Outpatient and Surgical Case Volume Before and After Adoption of Hospital and Private Practice Based Electronic Medical Record Systems
Kristofer S. Matullo, MD; David Roy, MD
St. Luke's University Hospital, Bethlehem, PA
Introduction: Adoption of an electronic medical record system (EMR) in accordance with the Patient Protection and Affordable Care Act of 2010 will lead to a decrease in the number of outpatient visits per day and surgical cases per day for an orthopaedic surgical practice.
Methods: The records of six orthopaedic surgeons practicing in a Level 1 academic center were reviewed to assess the number of outpatient visits and surgical cases before and after adoption of an electronic medical record system. The practice implemented the EMR in July 2013. The hospital implemented the EMR three years later in January of 2016. In order to control for the learning curve of adopting an EMR and to counter any effect of seasonal variation on patient volume, we collected data from October through March of both the year before (10/2012-4/2013) and after (10/2013-4/2014) implementation of the practice-based EMR. Similarly, we collected data from April through September of both the year before (4/2015-9/2015) and after (4/2016-9/2016) implementation of the hospital-based EMR. A paired-sample t-test was performed to determine if the EMR had a significant effect on the number of outpatient visits per office day or surgical cases per operative day during the study period.
Results: All surgeons were able to see an increased number of patients per office day (range: 0.3% to 15.8%) after implementing office-based EMR. Five physicians had an increase in surgical cases per operative day after hospital-based EMR implementation. As a whole, the practice was able to see a significant increase in the number of outpatients per office day and a significant increase in surgical cases per operative day.
Following the adoption of an office-based electronic medical record, our practice was able to see a significantly greater number of patients per day in the outpatient office. Following the adoption of a hospital-based electronic medical record, our practice experienced an increase in number of surgical cases per operative day, between 1.0% and 28.4% increase. While we were able to appreciate an increase in patient throughput after the implementation of an EMR, the effect on time spent with each patient in the outpatient setting, surgeon work hours, and surgeon satisfaction remain unclear.
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