The productivity paradox: EHRs need to be tough now to gain efficiencies later

The productivity paradox is the phenomenon that investing in IT leads to an initial decline in improvement and productivity instead of the expected immediate improvement in processes. It's a paradox widely observed in the healthcare industry following the implementation of EHRs. While times are challenging now, there is still promise for the future, according to Robert Wachter, MD, professor and interim chair of the Department of Medicine at University of California, San Francisco.

In a letter published in Annals of Internal Medicine, Dr. Wachter explores the productivity paradox in healthcare and writes that the industry can look to others for instances in which the productivity ultimately leads to the desired outcomes. "The history of the productivity paradox in other industries offers great cause for hope in healthcare, in that it seems to eventually resolve," Dr. Wachter writes. 

However, he says it typically takes about a decade for those efficiencies to be realized. With the majority of hospitals adopting EHRs within the past five years, it may be another five until this technology produces the desired outcomes, by Dr. Wachter's calculations.

The paradox highlights two main factors of achieving enhanced productivity through IT, according to Dr. Wachter. The first is that technology needs to continually improve, which he says it inevitably does. The second and more nuanced factor is that users need to reimagine their work for a more digital age, which Dr. Wachter says is a difficult thing for people to do. He quotes carmaker Henry Ford who reportedly said, "If I asked people what they wanted, they would have said 'faster horses.'" 

True improvements in quality and productivity are only achieved once people have worked with technology and begin questioning the old way of doing things, according to Dr. Wachter. In healthcare, some of those questions for providers may be ask why rounding happens in a certain way, why providers communicate using the tools they do, or why are notes written in a certain way.

"Reimagining the work is not easy, but it is achievable, particularly if there are people who have a deep understanding of both clinical work and technology, who can build and run teams effectively, and whose thinking naturally gravitates toward system improvement," Dr. Wachter writes.

More articles on EHRs:

74% of physicians say they haven't seen a return on EHR investment 
Computer, math science workers in hospitals increased 18% to help with EHRs 
Documentation in paper records more accurate than in EHRs, study finds 

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