Only 34 percent of physicians are satisfied or very satisfied with their EHR systems, according to a recent survey conducted by the American Medical Association and AmericanEHR Partners. Another survey published in the American Academy of Family Physicians' journal, Family Practice Management reported that only 39 percent of respondents who changed EHRs were pleased with their new system.
The results of these surveys outline how the decision to change EHR systems or not is a difficult one. After all, it's a significant financial investment and staff have spent a lot of time learning how to implement and use their system. If you change, your practice will have to foot these costs all over again. In addition, you face the potential loss of data and problems with data migration.
HANG IN THERE
"A well-designed EHR should be physician centric, specialty specific, and serve as a tool for the physician to document a patient's visit," says John Pitsikoulis, managing director of Berkeley Research Group, LLC, a firm located in Hunt Valley, Md. "The EHR must also meet the practice's business needs, including the revenue cycle. When an EHR doesn't align with a practice's specific day-to-day work flows, it makes the physician's job more difficult by increasing [his] administrative and compliance workload. By negatively impacting the physicians' time, patient care is impacted."
While it's tempting to want to replace something that doesn't meet your expectations, under certain circumstances you may want to give it more time. "First, determine if your current system offers enough functionality for managing your practice and achieves meaningful use requirements set forth by CMS. Also, verify that the vendor's strategy for future enhancements outweigh any short-term disadvantages," Pitsikoulis advises.
If your practice likes some of the core features and functions of the system, already developed specialty-specific templates, and can live with navigating through notes, orders, and prescribing without overwhelming frustration, living with the current system makes sense at least for the short term, Pitsikoulis continues.
One common complaint of physicians is that they have become data entry clerks at the expense of patient care. "This is a common physician finding, regardless of the EHR system," Pitsikoulis says. "But changing systems could result in the same functionality."
The truth of the matter is that a lot of systems aren't lacking in functionality and can be beneficial if you take the time to learn how to use them, says Eagan, Minn.-based Derek Kosiorek, principal consultant of Medical Group Management Association (MGMA) Healthcare Consulting Group. One way to determine if this is the case at your practice is by finding out which physicians successfully use the EHR. If it's more than half, then the EHR isn't the problem and other doctors need to invest more time in learning to use the system more efficiently. See if those doctors can assist others in learning the system.
Before throwing in the towel, see if the vendor is willing to work with you on resolving issues. Work with the vendor to identify each problem and then ask if the vendor can offer a solution, says Mechanicsburg, Pa.-based David J. Zetter, founder and consultant at Zetter HealthCare.
If it is more difficult to order tests or enter information into the medical record than before having the EHR, something is wrong, says Ann Arbor, Mich.-based Joette Derricks, owner of Derricks Consulting, LLC. The EHR should streamline the work flow, not add more steps. If employees are printing out information and still depending on paper, something is probably not set up properly. Open communication is critical to identify and resolve problems.
Making some enhancements to the EHR documenting process with voice recognition software, streamlining the physician coding function with built-in coding software, and optimizing the EHR features and functions with templates, could provide some shortcuts that make an EHR more desirable, Pitsikoulis says.
However, be cautious when adding these enhancements. Engage consultants with operational, technical, and coding compliance expertise to integrate the physician's work flow with the technology. "Otherwise, you might end up with similar performance dissatisfaction with the next tool," Pitsikoulis says.
PULL THE PLUG
Sometimes, despite your best efforts, you may want to call it quits. Poor technical support is a key reason to get a new vendor. "Oftentimes, marketing staff is very accessible early on and then a year after implementation you can't get a basic question answered," Derricks says. In this instance, it's time to move on.
Furthermore, if the vendor does not update its software to facilitate new medical technology or contractual payment updates, that's problematic, Derricks says.
In addition, if an EHR lacks the ability to integrate with other software such as laboratory tests, diagnostic tests, practice management systems, and so forth, it's probably time to start anew, adds Zetter. Other reasons to say "adios" are if staff cannot effectively use the system, if it impedes patient care, or if it's just too costly to continue to use.
Or, if information is consistently incorrect because the system is set up poorly, or you're finding bad data, start over, Kosiorek says.
MAKING A DECISION
Even though EHRs may pose a lot of challenges, their ability to exchange health information electronically has enormous benefits. EHR capabilities, such as electronic prescribing, improve patient and provider communication, while providing for the patient.
If you're unhappy with your EHR, it's important to understand what went wrong in your last EHR selection so you don't repeat those mistakes. Perform a needs assessment by categorizing the current deficiencies and determine if these can be improved. If not, then it's time to begin the process of selecting a better EHR.
CHOOSE RIGHT THE FIRST TIME
After incorporating a new EHR system, many physicians will have to change the way they've done their job since beginning their careers. "They are being asked to take information in their paper chart, shuffle it like a deck of cards, and then have it presented to them in various places on a computer screen," says Eagan, Minn.-based Derek Kosiorek, principal consultant of the Medical Group Management Association Healthcare Consulting Group. "Then, they have to get used to navigating to where the information is relocated. This can be difficult, as some vendors in the early days of creating EHR software didn't design it in the most user-friendly way for physicians."
Fortunately, this is evolving, but as a result it's leaving some physicians wondering whether to stick with the old or upgrade to something new.
Whether selecting an EHR for the first, second, or third time, the selection, implementation, and integration of work flow with new technology is complex, and requires continuous process improvement. "Usually, the need to make a decision and begin the implementation process gets in the way of a complete and thorough understanding of the technology and the practice's needs," says John Pitsikoulis, managing director of Berkeley Research Group, LLC.
When beginning the process of selecting an EHR, a practice's providers and staff should have an opportunity to "kick the tires." Yet, very few often do, says David J. Zetter, founder and consultant at Zetter HealthCare. Trying out a potential system gives users a chance to determine if it's a good fit. For example, they should ask the vendor "How will the EHR work with the practice's way of documenting a patient encounter? How will the practice management part of the software suite work? And, what is the reporting like?" And to make sure that the EHR will fit your unique needs, talk to other same-specialty practices that use the same system.
In addition, practices often fail to thoroughly check references. "Don't accept only a few names as references," Zetter says. "Ask proper questions of many practices that have implemented it, such as 'Would they choose it again? Why or why not?'"