The Practice Impact of Electronic Health Record System Implementation Within a Large Multispecialty Ophthalmic Practice

JAMA Ophthalmol. 2015 Jun;133(6):668-74. doi: 10.1001/jamaophthalmol.2015.0457.


Importance: Given the lack of previous reports examining the impact of electronic health record (EHR) system migration in ophthalmology, a study evaluating the practice and economic effect of implementing an EHR into an ophthalmic practice is warranted.

Objective: To examine the clinical and economic impact of EHR system implementation into a large multispecialty ophthalmic practice.

Design, setting, and participants: A retrospective case-control study was conducted comparing the pre-EHR and post-EHR time periods at the Cole Eye Institute, Cleveland, Ohio. Eight months were spent prior to implementation personalizing and customizing the system to enable advanced charting functions (July 1, 2011, to March 1, 2012). The periods were compared regarding total revenue, total visit volume, revenue per visit, coding volumes, and the number of diagnostic tests and procedures performed. In addition, the total costs of the EHR implementation and the expected return in EHR incentive payments were evaluated. Data analysis was performed from April 1, 2011, through April 5, 2013.

Main outcomes and measures: Net revenue, patient volume, revenue to volume ratio, diagnostic and procedure volume, capital and implementation costs, EHR incentive payments received, and coding volumes (including eye and evaluation and management [E/M] codes).

Results: A total of 28,161 patient encounters were identified (13,969 in the pre-EHR period and 14,191 in the post-EHR period). No significant change was identified with total net fiscal revenue between the periods (median, -$44,372 per month; 25th to 75th interquartile range [IQR], -$103,850 to $83,126; P = .42). No significant change in patient volume (median, +217.0; IQR, -511.5 to 812.0; P = .57) or revenue per visit volume (median, -$7; IQR, -$9 to -$1; P = .20) was identified. The volume of diagnostic tests and procedures billed was unchanged after conversion (median, +93; IQR, -20 to 235; P = .13). Overall use of eye codes declined (-15.7%) and use of E/M codes increased (14.7%) following EHR implementation (P < .001). The composition of eye codes showed a 2% change toward comprehensive codes over intermediate codes after implementation, but only the composition of new E/M codes increased (42.6%) (P < .001 for both values). Total capital costs amounted to $1,571,864, and personnel costs amounted to $1,514,334. A cumulative amount of $983,103 from meaningful use attestation is expected by 2016.

Conclusions and relevance: The analyses conducted in this study did not identify significant differences in revenue or productivity following EHR conversion in this clinical setting. The EHR incentive payments did not offset costs of implementation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care / economics
  • Ambulatory Care / organization & administration
  • Case-Control Studies
  • Efficiency, Organizational / economics
  • Electronic Health Records / economics*
  • Electronic Health Records / organization & administration
  • Health Plan Implementation / economics*
  • Health Services Research
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Medicine*
  • Ohio
  • Ophthalmology / economics*
  • Organizational Innovation
  • Professional Practice / economics*
  • Retrospective Studies