The impact of electronic health records on workflow and financial measures in primary care practices

Health Serv Res. 2014 Feb;49(1 Pt 2):405-20. doi: 10.1111/1475-6773.12133. Epub 2013 Dec 21.


Objective: To estimate a commercially available ambulatory electronic health record's (EHR's) impact on workflow and financial measures.

Data sources/study setting: Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008.

Study design: An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004-2009. Changes were evaluated 1-6, 7-12, and >12 months postimplementation.

Data collection/extraction methods: Data were accessed through a SQLserver database, transformed into SAS®, and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month.

Principal findings: Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received.

Conclusions: Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined.

Keywords: Electronic health records; financial performance; workflow.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care / economics
  • Ambulatory Care / organization & administration
  • Efficiency, Organizational / economics
  • Electronic Health Records / economics*
  • Electronic Health Records / organization & administration*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / organization & administration*
  • Primary Health Care / economics*
  • Primary Health Care / organization & administration*
  • Texas
  • Time Factors
  • Workflow