Week 12 – Bhargava and Mishra 2014 – Joe

Bhargava, H. K., & Mishra, A. N. (2014). Electronic medical records and physician productivity: Evidence from panel data analysis. Management Science, 60(10), 2543-2562.

Contrary to decision-makers in other industries, physicians in healthcare sector perform not only knowledge work, such as making decisions and crafting treatment regimen based on patient information, but also data entry and system operation with the wide adoption of EMR. More, they are the healthcare practitioners who drive a majority of care decisions. Therefore, EMRs hold the potential to improve physician workflows and productivity, and, consequently, contain healthcare costs. This paper attempts to examine two important research questions: (1) Does physician productivity change over time as a result of EMR implementation? (2) Does this impact differ for physicians of different specialties?

Measuring physician productivity is challenging, the authors argue that using WRVUs-relative value units generated for clinical activities rather than administrative, teaching, training, or care coordination activities, to measure physician productivity-can overcome the traditional measurement drawbacks, lack of robustness and normalization. More, the theory of Task-Technology Fit(TTF) indicates the heterogeneity of the effects of EMR implementation on physician productivity. Using the dataset, which contains 3,186 physician-month productivity observations collected over 39 months may suffer from OVB, self-selection bias, and attenuation bias when constructing the OLS casual model. The authors then use a Differences-in-Differences model and Arellano–Bond GMM to relief these endogeneity concerns. Their results show that that productivity drops sharply immediately after technology implementation and recovers partly over the next few months. The longer-term impact depends on physician specialty. The net impact of the EMR system is more benign on internal medicine physicians than on pediatricians and family practitioners.

The authors find that on one hand, present-day EMR systems do not produce the kind of productivity gain that could lead to substantial savings in healthcare; at the same time, EMRs do not cause a major productivity loss on a sustained basis, as many physicians fear. Other implications and contributions are also discussed.