisfaction” and “outcomes”.

    Time is a critical element that many programmers and EMR executives (and yes, even some doctors) don’t place ENOUGH value on. It is hard to design an EMR that saves time, and IF you can’t do it, you are wasting “someone else’s time”, so you choose to downplay the time issue and devalue the physician’s time. This is THE BIG PROBLEM with most EMRs.

    An EMR is “bad” in my opinion, if it does not save the physician’s time (or is not time neutral).

  • “I agree with John W that good process optimization and change management are more important than EMR.”

    John Payne, you and John W are both wrong. No matter how good the process, with a “bad” emr, you lose! All three elements are important. A “good” emr is a critical element.

    I can’t chop down a tree with a dull axe no matter how strong I am or how optimal my technique is!

  • “In fact, there is still no standardized definition for EMR. An EMR in a rural clinic would have a very different definition of good than one implemented in a hospital. ”

    There is a standard definition. For our purposes we can limit our discussion to an EMR being used in the outpatient setting. In an office or a clinic. This office or clinic can be rural or urban. It can have one provider or 20 providers.

  • “Among the primary drivers for EMR are facilitating billing, reducing administrative overhead for accounting and reporting requirements, and electronic prescribing”

    Jon Payne, your point about definitions is well taken.

    An Electronic Medical Record (EMR) is the medical record in an electronic form. Progress Notes, X-Rays, Reports, Labs, etc. Billing, Accounting, Reporting are part of the Practice Management System (PMS). An Electronic Health Record (EHR) is an EMR plus the PMS (Practice Management System).

    These terms DO need to be defined because they are not used consistently by many people and this leads to confusion. Some people use EHR and EMR interchangably. I use the term EMR and EHR interchangably (sometimes when I say EMR, I am limiting my comments to the EMR part of the EHR). I hope this helps.

  • We cannot accept mediocrity in our EMRs.
    We cannot accept EMRs that steal our (provider’s) time.
    We cannot accept answers that will not work (and don’t make sense).

    I say that the EMR Vendors can jump higher and run faster. They say it cannot be done. I say, “just do it! OR when it IS done, you will be out of business”. I KNOW it can be done, should be done and WILL be done!

    Does EHR software save time? If it does not save time, the company that produces it will be out of business “in no time”. 🙂

    Doctor have to INSIST that it saves time!

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