Switching EHRs becoming norm in healthcare

Love them or hate them, electronic health record (EHR) systems are a part of healthcare today.

But that doesn’t mean physicians are always content with the first-or even second or third-system they select for their practice. According to Medical Economics’ 2017 EHR Report, 62% of all respondents have switched EHRs during their career.

While nearly half of that group say a change in employment status or practice location caused the move, the other half note a variety of deficits in their previous system that led them to look for a replacement. 

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No matter the reason for the  change, it’s vital to have the right tools to improve patient care, says Robert Rowley, MD, a Hayward, California-based primary care physician and health IT consultant.

“EHRs are part of medical practice, part of what you do [as a physician] and you just have to find the one that seems to work best,” he says. “Increasingly, as physicians move away from what we do in our four walls as the basis of getting paid, and more toward measuring and reporting value to networks as part of value-based care, you want to have systems that those networks can use.”

So whether it is a large hospital system or a small private practice, a switch will come if the system can’t collect, analyze and report data that are critical to patient care-and to physician pay with the shift away from fee-for-service reimbursement.

Connectivity is key

Seeking better connectivity with their healthcare partners in the region for population health and other initiatives, Rowley and his colleagues are in the process of their own move to an Epic EHR. They believe the switch will increase access to patient records and accompanying data to meet value-based measures under Medicare payment reform and private payer programs more effectively.

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So the short-term hassles of changing systems will be more than offset by the long-term benefits of sharing patient health data, he says. “As we move more toward coordinated care and networks and systems that reimburse increasingly on value-based care, we need other people to see that information really easily,” Rowley notes. “From the standpoint of a small practice, anything that reduces the work burden on my staff is welcome.”

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In Dacula, Georgia, primary care physician Susan Jane Smith, MD, is also switching EHRs, also to Epic. Her employer, Northeast Georgia Physicians Group, is trying to link its 200 doctors to area hospitals as well as local clinics it operates. It also wants to improve connectivity with specialists to whom its physicians refer patients.

“It’s very important that we have interoperability and we’re not always faxing and scanning paper,” Smith says. “To be able to realize that goal, everyone needs to be on the same system.”

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Having changed systems four times already, Smith takes EHR switching in stride at this point in her career. “Physicians should remember that they are always smarter than a computer,” she says. “It’s just a fancy file cabinet. So don’t stress out about it.”

EHRs as an employment factor

Crystal Lake, Illinois-based internist Greg Jun represents the other half of survey respondents who have switched EHRs: those who did so due to a change in employment. In 16 years of medical practice in various settings, Jun has switched five times.

In 2016, Jun joined Centegra Physician Care and made sure to ask what system the practice uses as part of determining whether to work there. “With young residents out there looking for their first job, I tell them that EHRs are a very important part of your duties and your productivity, so it should be a significant factor as to where you want to work,” he says. 

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Jun advises asking potential employers these questions:

• What system are you using?

• How long have you used it?

• Are you planning on changing to a new system in the near future?

•  Is there a good informatics or IT department to help physicians?

As a former medical director of clinical informatics for a hospital system, Jun’s experience with various systems comes with the understanding that unless physicians make their concerns known, to administrators or vendors, EHR switching will continue.

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“We have all these companies creating products without active participation from clinical end-users, leaving us stuck where we are today,” he says. “But the more actively involved you are and the more feedback we as physicians can give, the more we can make these products more clinically relevant.”

New models, same frustrations 

Like Jun and Smith, primary care physician Richard Berry, MD, recently made a change in his work status. But rather than switching employers, Berry struck out on his own to become self-employed.

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In 2015, the Seiling, Oklahoma-based doctor founded UpFront Health, a direct primary care (DPC) practice in a rural part of the state. Having previously worked in a fee-for-service practice and done locum hospital work, Berry was no stranger to EHRs. Still, he sought advice from colleagues when selecting an EHR for his new practice.

By and large, EHRs are designed for practices or hospitals that accept third-party payments. As such, the systems include billing, coding and other features not required by physicians working in the mostly insurance-free DPC model.

Berry picked an AtlasMD system that met most of his needs. But even as recently as this year, he contemplated switching to an EHR better suited to his DPC practice.

And that’s Berry’s advice to fellow physicians considering a change: They should find the best fit for their practice.

“First, go to the person who’s selling you the system and get a huge list of features,” he says. “Then sit down and put a line through everything that has nothing to do with your practice, whether it is payer-related features or features for [Medicare payment reform] and see what’s left on your list. Then, look for the software that does that. That’s an EHR you can live with.”