How Palmetto Health Doctors Defied the Health Information Technology (HIT) Productivity Paradox: Part 2

18 September 2013 | Dr. Dennis Schmuland, Chief health strategy officer, U.S. Health and Life Sciences, Microsoft

Part 2: How Palmetto Health Defied the HIT Paradox Curse

About a year ago, when Microsoft announced Windows 8, I predicted that Windows 8 and the new ecosystem of mobile tablet PCs would enable clinicians to overcome the HIT productivity paradox.  Over the past several months we've been receiving a steady stream of customer feedback from front line physicians telling us that they are in fact, defying the HIT productivity paradox by running their EHRs on Windows 8 and Surface Pro, together, and finding that they're not only able to restore their pre-EHR productivity levels, but actually surpass them.  One of those recent reports came from Palmetto Health, based in Columbia, SC, the largest Cerner ambulatory EHR deployment, covering 60 practices.

A few months ago, several Palmetto Health doctors bought Surface Pro tablets for themselves at a local Best Buy retail store, brought them in to work with them, and found that they could run their fully functional EHR in virtualization mode with all the inputs they needed to be maximally productive: pen, voice, touch, keyboard, and mouse.  As a result, these docs reported that they're seeing at least 2-3 more patients per day, spending more time with patients, going home on time, and improved their CGCAHPS scores (Clinician and Group Consumer Assessment of Healthcare Providers and Systems).  Watch this video footage that captures their experiences in their own words:  Doctors prescribe Surface Pro to improve patient care.

When I heard about this amazing story, I decided I had to make the trip to Columbia to witness firsthand the productivity gains they were reporting, and dig deeper into what exactly they were doing right that other clinical practices weren't.  I wanted to understand how these physicians were using Surface Pro and Windows 8 to overcome some of the EHR productivity killers that were frustrating so many other physicians.,  I also wanted clarity on what was it about the Surface Pro that enabled them to improve their productivity and improve patient satisfaction so dramatically.

Here's what I found out when I arrived.  The post-EHR implementation problem they had to solve was a common one: Making patient record access and documentation with their EHR as easy as it was with the paper charts they carried with them before, during and after they entered the patient room.  Previously they could pick up the paper chart before they entered the room, quickly scan it to review the history and understand the purpose of the visit before they entered the room.  The instant they entered the room, they could immediately start a contextually relevant conversation and start taking notes before they even sat down.  However, once they implemented their EHR, they couldn't access their EHR until they were in the room and logged into one of the multi-user workstation that were installed in each exam room--which meant that they had to wait until they sat down and logged into the multi-user workstation to get their first glimpse at the patient's chart.  In order to scan the EHR before entering the room—like they were able to with their paper charts--some physicians would go back to their private office and log into their workstation between visits.  Further, if they could not complete their documentation while the patient was still in the room, they had to log off of the workstation, discharge the patient, and delay the completion of their charting to a later time, which was more often than not, after the clinic closed, which meant getting home later.  According to the physicians, this amounted to roughly a loss of at 1.5-3 minutes of productivity per patient, which added up to 30-60 minutes productivity lost per 20 patient day.

Like many, they turned to iPad as a way to reclaim lost productivity before, during and after the patient visit and maintain better eye contact with patients during the visit.  The results were disappointing.  When they attempted to run their EHR in virtualization mode on the iPad, their experience mirrored what most of their colleagues experienced:  iPads work well for accessing information and media but fell far short in the full functionality they needed to replace the multi-user workstations.  According to Dr Nick Patel, a self-confessed Apple fan, "...the problem with the iPad was that it didn't have the horsepower to run the complexity of our EHR.  You also have to go to a remote sign-on which was extremely slow." 

After spending an entire day with the Palmetto Health care team, it became clear to me that by doing five things right with their Surface Pro, their primary care physicians were able to not only reclaim the productivity lost to their EHR implementation, but actually exceed their pre-EHR productivity levels. 

Do you know any primary care clinics that have increased their productivity and patient satisfaction above and beyond their pre-EHR implementation baseline?  If so, what did they do right?

Stay tuned for the Part 3 of this series coming next week! If you have a comment or opinion on this post or a question for the author? Send us an email at or let us know on Facebook here or via Twitter here.

How Palmetto Health Doctors Defied the Health Information Technology (HIT) Productivity Paradox: Part 1

How Palmetto Health Doctors Defied the Health Information Technology (HIT) Productivity Paradox: Part 3

Dr. Dennis Schmuland
Chief health strategy officer, U.S. Health and Life Sciences, Microsoft