Electronic Medical Record Adoption: The Effect on Efficiency, Completeness, and Accuracy in an Academic Orthopaedic Practice

Introduction: The electronic medical record (EMR) is the new platform for documenting health information. The purpose of this study is to evaluate the impact of the EMR on efficiency, completeness, accuracy, and surgeon attitude in the orthopaedic program of a training hospital. Methods: Sixty paper charts were compared with 60 EMRs. Pre-EMR and post-EMR billing data was used to determine outpatient clinic volume and the number of providers seeing patients per month. Completeness was evaluated by noting the presence of items from a predetermined list of clinical information pertinent to each diagnosis. Age and side of injury was used to evaluate note accuracy. A survey was used to evaluate surgeon's attitudes regarding the EMR. Results: There was no difference in monthly volume pre-EMR and post-EMR. There was an increase in the number of providers needed to see patients, equating to a 19% reduction in the number of patient visits per provider. The EMR was 1.3 times more likely to include pertinent clinical information. Both paper charts and the EMR were highly accurate. The surgeon attitude survey revealed concerns regarding clinic efficiency, increased "off-hours" record keeping, and decreased clinic teaching. Discussion: EMR is an important and essential component of medical care delivery. Record completion and accuracy were similar across medical record types. The use of EMR led to a 19% reduction in patients per provider. Creating the record in the clinic setting appears to detract from patient interaction, and resident/fellow education time. A more focused, specialty designed, EMR may be more efficient for an orthopaedic practice. Future EMR technology should allow a focused EMR designed for specialties that is efficient to create but that can be electronically converted into a "master record" that meets the needs of an associated larger organization.