title: The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study.
abstract: BACKGROUND
  The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques.
  
  
  OBJECTIVE
  To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices.
  
  
  METHODS
  Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members.
  
  
  RESULTS
  High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients.
  
  
  CONCLUSIONS
  This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.
authors.affiliation: Department of Industrial and Systems Engineering University at Buffalo 339b Bell Hall Buffalo, NY 14260, USA. yuanzhou@buffalo.edu.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Departments of Pediatrics and Public Health, Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Ancker
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA.
authors.forename: Mandar
authors.initials: M
authors.lastname: Upadhye
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA.
authors.forename: Nicolette M
authors.initials: NM
authors.lastname: McGeorge
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA.
authors.forename: Theresa K
authors.initials: TK
authors.lastname: Guarrera
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Hegde
authors.affiliation: Department of Emergency Medicine, University of Rochester, Rochester, NY 14642, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Crane
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, DC 20008, USA; Department of Emergency Medicine, Georgetown University, Washington, DC 20007, USA; Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA.
authors.forename: Rollin J
authors.initials: RJ
authors.lastname: Fairbanks
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Bisantz
authors.affiliation: Center for Healthcare Informatics and Policy, Weill Cornell Medical College, NewYork, NY 10065, USA.
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY 14260, USA; Health Information Technology Evaluation Collaborative Investigators.
authors.forename: Li
authors.initials: L
authors.lastname: Lin
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003198:Computer Simulation; D057286:Electronic Health Records / Q000458:organization & administration*; D006801:Humans; D009010:Monte Carlo Method; D011216:Practice Management, Medical / Q000458:organization & administration*; D036301:Qualitative Research; D018511:Systems Integration; D057188:Workflow