Avoid common mistakes in switching EHRs

Whether you are a large, multi-location health system or a solo practice, when it comes to switching to a new electronic health record (EHR) system, those who have made the change say there is one critical piece to success.

“Workflow, workflow, workflow,” Jacqueline W. Fincher, MD, an internist from Thomson, Georgia, told attendees at the American College of Physicians 2016 Internal Medicine Meeting in Washington, D.C. “It’s what you can do on the front end to make the biggest difference on the back end.”

Related: How to prevent malpractice lawsuits due to EHR errors

Fincher detailed her practice’s 2014 experience in merging her original five-physician practice with a neighboring 30-physician primary care practice. One of the attractive features of the new partnership was that it was using the same EHR-down to the same version with the same updates-as was her  practice; a $250,000 investment in 2006. So instead of having to re-invest in another system, Fincher’s practice thought it would be a seamless transition to merge the two platforms together into one new cohesive product.

She thought wrong.

“In April 2015, the vendor told us, ‘We’ve never done a merger of an EHR in one group to another group with the same EHR,’” Fincher said. “In this day of consolidation and integration … there was no business model to do so?”

What followed was a long and costly endeavor involving a third-party interface vendor to bring the two systems together and leaving the task largely to IT experts to get everyone on-board and online for a go-live date in mid-2015.  That day also would not go as seamlessly as Fincher and her colleagues thought.

Further reading: Are HIPAA and interoperability at odds?

From a slow system to malfunctioning printers and inability to open attachments, physicians struggled with the new integrated EHR during patient visits, causing “a lot of pain and suffering,” Fincher noted.

One of the main mistakes she admits to was not understanding-or comprehensively discussing-the difference in workflows between her practice and their new partner, from how they order labs to the acronyms they use so that the new EHR mirrored what was happening daily in the practices separately so they were prepared when they were one entity.

Next: 11 lessons learned

“You have to understand the difference,” she said. “We did things a little differently than the practice we joined … so your IT folks must understand that workflow. And you have to understand the workflows of each practice, including which ones will remain the same and which will change post-merger.”

Further reading: EHRs are ruining the physician-patient relationship

In addition, Fincher shared 11 other “lessons learned” with her fellow internists, including:

• Make a timeline of 6 months prior to go-live date

• Decide on digital push or manual load of information (Fincher’s practice utilized the third-party to transfer the data, but in hindsight she admits that may not have been the best-or most financially beneficial-move.)

• Have clinical staff  pre-load charts with problem list, last set of labs, preventative screenings / dates, and other key data for each patient

• Leave your old EHR system in place for reference in “view-only” mode for one year or more; and examine the cost to do so

• Put old records in PDF files after one year

• Educate staff on new workflows and have all staff in teams shadow the new partner to observe administrative, clinical and electronic workflow

In addition to Fincher, Michael J. Donnelly, MD, an internist and associate professor of medicine at MedStar Georgetown University Hospital in Washington, D.C., discussed his transition to a new EHR across offices in Maryland, Virginia, and the nation’s capital.

He echoed Fincher’s recommendation for evaluating and understanding the workflow of all offices involved in the switch, to ensure the new system can accommodate how each physician works on a daily basis. He noted the importance of physicians being a part of work teams or groups involved in implementing a new EHR.

“Each office has a different workflow in some shape or form,” Donnelly said.  “Your workflow at your office will be different, so you need to understand those differences in setting up a new system, so you [physicians] need to be involved [in the transition] … You need to understand everyone’s point of view and decide what’s important.”