THE IMPACT OF HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION ON STAFFING PATTERNS AND COSTS

Purpose:

Legislation incentivizing electronic health records (EHR) in healthcare was introduced with the goal of improving quality and safety while reducing costs of care. Evidence for safety improvement is compelling, but projected cost savings remain unrealized. Evaluation of EHR implementation on inpatient units has focused on patient outcomes and provider efficiency. This study examines the impact of EHR on clinical support and clerical staffing patterns and costs.

Methods:

We analyzed over five years of staffing and daily census data from two hospitals comprising a large, regional health system. Retrospective human resources data provided staff hours worked in four administrative and clinical support roles: unit clerks; patient care technicians (PCT); a blended clerk / technician role (PCT2); and nurse externs. Staffing data were stratified by hospital and by shift and reported in two-week increments. Staffing data were combined with daily census data for analysis. Data were available beginning July 2008, capturing the introduction of CPOE at one hospital and the introduction of both CPOE and eMAR at the second.

Results:

While electronic medication administration records (eMAR) did not significantly impact utilization of clinical support and clerical staff on medical-surgical units (p= 0.31), the subsequent introduction of computerized provider order entry (CPOE) yielded significant reductions in the total number of hours clinical support and clerical staff worked per thousand patient hours (p<0.001). CPOE use also redistributed these staff, yielding significant reductions in job specific hours worked per thousand patient hours by unit clerks, patient care technicians, and nurse externs (p<0.001). This paralleled an increase in number of work hours per thousand patient hours in a blended clerk/tech role (p<0.001). Following CPOE introduction, wage costs for clinical support and clerical staff fell from $3,788 to $3,519 per thousand patient hours (p<0.001).

Conclusion:

Inpatient EHR appears to create more streamlined and flexible clinical support and clerical unit staff functions while reducing wage costs. Further investigation is required to establish if these changes reflect work eliminated by the introduction of EHR or work shifted to nurses and physicians.