Volume 49 | Number 1pt2 | February 2014

Abstract List

Neil S. Fleming, Edmund R. Becker, Steven D. Culler, Dunlei Cheng, Russell McCorkle, Briget da Graca, David J. Ballard


To estimate a commercially available ambulatory electronic health record's ('s) impact on workflow and financial measures.

Data Sources/Study Setting

Administrative, payroll, and billing data were collected for 26 primary care practices in a fee‐for‐service network that rolled out an on a staggered schedule from June 2006 through December 2008.

Study Design

An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004–2009. Changes were evaluated 1–6, 7–12, and >12 months postimplementation.

Data Collection/Extraction Methods

Data were accessed through a server database, transformed into , and aggregated by practice. Practice‐level data were divided by full‐time physician equivalents for comparisons across practices by month.

Principal Findings

Staffing and practice expenses increased following implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received.


Expenses increased and productivity decreased following implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined.