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Study: Ophthalmologists Report Declining Productivity, Revenues Following EHR Adoption

January 2, 2018
by Rajiv Leventhal
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Approximately 72 percent of U.S. ophthalmologists have adopted EHRs (electronic health records), but they are reporting that their net revenues and productivity have declined since implementing these systems, and that practice costs are higher with EHR use.

The findings of a recent study of 348 responding ophthalmologists by researchers at the Department of Ophthalmology and Vision Science, University of California, Davis, the Wilmer Eye Institute, Johns Hopkins University School, and elsewhere, were published in JAMA Ophthalmology. The research found that the EHR adoption rate among ophthalmologists has doubled since 2011—similar to the adoption rate of primary care physicians, which the study’s authors noted is around 79 percent— but in comparison with two previous EHR surveys, perceptions of practice costs and clinical productivity are more negative.

Back in 2006, a survey of U.S. ophthalmologists assessed adoption and perceptions of EHR systems, and found that the adoption rate of EHRs was low (19 percent), but was in line with that of other medical specialties in the U.S. at that time. That survey also found that the satisfaction rate of ophthalmologists already using an EHR at that time was high (69 percent satisfied or extremely satisfied). Then, in 2011, a follow-up survey was conducted that showed that the adoption rate of EHR had more than doubled to 47 percent among surveyed ophthalmologists. However, the satisfaction of ophthalmologists with their EHR and their perception of beneficial effects on practice productivity and costs had fallen in comparison with the 2006 data.

As such, the survey’s findings around ophthalmologists’ perceptions of their revenues and productivity levels in the last few years are perhaps most noteworthy. Respondents who were present during the conversion from paper records to EHR were asked questions about the perceived financial and clinical effect on their practice. They were also asked about productivity changes in terms of the number of patients seen per day. The data in the table below shows that a growing proportion of respondents perceive that productivity had decreased after EHR adoption when comparing results from the three different surveys.

Source: JAMA Ophthalmology

Meanwhile, perceptions of overall practice costs have changed since the 2006 survey, and the proportion of ophthalmologists who felt that costs were higher after the implementation of EHRs had increased (seen in figure below). The perception of net practice revenue after EHR was mixed; 35 percent thought it had stayed the same after EHR adoption and 41 percent thought it had decreased. Almost 9 percent felt that net revenue had increased, and 1.6 percent were unsure.

Source: JAMA Ophthalmology

The survey also found that of those ophthalmologists who attested for Stage 1 of the EHR incentive program (meaningful use), 83 percent had already or were planning to attest to Stage 2, but 9 percent had no plans to do so. One in five of responding ophthalmologists said they never had plans to attest to Stage 1 of the program.

Reasons for not attesting to Stage 1 were that their EHR was not certified (4 percent); the incentive was not relevant to their practice (23 percent); the cost of participating was too high (45 percent); and the complexity of participating was too high (38 percent). And reasons for not planning on Stage 2 attestation were the incentive was not relevant to their practice (5 percent); the cost of participating was too high (63 percent); and the complexity of participating was too high (68 percent).

The researchers concluded that the findings “suggest a need for improvement in two areas: usability of EHR and meaningful use requirements.” They added, “For example, more streamlined methods of viewing and interpreting diagnostic images and faster data entry for high-volume practices are necessary. Finally, while a significant proportion of respondents are engaged in federal EHR incentive programs, the cost and complexity of the programs are potential barriers to participation, and this emphasizes the need to simplify measures that are a part of the new Advancing Care Information [ACI] program that is the successor to meaningful use.”

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