Switching EHRs

Stanley Anderson, MD, founder of an independent three-physician family practice in Canton, Ohio, says he “loved” the first electronic health record (EHR) system his practice implemented  in 2012.

“It had such a great primary care focus, which so many of the EHRs at the time didn’t have,” he says. “And it was very easy for us to use, too.”
But the combination of regulatory changes, as well as his practice’s participation in an accountable care organization (ACO), made the system unsustainable from both a clinical and business perspective.

“All of a sudden, we needed to have direct messaging. Then a patient portal. And we needed to be able to e-prescribe narcotics and be able to connect to a national database,” he says. “Once we joined the ACO, we found our EHR could not interface with their system-we had to manually extract information to get it over to them.”

Anderson’s EHR vendor said that it could add functionality to the system to meet these new requirements, but at a significant cost-nearly three times the monthly fee that the practice was already paying.

“It was a lot more money than an independent family physician group should be paying,” Anderson says. “So we decided that it was time to start looking for a more cost-effective alternative that could get us all the functionality we needed.”

As the healthcare industry continues to evolve, driven by a variety of clinical and regulatory forces, many provider organizations, are wondering if it’s time to move to a new EHR. In a recent survey,  Reaction Data reported that 39 percent of their provider respondents said their organizations were considering making a switch.

And research conducted by Black Book Research in 2018 suggests that larger health systems and hospitals are not the only ones thinking about ditching their current EHRs. Black Book found that 30 percent of physician practices intended to invest in new systems within the next three years.

There are many reasons why individual practices and hospital systems may be considering a new EHR-ranging from physician dissatisfaction with the current system, to outdated software that is no longer adequately supported by vendors, to a need for platforms that better facilitate data analytics and value-based care models of reimbursement.

But Leela Vaughn, vice president at Epic, a leading EHR vendor, says that many healthcare organizations are eyeing a switch so they can fulfill their most basic mission: to provide the highest quality care for their patients.

“These organizations are considering factors like interoperability, efficiency, and data analytics in their decisions,” she says.

And for good reason: having such functionalities on hand can vastly improve care coordination, provide workflow efficiencies, and help providers better understand and meet the needs of the patients they serve.

But with so much in flux, how can provider organizations know when it’s the right time to make their move?

Making a decision

In recent years, large healthcare systems like the Mayo Clinic, Houston Methodist, and the U.S. Department of Veterans Affairs have rolled out new EHR platforms. Vince Vickers, a partner at the consulting firm KPMG who specializes in the healthcare industry, says it’s not surprising. The continued consolidation of provider organizations, as well as the release of more innovative and more secure technologies like the cloud, have provided new incentives for provider organizations to make a switch. And, he notes, EHR vendors are now dealing with a very different type of customer than before.

“The doctors who are coming into the field today are much more tech-savvy than their predecessors. They have expectations for the kind of systems they want to use,” he says. “Patients have changed, too. They want to be able to interact with providers in new ways. The older your system is, the less likely it’s going to be able to meet those new needs.”

Nicholas Desai, MBA, chief medical innovation officer at Houston Methodist who oversaw the system’s move to the Epic platform in 2016, says that the right time to change EHRs will vary from organization to organization. With so many new systems now on the market – not to mention many older, smaller EHR vendors going out of business for failing to meet regulatory and technology demands – he says it would be all too easy to put off making a decision about investing in a new platform. But, he cautions, taking a wait-and-see approach could backfire.

“Many organizations think they can put  off getting a new EHR for a couple of years and just make do with what they have,” he says. “But when you are working that hard to just make do, you lose your competitive edge. You lose out on ways to improve care and patient satisfaction. You may lose providers who don’t want to keep dealing with workarounds or putting in extra time to get the data they need. You put yourself in a really bad spot.”

Vickers adds that it’s not easy, especially for smaller physician groups, to make the decision to switch, since doing so is expensive and time-consuming.

“It’s going to cost you to make the jump,” he says. “So, if you are only mildly dissatisfied but your current EHR isn’t impacting your business that much, stay where you are. Instead of getting something new, find ways to stay in tune with the market, getting better educated on what’s out there and what’s coming, watch what your peers are doing, and learn more about what opportunities might work once things change.”

By developing specific evaluation criteria, based on their organization’s needs and core values, providers can better gauge when that clinical or business impact may become too much to bear. But, Desai adds, as healthcare continues to evolve, providers also need to keep one eye to the future as they deliberate on the matter.

“Simply put, if your current solution can’t evolve with your organization and doesn’t integrate well with the systems your doctors need in order to provide the right care to patients, it’s time to find a new EHR,” Desai says.

Devising a Plan

Mark Hess, senior vice president at Stoltenberg Consulting who has advised several provider organizations on EHR selection, says deciding to replace your current EHR platform may be the easiest part of the process. Once that decision is made, the real work begins. It’s important that organizations take the time to develop a detailed plan to help guide them from vendor selection to implementation.

“Ultimately, an EHR is just a tool. It’s an important tool but in and of itself, it can’t meet your core values or your goals,” he says. “So in order to invest in the right one once you’ve decided to switch, you need the input of your providers. Take the time to speak to them about what they really need so you can look at potential replacements through that lens.”

Anderson strongly recommends asking other providers about their EHR experiences to help make a suitable replacement selection.

“Talk to the people who are using a particular system. Talk to them about the mistakes they made, what they wish they had known, and what they would do differently if they had to make a switch again,” he says. “No EHR is perfect. But by talking to the people who use it every day, you can gain better perspective on what will work for you and what won’t.”

Desai says such conversations are important, and providers should be having frank conversations with EHR vendors as well. He adds that choosing a new EHR cannot be an IT-driven initiative-patient care needs to be at the center of any plan. He recommends that providers be given the opportunity to test new technologies early on in the process so they can determine whether it will work for them, with a specific focus on how well a new system will integrate with existing systems, and whether it can be customized for specific specialties or programs.

“This is your chance to ask questions and see how a system actually fits into how your people actually do their work,” he says.

Perhaps most importantly, Desai says healthcare organizations, regardless of size, need to develop strategies for successfully managing change during design, build, implementation, and data migration. By putting together a strategy that includes change management every step of the way, provider organizations are more likely to maintain clinical efficiency as they transition between EHRs.

“Change is never easy, so you really need to be prepared,” he says. “You need something that can pull information in real time, aggregate it, and then source it in a way so that a provider, whether it’s a physician or nurse or therapist, can use it in a way that fits into the flow of what they do every day. That takes a lot of upfront planning. But if you do it, you have a much greater chance of selecting something that’s sustainable even as healthcare, as an industry, continues to evolve. That’s really what you need.”