IT Implementation: Why EHRs falter

When Gil M. Holland opened a solo practice in Chandler, AZ, in late 2004, he decided to start out with an electronic health record system right off the bat. Relying partly on advice from his specialty society, the young, computer-savvy family physician bought a state-of-the-art EHR and practice management system from NextGen.

To begin with, he says, errors in the billing interface resulted in a large batch of his charges being downcoded from "new" to "established" visit codes. By the time he'd figured out what was happening, he'd lost $90,000 in revenue. Since it was too late to file new claims, he asked NextGen to write a letter to the health plans explaining what had happened. That was last September, and although he says that NextGen did fix the interface, he didn't get the letter he'd requested until January. Holland doesn't believe the plans will pay his refiled claims at this point.

At this point, says Holland, his growing practice should be able to meet its overhead, but it hasn't because of computer-related costs. Aside from paying off the system, he also has costs from the downtime required to troubleshoot the software and the staff time spent on calling the vendor for help. He's now considering whether to switch to a different EHR with "fewer bells and whistles."

NextGen challenges Holland's account, saying his problems resulted from "human input errors" and that there was never any interface problem. The company also questions whether the system really goes down as often as Holland claims, and it denies that any "error or bug or flaw" in its product is to blame.

Widespread problems plague implementation

It's often said that about half of all EHR installations fail. That may be true, "but it depends on how you define failure," says Ron Rosenberg, a consultant in Sausalito, CA. "Is it that the system is abandoned, or is it getting less than optimal use?"