It’s no secret that dissatisfaction with EHR systems has been a major concern for physicians. In fact, several recent surveys report as much as a 25 to 30 percent unhappiness level among doctors and practices.
This presents a real challenge. Physicians usually will have signed a vendor contract that requires them to remain with the EHR system for an agreed upon period of time, so they likely are stuck with it unless they are willing to lose the money.
David Zetter, a member of the National Society of Healthcare Business Consultants (NSCHBC), explains contracts are proprietary to each EHR vendor, and while each is different, there are usually no escape clauses.
“The issue is not whether you can drop the EHR, because you can at some point, but you still paid for it and you are not going to get those monies back,” he says. “The EHR company is not going to refund the price of the purchase unless you can truly prove that they breached their own contract terms, which usually is difficult to prove.”
Generally, EHR contracts are a minimum of two years because of how long it takes to get everything set up, after which they then convert to a month-to-month contract.
Why doctors want out
Russell Libby, MD, founder, president, and medical director of the Virginia Pediatric Group, Fairfax, Va., notes that EHRs have been built around reporting and billing needs, so they create distractions rather than complementing the patient encounter.
“Physicians end up spending excessive time fulfilling program expectations rather than their clinical inclinations—this can be very frustrating,” he says, adding that EHR companies lack customer service and flexibility.
Zetter says the main reasons most physicians are unhappy with their EHRs are because they did not thoroughly compare and test drive the various models, and the implementation process is almost always done incorrectly. Before contracting with any system, he recommends obtaining names and numbers of those that utilize it and asking pointed questions about what the issues were with the installation and implementation.
Lansing Urgent Care in Lansing, Mich., wanted to expand its business, but as the clinic grew, their EHR system did not scale with them. The clinic soon found itself being bogged down by workflow inefficiencies, which significantly increased costs.
Catherine Matthews, CEO and owner of the facility, says even though the sales process was terrific, once the deal was signed and the system went live, the customer service for the EHR was lacking.
“When we had issues, we had a hard time getting calls returned,” she says. “We knew we needed a new and efficient EHR solution and went looking for a company that would have a true partnership with us, was open to our ideas, and helped to support us throughout our tenure as a customer.”
There was a moderate amount of work involved with switching, but the new company helped migrate the data and supplied an on-boarding team to lead the urgent care through the various steps of setting up their tool, customizing it, training the staff, and going live.
Pradeepa Selvakumar, MD, once worked as a hospitalist at Marin General Hospital in Greenbrae, Calif., and experienced multiple problems with the EHR system the facility was using. However, the hospital was unable to cancel or recoup the contract.
“As part of the IT committee, we lodged multiple complaints and appealed directly to the EHR vendor at their headquarters without any resolution,” she says. “We needed a collaboration solution and used a third-party software to pull information from the EHR and then worked with the [software company] to create what we needed.” This modification served their needs better.
Now, she is an internist with San Mateo Primary Care, San Mateo, Calif., and utilizes an EHR that is part of a larger hospital system, and says that also comes with some challenges.
“Larger hospital systems are very restrictive in working with third-party software so we have no leverage [to make changes] at this time,” Selvakumar says.
KLAS Research and its ARCH Collaborative recently collected data on EHR adoption and usability from more than 16,000 physicians. The finding revealed the top three determinants of physician satisfaction with EHRs are giving them at least six hours of training, offering customization, and providing an IT culture that is physician-user focused.
That’s why the experts believe that when looking for an EHR, physicians need to consider capabilities such as easy appointment scheduling, monitoring patient workflows in real-time, and easy access to patient history. There are critical features.
A legal way out?
Corinne Smith, JD, a member of Clark Hill Strasburger’s healthcare law team in Austin, Texas, says a remedy may lie within the terms of the EHR vendor contract.
She says in rare cases, a provision for early termination without cause can be added, but a physician would have to demand it. Normally, these require 90-120 days’ written notice to the vendor.
“If you don’t have an early termination provision in the agreement, it is worth trying to negotiate an early termination,” Smith says. “Typically, the vendor does not want to continue supporting a disgruntled practice and they may be willing to negotiate an early exit. It can be in both parties’ best interest to end the relationship without acrimony.”
If this doesn’t work, Smith says a physician or practice should pull out the EHR contract and examine the terms and review key provisions.
“Is there a breach that could be grounds for termination? If so, then the practice can provide written notice of the breach consistent with the requirements of the contract,” she says. “Sometimes a written letter and threat to terminate the agreement is all that it takes to get action. It is critical that the notice letter comply with the requirements in the agreement for termination for breach.”
Some agreements specifically provide a mechanism for dispute resolution. Typically, the agreement either provides for mediation process prior to pursuing litigation or it will call for arbitration, Smith says.
“If the contract has a clause for mandatory arbitration, the dispute will not be settled in a court of law,” she says. “Arbitration requires the parties to submit their dispute in writing to a third-party arbitrator.”
Smith says if the vendor is non-responsive to complaints or concerns and the issues relate to the product’s certified capabilities, contact the Office of the National Coordinator for Health Information Technology.
However, even if there are issues, she advises never to stop making payments on the contract.
“The legal obligation to pay exists under the written agreement regardless of whether you are satisfied with the vendor,” she says. “If you withhold payment, you may be hit with a collections suit and fines for late payment.”
In the rare case that physicians are able to get out of a contract with an EHR vendor, extra fees should be expected, Zetter says. And because all systems are different, physicians making a switch should expect fees for data transfer.
Barring an escape
Since physicians may not be able to get out of a contract, they are going to have to find a way to make it work.
Libby says in some cases, the best way to find a resolution is to engage with the EHR company you are working with.
“That often involves investing time and money, but there may be solutions available,” Libby says. “Some might be surprised to know that there are some EHR providers who are willing to work with doctors to make the systems more functional and affordable.”
A good way to start, he says, is to designate a “super-user” in the practice who understands the inner workings of the system and can present the issues the practice is experiencing to the EHR company.
“When we aren’t getting solutions, we might feel that we’re asking the wrong person at the EHR company when in fact the issue is that we don’t know how to define the problem well enough to even ask for help fixing it,” Libby says. “It takes time and investment to gain that knowledge—sometimes it means going to user conferences and on-site headquarters trainings.”
Still, sometimes, no real potential for improving the functionality of the system exists. In those cases, physicians must step back and decide whether switching providers is the right path.
Libby says in some extreme circumstances, physicians may join a group or be acquired by a third-party who can provide a better EHR.
Another idea, Libby suggests, is visiting other practices that have made the same system work for them.
“Finding out what they’re doing right could be immensely helpful and sharing knowledge and experience is important,” he says.