• Eric Schwartz, Allison Ruff, Michael Kinning, and A Mark Fendrick.
• Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Email: schwarte@med.umich.edu.
• Am J Manag Care. 2019 Oct 1; 25 (10): 517-520.

ObjectivesThe use of electronic health record (EHR) systems by US clinicians is nearly ubiquitous. One motivation for EHR implementation is the ability to increase provider efficiency and improve patient-centered outcomes. There are no data examining how EHR design aligns with the ordering of high- and low-value clinical services.Study DesignA survey of outpatient providers utilizing various EHR systems.MethodsFive high-value and 5 low-value services that would typically be ordered in a primary care setting were identified. Providers using different EHR systems quantified the number of computer clicks required to order each service.ResultsFive unique EHR systems representing those used by nearly two-thirds of health systems were included. No correlation was found between the ease of EHR ordering and the value of the clinical service. Three of the 5 services that were easiest to order were low value, and 3 high-value services were among the most difficult to order.ConclusionsIn EHR systems used nationwide, no association existed between the clinical value of a service and the ease of ordering. This disconnect suggests that EHR redesign can significantly improve clinician workflow to facilitate the use of more high-value care and fewer low-value services.

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