Physicians who consider changing EHRs can take steps to ensure the next system meets their needs
Physicians are frustrated with their current electronic health record (EHR) system–58% of doctors surveyed described their EHR as “hard to use,” according to a 2015 Accenture report. With the evolving marketplace, switching EHRs may become increasingly commonplace as some systems are discontinued and others prove unable to meet future needs for information exchange, patient engagement, and data analytics. At the same time, providers must understand their role in an EHR’s success or failure and be willing to take steps to ensure the best possible outcome.
Moving to a new EHR also is fraught with stresses ranging from the cost of implementation and transferring data to the learning curve associated with a replacement system. Still, many practices are making the switch successfully. If you believe it is time for your practice to make a move, here’s what to consider to ensure your next EHR is a worthwhile investment.
Why do you want to switch? Answering that question is the first step in determining whether you will be happy with your new system. If you are upgrading your system to add functionality or because your current system does not allow you to achieve meaningful use (MU), you are more likely to find a switch worthwhile than if your motivation is to boost productivity, decrease costs or eliminate technical problems.
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Melissa Lucarelli, MD, a family practice physician in Randolph, Wisconsin, and a member of the Medical Economics editorial advisory board, recently switched to a new vendor after losing confidence that she could meet meaningful use stage 2 (MU2) requirements with her previous EHR, which had made attestation cumbersome.
“With meaningful use stage 2, there were a lot of extra clicks, and creating encounters and not charging for them and deleting them just so you could get the data in there,” she said. “With meaningful use stage 2 attestation and ICD-10 happening this year, I wasn’t comfortable they were ready to go.”
Lucarelli’s first EHR initially was provided for free, but when the time came to become a paying customer, she knew the product’s shortfalls remained too numerous to ignore. When searching for a replacement, Lucarelli considered only ambulatory products for one to 10 physician practices rated “best in class” by KLAS Research and others. She accepted the fact her monthly costs would increase, but felt the money would be well spent.
“What is really expensive in a medical practice is your staff–their time and their benefits,” she explains. “If you can find a product that makes it easier for your staff to get their job done and be more efficient, you are going to save money. It’s worth some extra financial investment to have a more robust product that is efficient for your staff.”
Because her new vendor guarantees, MU2 attestation and ICD-10 transition, Lucarelli says she is confident the company places the same priority on successful compliance with federal government mandates as she does.
“Part of the reason why most of us went ahead and made the leap and converted to an EHR is the need to meet these metrics,” she says. “We initially had incentives. Now we’re past the carrot and moving onto the stick. You need to make sure you’re compliant with ongoing regulations.”
When considering switching EHRs, Peter Kilbridge, MD, senior research director at The Advisory Board Company, says physicians have to recognize that some inherent problems with EHRs won’t disappear when a new system is installed.
“There are common things people complain about with EHRs but they tend to be common across EHRs,” he says. “It takes more time to document things than it did using paper, but going to another EHR isn’t going to eliminate that problem. Maybe the tools you had in the first one aren’t as good as you hoped and you want to try a different one, but saying documentation is taking longer is a common complaint, not necessarily a reason to switch.”
Joseph Scherger, MD, vice president of Primary Care at Eisenhower George and Julia Argyros Health Center in La Quinta, California, and a member of the Medical Economics editorial advisory board has been using an EHR since 1994. Now he is helping to select a new EHR for Eisenhower Health Center, a change brought about by the scheduled phase-out of Eisenhower’s current system as well as its inability to keep up with reporting requirements.
Having used numerous EHRs during his career, Scherger has words of hope for physicians whose frustration levels with their current systems have reached a tipping point. “Your first conversion to an EHR is your most difficult conversion,” Scherger says. “Professionally, it is one of the most difficult things you will do in your career, and one of the last things you want to do is go through it again. But the second and third times are a lot easier.
“It’s kind of like a bad marriage,” Scherger adds. “Do you want to spend the rest of your life in a bad marriage? If it is really that bad, you should make the change and get in a better situation.”
For physicians looking for a fresh start with a new EHR, here are “lessons learned” from your peers:
Consider only meaningful use 2 EHRs.
Kilbridge maintains that physicians should begin their search for a new EHR by looking only at ambulatory EHRs that have been certified to meet MU2 criteria. “That’s not a terribly high bar, but it is an absolute minimum,” he says. “If it is not meaningful use certified, you can’t be sure it is going to do a lot of basic things that are going to become required in the near future.”
Don’t rush to judgment.
Research and review multiple EHRs before deciding on a new system. “If you don’t like product A, just don’t see one demo of product B and buy it,” Kilbridge says. “If you are unhappy the first time, make sure you look at a bunch of possibilities the second time.”
Know which functions you must have.
Is patient information stored simultaneous-ly in multiple places? Does the EHR include a search function to aid in reporting Physician Quality Reporting System metrics? “We’re moving away for payment for service to payment for value,” Scherger says. “Your record needs to be robust in telling you how you’re doing managing the patients and populations you’re serving.”
Evaluate clinical decision support.
Not all EHRs are created equal in terms of clinical decision support. Scherger suggests finding one that “helps you do a better job.” “Does it give you a good patient history?” he says. ”Does it take that patient history and give you suggestions on what diagnoses should be considered and what tests probably should be done? This is the digital brain that has the potential of enhancing our practice of medicine.”
Incorporate your staff in the decision.
While one physician ultimately may decide which EHR to select for your practice, many voices should influence the decision. “It is important not only to get physician buy-in, but to get input from the rest of the practice” when selecting an EHR, says Derek Kosiorek, CPEHR, CPHIT, a principal with Medical Group Management Association (MGMA) Health Care Consulting. “You want to bring in a representative from the front desk staff, nursing staff, billing staff, if you’re including practice management, and have them all give input on their own area because this is defining how the practice works.”
Go beyond a product demonstration.
Once you’ve determined the finalists in your selection process, see the products in action in another physician’s practice. “Talk to other physicians and do a site visit,” suggests Faith Protsman, MD, a family practice physician in Gilroy, Calif. “Look at their workflow. Look at how easy or difficult it is to work with the system on a day-to-day basis.”
Consider integrated systems.
When replacing a “bare bones” EHR, Protsman opted for an integrated, “robust” system that included EHR, medical billing and practice management and communication services, “I talked to folks in my local area, many of whom are solo docs. Many had smaller, cheaper systems that just offered the EHR or they had one system for the EHR and one system for practice management, and everybody had complaints. Nobody was happy,” Protsman says.
Recognize the importance of training.
“You’re not going to get trained on a complicated product that does all your billing for you and all of your meaningful use in two days. That’s never going to happen,” says Lucarelli, who was impressed by her replacement EHR’s 13-week training program that included weekly meetings, online webinars, and training modules.
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Understand the upgrade process.
“What is it going to cost when there is a new, upgraded version of the record?” Scherger asks. “How much is it going to cost me and how much pain am I going to go through? Those are important considerations.”
Partner with your vendor.
“You not only are purchasing a product but you are purchasing a partnership with that company. Your livelihood depends on how well that software does or doesn’t perform over the next 10, 15, 20 years or longer if it becomes a true, meaningful partnership,” says Erik Bermudez, KLAS Report Research director.
Look to the cloud.
“Small practices are notoriously poorly resourced in terms of IT support,” Kilbridge says. “You don’t have an IT staff in a three-physician practice. You need products that are designed for that environment and don’t require a lot of support. Cloud-based solutions can be a good bet for exactly that reason. You don’t have to maintain the system on your own computers.
“People worry a lot of about security and privacy,” he says. “I think security and privacy capabilities of the cloud are at a point where they really shouldn’t be an issue.” In addition, a good Internet connection is a must with a cloud-based system, as is a strong service level agreement that states how much downtime is acceptable.
Select a “scalable” EHR.
In addition to knowing what functions you want to retain from your current EHR, it is important to consider what features you may want to add in the future. “Make sure the tools are available that you want to grow into,” Kosiorek says. “The scalability of the system should be there. You should have a solution for a patient portal right off the bat. Any tools like that need to be available, evaluated and looked at early on.”
Insist on strong customer support.
EHR customer support and service can range from dedicated support personnel to outsourced support departments, which often lead to unresolved technical problems and poor on-going training. “We see the account manager, who has the customer’s back, to be a very successful model,” Bermudez says. “A lot of vendors don’t have that. They have a support desk and you get a random person each and every time you call. Push your vendor. Ask them: ‘Is there someone willing to give me their name and phone number and I stick with that person to make sure I am successful as your customer?’”
Negotiate with the vendor.
Review your original vendor contract and determine what worked or didn’t work. When presented with a contract from a new vendor, know that all terms are negotiable. “The purchase agreements are written 100% sided toward the vendor,” Kosiorek says. “If you sign it, you are giving away a lot. Anything in the contract is negotiable.”
Understand your “escape clause.”
Similar to a prenuptial agreement, an escape clause outlines the terms of the dissolution of your marriage to your EHR vendor, so know the potential costs involved. “There should be a clear explanation of what the process is for conversion to another system,” Lucarelli says. “What happens to the data? How does it get converted? How much is it going to cost to get your data into a format that will go somewhere else?”
Reward your staff.
Switching EHRs typically adds to a staff’s workload, so reward them for their extra work. At the end of her practice’s “go live” day using their new EHR, Lucarelli personally thanked each staff member and told them they would be receiving a raise. “That little bit says I understand this is battle pay for going above and beyond,” she explains. “Appreciate your staff. It would be awful to have staff members jump ship because you are making a conversion. All of the sudden you’re training someone new at the same time you’re starting with a new product.”