We must shift the focus from the volume and profitability of services provided-physician visits, hospitalizations, procedures, and tests-to the patient outcomes achieved. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need. At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost. It’s time for a fundamentally new strategy. Health care leaders and policy makers have tried countless incremental fixes-attacking fraud, reducing errors, enforcing practice guidelines, making patients better “consumers,” implementing electronic medical records-but none have had much impact. Around the world, every health care system is struggling with rising costs and uneven quality, despite the hard work of well-intentioned, well-trained clinicians. Role of the Sponsor: The NIH-NLM and the ACP had no role in the design and conduct of the study collection, management, analysis, and interpretation of the data preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.ĭisclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the ACP, NIH-NLM, or the US Department of Health and Human Services.In health care, the days of business as usual are over. Obtained funding: McDonald.Īdministrative, technical, or material support: McDonald, Weissman, Goodwin, Mundkur, Kuhn.Ĭonflict of Interest Disclosures: None reported.įunding/Support: This research was supported in part by the Intramural Research Program of the National Institutes of Health and National Library of Medicine (NIH-NLM), and the American College of Physicians (ACP). Statistical analysis: McDonald, Callaghan, Weissman. Study concept and design: McDonald, Weissman, Goodwin, Kuhn.Īcquisition, analysis, or interpretation of data: McDonald, Callaghan, Weissman, Goodwin, Mundkur.ĭrafting of the manuscript: McDonald, Callaghan, Weissman, Goodwin, Kuhn.Ĭritical revision of the manuscript for important intellectual content: McDonald, Callaghan, Weissman, Goodwin, Mundkur.
doi:10.1001/jamainternmed.2014.4506.Īuthor Contributions: Drs McDonald and Callaghan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. McDonald, MD, Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, MSC 3828, Building 38A, Room 7N707, Bethesda, MD 20894 ( Online: September 8, 2014. For the 59.4% of all respondents who did lose time, the mean loss was −78 minutes per clinic day, or 6.5 hours per 5-day clinic week.Ĭorresponding Author: Clement J. The mean loss for trainees was −18 minutes per day, less than that of attending physicians ( P < .001). The mean time loss for attending physicians was −48 minutes per clinic day ( P < .001), or 4 hours per 5-day clinic week. Surprisingly, a third (33.9%) reported that it took longer to find and review medical record data with the EMR than without, and a similar proportion, 32.2%, that it was slower to read other clinicians’ notes. Most (70.6%) used all of the EMR functions listed in Q4, and 82.5% had EMRs in their practice for more than a year (Q7).Īmong all respondents, 89.8% reported that at least 1 data management function was slower post-EMR adoption, and 63.9% reported that note writing took longer.
Of these 9, the Veterans Affairs’ Computer Patient Record System (CPRS) was associated with the least free time loss (−20 minutes) ( P = .04).
Nine EMRs were used by 20 or more respondents, accounted for 324 (78.8%) of all users, and users of each of these lost free time ( P < .05 for all). The respondents used 61 distinct EMR systems (Q4) and came from a broad range of practice types (Q1).
Except for the proportion of ACP members ( P < .001), respondents and nonrespondents did not differ overall across 8 measured characteristics ( Table 2). While most (3 of 4) were attending physicians, trainees were more likely to respond. We removed 69 who reported no EMR use or no ambulatory practice (a 53.6% response rate ), and 5 who did not answer the main outcome question, to yield 411 respondents for analysis. Of 845 invitees, 485 opened the e-mail (a 62.5% contact rate). Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.