New research from the University of Notre Dame shows that “basic” EHRs (electronic health records) actually have increased doctors’ tenure at hospitals, while “advanced” EHRs have caused doctors to shift to other hospitals.
It should also be noted that the study did not find any correlation between EHR implementations and physician retirement. The study, “The Mobility of High Status Professionals after the Implementation of Enterprise Information Systems,” is upcoming in information systems research, and is led by Corey Angst, professor of IT, analytics, and operations in Notre Dame’s Mendoza College of Business. Angst and his colleagues examined how the implementation of basic and advanced EHRs influences the ability of organizations to retain highly trained professional workers.
The researchers used information on the mobility of physicians from the Hospital Inpatient Dataset provided by the Florida Agency for Health Care Administration (AHCA), which provides detailed accounts of each patient admitted to Florida hospitals in addition to information on where physicians have been treating patients during the course of the sample.
Data regarding EHR implementation were retrieved from HIMSS Analytics, a nationwide survey of healthcare delivery organizations, granting access to information regarding hospital level adoption of EHR systems at the module level, as well as organizational characteristics such as for-profit status, teaching, specialties, vendor information and size, at the year level.
When combined, the data offer information regarding physician employment and EHR implementation at the physician-hospital-year level between 2000 and 2010.
“Specifically, we look at how this usage affects the decision of physicians to continue practicing at their current hospital,” Angst said. “Results suggest that when EHRs create benefits for doctors, such as reducing their workloads or preventing costly errors, their duration of practice increases significantly. However, when technologies force doctors to change their routines, there is an obvious exodus, though it’s more pronounced with older doctors, especially specialists, and those who have been disrupted in the past by IT implementations.”
The researchers differentiated advanced EHRs, which utilize CPOE (computerized physician order entry) or PD (physician documentation) and are known to be more disruptive to doctors’ routines, from basic EHRs, which are more automated but also have been in use longer, meaning doctors are more comfortable with them.
“Most doctors don’t want to have to look at a screen and document what the patient is saying while doing an exam,” Angst noted. “The PD module requires doctors to either document the things they are doing at the moment of the exam or immediately following — or they have to employ a scribe to do it while they are doing the patient exam. The CPOE creates alerts that many doctors ignore because they think they know better or because of a known history with the patient. These can be very disruptive and in some cases they require doctors to work around the alert.”
Angst said that his team’s study offers reassurance that doctors won’t be scared off as hospitals continue adopting new technologies — as long as they’re not too disruptive to routines.
“With the ubiquity of EHRs today and federal policies that mandate adoption, there is now ‘nowhere to hide,’” Angst said, “but during the timeframe we examined, it was possible for doctors who disliked EHRs to relocate to other hospitals or retire. Interestingly, we did not find increases in retirements or wide-scale departures, but we did find that advanced EHRs did push doctors to less sophisticated hospitals, while basic EHRs actually increased tenure at the hospital.”
Nonetheless, the University of Notre Dame press release on the study noted that many journalists and others, including Pulitzer Prize-winner Charles Krauthammer, have written that doctors are leaving the practice of medicine because adopting and using EHRs is frustrating and debilitating.