EHR system can help practices pinpoint areas for improvement

Electronic health record (EHR) systems can help medical practices improve their design and payment structures, according to one doctor's examination of his five-physician internal medicine practice, published in the April 29 issue of the New England Journal of Medicine.

Richard J. Baron, MD, and colleagues used their EHR system to gauge their work both inside and outside the exam room for a year. During the studied period, the practice had a caseload of 8,440 patients aged 15 to 99 years. On a typical day, each physician saw 18 patients, made 24 telephone calls, handled 12 prescription refills, sent 17 e-mail messages,reviewed 20 laboratory reports, looked at 11 imaging reports, and examined 14 consultationreports.

The practice included 3.5 support personnel per doctor, and support positions included four medical assistants, five front-desk staff, a business manager, a billing manager, a health educator, and two clerical staff. Based on the EHR analysis, the practice hired a registered nurse to "triage" information from lab reports, phone calls, and consult notes. Also, additional front-desk staff and medical assistants were hired to help with tasks associated with the management of chronic diseases. Additionally, the practice's compensation structure now accounts for phone calls and e-mails.

"The focus of use of the [EHR] has moved from word processing and progress-note generation to information management and active support of clinical-practice activities," Baron writes.