Orthopedic clinic sees increased documentation time, costs after EMR implementation

After implementing an electronic medical record (EMR) system, an orthopedic clinic saw its labor costs and staff documentation time significantly increase during the first several months before then returning to previous levels, according to a study.

The study, published online Sept. 19 in the Journal of Bone and Joint Surgery, examined the implementation of an EMR system at an outpatient orthopedic clinic impacted its labor costs and time spent with patients and documenting. Researchers used time-driven, activity-based costing to evaluate effect of EMR implementation at the clinic. They then compared patient data from before EMR implementation.

According to the study, the documentation time saw a significant increase before and after the EMR system was in place. Prior to implementation, average documentation time was 3.28 minutes. Two months after implementation it was 7.63 minutes; six months after, it was 8.43 minutes; and two years after, it was 5.34 minutes.

Additional changes over time included:

  • Documentation costs: $2.28 before implementation, $4.70 after two months, $4.22 after six months and $1.48 after two years.
  • Clinic staff time per patient: 35.18 minutes before implementation, 51.65 minutes two months after and 52.30 minutes two years after.
  • Clinic staff costs: $36.88 before implementation, $46.04 after two months and $37.73 after two years.
  • Attending surgeon time: 9.38 minutes before implementation, 10.97 minutes after two months and 9.41 minutes after six months.
  • Attending surgeon costs: $21.10 before implementation, $27.01 after two months, $22.68 after six months and $26.15 after two years.

Based on the results, researchers said it’s possible for costs and documentation times to return to previous levels after EMR implementation, but it’s worth noting the impact that type of change can have on providers and workflows.

“Labor-cost increases were in part due to increased certified medical assistant time spent with patients at all time points compared with the time certified medical assistants spent pre-implementation,” the authors concluded. “Healthcare systems and policymakers should be aware that the length of the implementation period may be approximately six months and can lead to substantial disruptions in provider workflows and efficiency and possibly to even less clinician time spent with patients.”