Reducing Appointment Delays: The Impact of Standardized EHR Usage on Physician Timeliness

Problem definition: Wait times in appointment systems, defined as the duration between scheduled appointment times and the start of the appointment, significantly impact customer satisfaction and serve as a critical measure of service quality. Task standardization is a crucial operational strategy to reduce service time and, consequently, service provider delay for subsequent appointments. While prior research has demonstrated the effectiveness of task standardization in reducing wait times, a nuanced understanding of task standardization's short-term and long-term effects is crucial for improving service quality. Without this insight, standardization interventions may address immediate wait time issues but could inadvertently create new challenges over time, such as affecting follow-up appointments. Methodology/Results: To explore task standardization's short-term and long-term effects, we focus on the specific case of Electronic Health Record (EHR) documentation. Using a dataset of over 120,000 appointments from 57 physicians at a major academic medical center, we investigate how the standardization of EHR documentation tasks affects appointment delays. Our unit of analysis is the individual appointment. We define our treatment variable as the Standardization Ratio, which measures the level of standardization in each appointment. It is calculated as the time spent using EHR tools like SmartPhrases, as a fraction of the total work done. Our approach enables us to assess both the immediate impact of standardization on appointment durations and its longer-term effects, such as the length of follow-up appointments. We employ double machine learning as our primary method to address potential endogeneity in SmartPhrase usage, given its ability to handle continuous treatments and high-dimensional covariates while providing robust and unbiased estimates. To validate our findings further, we also use nearest-neighbor matching. Our model results are consistent between the two estimation procedures. Our findings indicate that a 10% increase in the proportion of appointment time dedicated to standardization tools reduces appointment delays by 0.4%, likely due to a 6.8% decrease in the proportion of time physicians spend in the patient room. Managerial implications: This demonstrates that, in the short term, task standardization can effectively reduce delays. However, this shift also leads to a 78-word increase in clinical documentation and a 0.25% rise in the in-room time ratio for future follow-up appointments, suggesting potential long-term trade-offs in clinical efficiency. This highlights a trade-off between short-term efficiency and long-term task burdens. While task standardization is known to improve timeliness and reduce wait times, our results emphasize the need for a balanced approach. Standardization tools streamline processes and improve immediate efficiency but may increase future workload and prolong future interactions.