EHR Failure: What's A Practice To Do?

By Michael Nissenbaum, president and CEO, Aprima Medical Software

Physician dissatisfaction with EHRs has been well-documented in recent years, as has the growth of the EHR replacement market. In Kalorama Information’s report, The State of the EMR Market in 2017, the authors estimate that approximately 15 percent of physicians are seeking EHR replacement systems in order to mitigate frustrations with awkward and non-intuitive interfaces and functionality gaps.

Ambulatory physicians are particularly driven by the desire to address new quality tracking and reporting requirements under the Medicare Access and CHIP Reauthorization Act (MACRA). A provider who fails to meet MACRA targets could face as much as a 9% reduction in Medicare reimbursements.

Along with meeting regulatory requirements, physicians want solutions that support interoperability with other systems and provide workflows that are efficient and enhance productivity.

For a practice struggling with its existing EHR, how do physicians and staff know when the time is right to walk away from their current system and seek a replacement? More importantly, what can a practice do to avoid past selection mistakes and make sure its next EHR satisfies today’s needs, as well as future requirements?

Evaluate Objectively

Before a practice abandons its existing EHR, physicians and staff should not only do an objective evaluation of the system and vendor, but also consider whether users have had realistic expectations and been truly committed to the EHR’s success. Practices should ask themselves if a response time of a few hours for a routine issue is sufficient reason to switch vendors, or if it’s an annoyance they can live with. On the other hand, if the support staff consistently takes four days to return calls, the practice may very well want to investigate other options.

Practices should also consider whether or not they’ve adequately invested in training resources, especially following the implementation of new features or a turnover in staff. A practice that resists spending money for ongoing education may be equally discontent with its next EHR.

Specific Considerations

Before switching EHRs, users should take the time to verify whether or not particular issues can be fixed and/or if they can live with certain limitations. For example:

• Challenging workflows — Physicians often complain that their EHRs are slow — or simply don’t work. The problem, however, could be that a particular EHR is not designed or adaptable to a provider’s specific workflow. For example, the workflow of a primary care provider seeing 30 patients per day is very different than that of a specialist treating fewer, more complicated patients, or one seeing a mix of follow-up patients and patients requiring in-office procedures. The EHR may include all the functionality the physician needs to thoroughly document a regular office visit, yet be inefficient for documenting procedures — or vice versa. Depending on the EHR, the documentation process may require an inefficient number of steps and reduce the number of patients the doctor can see per day. Practices should ask their vendor if the EHR supports alternate workflows that are better suited to an individual provider’s needs based on specialty and patient flow.
• Lack of system enhancements — A practice may have implemented an EHR that worked great for several years, but now the vendor is failing to keep up with the latest regulatory requirements, or with new technologies that increase efficiencies or enhance revenues. This is the situation that many providers are facing as they scramble to address MACRA requirements. Other vendors may be addressing government-mandated changes, but not offering solutions to enable interoperability with other providers, or to facilitate participation in optional revenue-enhancing programs, such as CMS’s Chronic Care Management (CCM) Services.
• Technology limitations — Practices that use one software for practice management or billing and another for EHR often face a myriad of challenges. A practice must manage two vendors on a business level, plus coordinate timing for updates to minimize the risk of “breaking” things. Full integration between disparate financial and clinical systems is increasingly rare, making the “best of breed” approach a struggle for practices trying to address today’s burdensome regulatory and reporting requirements.
• Support — No matter how great a system is a practice is going to struggle if its vendor fails to address system issues in a timely manner. A practice must evaluate its vendor’s ability to deliver consistent and reliable access to knowledgeable support professionals who can communicate clearly and provide appropriate instructions and advice.

Moving Forward

If, after a thoughtful evaluation, physicians and staff decide it’s time for a new EHR, all stakeholders must commit to a business-like evaluation process that objectively considers multiple factors and avoids a repeat of previous selection and implementation mistakes. Practices should identify in advance what features and functions are critical and not assume that every EHR has the same capabilities as the old system. Practices should talk to reference customers, evaluate company strengths and weaknesses, and consider third party validations. Everyone involved in the selection process should maintain a running record of their impressions of different solutions in order to minimize confusion between the various options.

Some of the key evaluation factors include:

• Features and functions — No two practices have identical requirements in terms of features and functions. However, providers should be mindful of larger industry trends, such as the need for interoperability between systems and the transition to new quality tracking and reporting models, and remain focused on the need to maximize practice revenues and collections. Interoperability requirements may vary between communities based on what technologies are used by local health systems, individual providers and ACOs. To address value-based care requirements, practices should verify that prospective systems include the ability to track and report on quality measures, handle bundled payments, and analyze and manage populations of patients. For practices managing patients with chronic conditions, CCM functionality is a must, and practices serving patients with high out-of-pocket costs, large deductibles and/or large co-pays need a solution for managing and collecting patient balances that includes an integrated credit card on file program. Finally, in order to minimize challenges with incompatible technologies, practices should seek solutions with fully integrated practice management and EHR capabilities running on a single database.
• The company — The company, its customer support, and its track record in the industry are arguably more important in EHR selection than the actual product: a sexy, bleeding edge EHR is relatively worthless if the company behind it lacks a commitment to the ongoing delivery of quality training and support. Look for “high-touch” vendors that are dedicated to developing strong relationships with their customers across all departments. Weigh the relative benefits of privately-held companies versus public companies; consider their financial strengths and the ability to nimbly adapt to changing industry requirements; assess the companies’ commitment to healthcare and healthcare IT; and, review the organizations’ history of delivering product updates and enhancements. Be wary of products supported by a minute division of a huge entity that could eliminate the solution with a stroke of a red pen. Finally, look for a partner that has a solid record of client retention.
• References — Ask vendors for client references, but don’t be too concerned if the practices don’t match your exact size/geography. What’s more important than a precise match is the ability to talk to a cross-section of similar customers and seek their opinions on their vendor, the functionality of products, the quality of training, and the responsiveness of the support organization. Also ask references how their solution has impacted the practice from a financial and clinical standpoint.
• Third-party validation — In addition to product demonstrations and talking to customers, investigate third-party validations from recognized industry analyst organizations such as Frost & Sullivan and KLAS. The views of outside analyst firms can help validate your own research — or raise new questions to ask potential vendors.

Even when a practice commits to an objective and thorough EHR selection process, over time a solution may fail to meet an organization’s needs. When and if that occurs, a thoughtful and business-like approach to evaluating systems will increase the likelihood that the replacement EHR meets the practice’s current and future requirements.