EJBI – Volume 14 (2018), Issue 4 12 Original Artcle Mixing Electronic and Non-Electronic Health Records Limits Physician Productvity - The Arizona Experience Willaim G Johnson 1* , Richard J Butler 2 and Gevork Harootunian 3 1 Department of BioMedical Informatcs, Arizona State University, Arizona, USA 2 Department of Economics, Brigham Young University, Utah, USA 3 Center for Health Informaton and Reseearch, Arizona State University, Arizona, USA 1 Introduction Tis study analyzes the efects of mixing electronic health records (EHRs) with non-electronic records on physician productity using data on 7,725 physicians in Arizona during 2012-2014. Ofce based physicians in the United States increased their use of EHRs from 18% in 2001 to 78% in 2013 [1]. In Arizona, EHR use, by ofce based and non- ofce based physicians, increased from 45% in 2007-2009 to 81% in 2012- 2014 [2]. Te predicted improvements in productivity from EHR use have not, however, been realized [3, 4, 5, 6]. Te predictions failed to adequately adjust for the substantial lag between adoption of an EHR by a medical practice and reliance on EHRs as the only form of medical record. Eighty-three percent of Arizona physicians with EHRs and 80% of physicians nationally, combined EHRs with paper and/or scanned records [2, 7]. Te shortage of health information exchanges (HIEs) over which EHRs can be exchanged also limits the efectiveness of EHRs. Avoiding duplicative tests and adverse events, for example, requires sharing among providers, but only 14% of ofce based physicians in the U.S. exchange Abstract Objectve: Estmate the efects of electronic health records (EHRs) on physician productvity in day-to-day practce by including the combinatons of EHRs with non- electronic records that typify current practce. Study Design: Cross secton of 7,725 physicians representng 70% of physicians who provided patent care in 2012-2014 in Arizona. The sample was divided into ofce based (OFB) and non-ofce based (NOFB) physicians. Methods: Informaton from licensing applicatons was combined with a survey of the uses of electronic and non- electronic health records. Productvity was measured as patent visits per hour in a typical work week. The efects of EHRs on productvity were estmated from a regression model that compared users to non-users and an model that included combinatons of electronic, paper and scanned records. The results are compared to the physicians’ rankings of the efect of each combinaton of records on staf and physician productvity. Results: The productvity of OFB physicians is increased by the use of e-prescribing (+17.4%, p<0.001) and interventon reminders (+5.7%, p=0.03). There are no signifcant efects of the diferent mixes of health records. Among NOFB physicians, e-prescribing is the only contributor to productvity (+7.7%, p=0.069). Physicians rank EHR-only as more productve than any combinatons of EHRs with non-electronic records. Conclusion: The potental productvity of EHRs is severly limited by the typical practce of combining EHRs with non-electronic records. Reducing the number of diferent types of records used in a practce will increase the positve efects of EHRs on productvity. One requirement for such reductons is an increased availability of health informaton exchanges. Keywords Electronic health record; Physician; Productvity Correspondence to: Prof. Dr. habil. Bernd Blobels, FACMI, FACHI, FHL7, FEFMI, MIAHSI Medical Faculty, University of Regensburg, Germany. E-mail: bernd.blobel@klinik.uni-regensburg.de EJBI 2018; 14(4):12-19 Received: September 22, 2018 Accepted: May 10, 2018 Published: May 17, 2018 Correspondence to: William G Johnson Department of BioMedical Informatcs, Arizona State University, Scotsdale, Arizona, USA. E-mail: William.G.Johnson@asu.edu