Association Between Electronic Medical Record Implementation and Otolaryngologist Productivity in the Ambulatory Setting

JAMA Otolaryngol Head Neck Surg. 2017 Jan 1;143(1):20-24. doi: 10.1001/jamaoto.2016.2528.


Importance: In the current health care era, many medical practices are transitioning to a new electronic health record system. Until now, there has been little information published on the association between electronic medical record (EMR) use and otolaryngologist productivity in the ambulatory setting.

Objective: To examine the association between transitioning to an EMR system and physician productivity in otolaryngology.

Design, setting, and participants: Observational study at a tertiary care academic ambulatory center. Participants were 5 full-time otolaryngologists in practice, among whom a retrospective analysis of physician productivity was performed from May 5, 2013, through April 30, 2015.

Main outcomes and measures: We examined 5 practicing otolaryngologists for 24 months (12 months before and 12 months after transitioning to a new EMR system). Physician productivity was measured using the mean work relative value units (wRVUs) and the mean number of clinic visits. Each practitioner, with his wRVUs and clinic visit volume, was compared before and after implementation of the EMR system. The overall change in wRVUs and clinic visit volume was measured. The mean time spent after a full clinic day editing documentation before and after implementation of the EMR system for each practitioner was also recorded.

Results: Among all 5 practitioners (age range, 38-51 years), the monthly wRVUs decreased from a mean of 334 before EMR implementation to a mean of 284 after EMR implementation, with an absolute difference of 50 (95% CI, 6-85). The monthly clinic visit volume decreased from a mean of 132 to 121, with an absolute difference of 11 (95% CI, 0-18). When examined individually, only 1 physician had a significant decrease in wRVUs. The remainder of the physicians did not demonstrate a significant change in wRVUs or clinic visit volume. On average, the physicians spent 2.1 hours after clinic reviewing and editing documentation before the transition to the EMR system and 1.9 hours after the transition.

Conclusions and relevance: Transitioning to an EMR system in an ambulatory otolaryngology tertiary care setting slightly decreased physician productivity as measured by wRVUs and clinic visit volume in the 12-month period after implementation in an incentivized compensation system.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Ambulatory Care / statistics & numerical data*
  • California
  • Efficiency, Organizational / statistics & numerical data*
  • Electronic Health Records / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Otolaryngologists / statistics & numerical data*
  • Otolaryngology / organization & administration
  • Outcome Assessment, Health Care*
  • Practice Patterns, Physicians' / organization & administration
  • Retrospective Studies