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Explore fixes to your EHR system before deciding to replace it


Electronic health record system usage among doctors has grown substantially in recent years, and with it, increasing levels of dissatisfaction with the available systems.

Electronic health record (EHR) system usage among doctors has grown substantially in recent years, and with it, increasing levels of dissatisfaction with the available systems.

A recent survey of physician-user satisfaction conducted by the American College of Physicians and AmericanEHR Partners shows that satisfaction has deteriorated since 2010, to the point that nearly 40% of doctors would not recommend their EHR to a colleague.

Another survey, taken by Black Book, found that 31% of users were dissatisfied enough with their HER to consider making a change, and 17% could change their system this year.         

If you are dissatisfied with your EHR, what are your options? Many doctors’ first impulse is to “rip and replace,” which is expensive and time-consuming. So before taking this drastic step, it would be worthwhile to explore alternatives with your existing system.

Start by analyzing the source(s) of your dissatisfaction. In my experience, the biggest cause of unhappiness with an EHR system is its impact on practice productivity. Try to detail exactly where the EHR is lacking. The more detailed, the better. Some typical ambulatory workflow pain points:

  • Chart note creation. Is the templating system stiff or cumbersome? If so, can this task be accomplished in a better way?

  • Medication refill handling. Does the system address refills for controlled substances, or does some work-around need to be created to handle this?

  • Referrals to outside practices. Do the needed data easily flow back and forth? Is the administrative authorization process considered?

  • Scanned document management. How much  staff time is taken up getting outside documents into the record? What is the lag time between when a document is received and when it appears in the chart?

Note that even if you are employed by a hospital or health system and not in a position to influence the purchase of your employer’s EHR, you still can provide feedback that identifies problems. Chances are that other practices in the system are experiencing the same problems.

Once you’ve identified the specific pain points, you can try to address them, either with your vendor or through the consultant that recommended and/or installed the EHR system. Meet with the vendor or consultant and go through the list of problems and bottlenecks.  Ask about work-arounds that might address the problems. Perhaps some configurable aspect of the EHR can be modified.

Remember, most EHR vendors and consultants want to keep their customers/clients happy. If given specific feedback on where a product is lacking, it is in their interest to try to address the problem(s).

If, however, the problems are not addressed to your satisfaction and you conclude that your EHR is simply not the right tool for the job, then you need to notify the vendor or consultant and begin developing a data migration strategy to your new system. At that point, a workflow re-engineering  strategy would also need to be developed.

One of the limitations of health information technology (HIT) is that most EHRs are closed, proprietary systems. An open-platform basis for HIT may be available some day, but for now, if you’re unhappy with your EHR, your only choices are to try and improve what you have or look for a system that better fits your needs.

The author is a family physician and healthcare information technology consultant in Hayward, California. Send your technology-related questions to


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