Electronic Health Record Implementation Is Associated With a Negligible Change in Outpatient Volume and Billing

The Health Information Technology for Economic and Clinical Health (HITECH) Act mandated that hospitals begin using electronic health records (EHRs). To investigate potential up-coding, we reviewed billing data for changes in patient volumes and up-coding around the time of EHR implementation at our academic medical center. We identified all new, consultation, and return outpatient visits on a monthly basis in the general internal medicine and orthopedics departments at our center. We compared the volume of patient visits and the level of billing coding in these 2 departments before and after their transitions to ambulatory EHRs. Pearson χ2 test was used when appropriate. Patient volumes remained constant during the transition to EHRs. There were small changes in the level of billing coding with EHR implementation. In both departments, these changes accounted for minor, but statistically significant shifts in billing coding (Pearson χ², P.001). However, the 44.7% relative increase in level 5 coding in our orthopedics department represented only 1.7% of patient visits overall. These findings indicate that lay media reports about an association between dramatic up-coding and EHRs could be misleading.