September 5, 2016

Health Authority loses millions of dollars to slow computer logins

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I was curious how much money our Regional Health Authority loses waiting for computers to login.

A back-of-the-napkin estimate suggests

a.  It costs about $15 each time an ER physician logs into a computer

b.  During an eight hour shift, an ER physician may spend up to an hour waiting on computers

c.  A single ER may lose a million dollars of productivity annually from slow computers.

Money & time lost loading EHR on slow computers in ED

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Money & time lost loading electronic health record on slow computers in emergency department
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The Math

a rough average suggests

$5/per minute (rough estimated ER physician salary)
x 3 minutes to login
= $15 a login

x 20 logins a shift
= $300 dollars worth of time (about 1 hour) spent logging into computers

x 7 ER physicians covering the department per 24 hours
= $2,100 a day in ER physician salary spent logging into computers

x 365 days a year
= $766,500 a year one ER may spend on ER physicians waiting for computers to login

Where do these numbers come from?


From what I gather, ER physicians at our tertiary trauma hospital are paid around $260 - $375 an hour.  That is $4.38 - $6.25 a minute.

[update Sept 24 2016: I have been informed this is higher than the actual local salary]

Login Time

'Login time' is defined as the time it takes from approaching a computer until the EHR is loaded. I timed all combinations of: the time it took to load from a fresh boot-up, switching users, switching users to a user profile previously loaded, restarting the machine, new computers, old computers, etc.

The quickest login was 1:55 min. The average was around 3 minutes. Sometimes it even took up to 5 minutes.

'Login time' does not include: (a) the time spent finding or waiting for a free computer when all are in use, or (b) time wasted by entering the incorrect password (we have multiple login accounts that all change their passwords at different times).

Number of Logins

Admittedly this is the weakest part of the estimate. It is based off ER physicians recalling how many times a shift they login. It would have been more accurate to provide physicians with a pocket counter to track and time their logins.

The physicians I asked worked in a hospital that uses EHR for information retrieval. Presumably the of logins is higher at sites that use EHR for order entry and documenting notes.

Not included in this estimate

During daytime hours people are almost always working on the computers. The numbers above only accounts for the opportunity cost of ER physicians using the computers. It does not capture the time spent by nurses, occupational therapists, pharmacists, physiotherapists, residents, students, social workers, unit clerks, or other physicians.

The estimate is only for one emergency room in the city.

Most computers and computer users in the hospital are not in the emergency room.  This estimate does not factor in lost productivity on those machines.


[a] Are the computers really that slow?  Yes. Time how long it takes to load a physician profile from sitting down at a computer until the EHR loads.

[b] The term 'costs' and 'loss' is not appropriate, because ER physicians are paid a salary regardless of what they 'do'. Loss is an appropriate term, because it is the opportunity cost of time and salary spent on the task.

[c] Most physicians outside of the ER are fee-for-service. The time they spend waiting for slow computers to login comes out of their pocket, not the healthcare system. See answer to IV.

[d] If ERs become too efficient people will no longer have to wait. This will encourage people with non life-threatening illnesses to go to ERs and be treated by physicians whose hourly salary is no longer proportionate to the social value of care being provided.  Correct, we should aim to ensure waitlists are long and care is sparse, as it helps reduce healthcare expenditures.

[e] Physicians can multitask as they wait for the computer to login. This reduces the amount of 'wasted' time.  Not entirely. Multiple cranks, leavers, and clicks are required in order to safely steer the computer through the login screens.

Thanks to Alain Beaudry for review & feedback

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