By Sheri Stoltenberg, founder & CEO of Stoltenberg Consulting, Inc.
With today's healthcare dollars being pulled several different ways, the decision to implement new EHR technology requires large-scale thinking — it isn't a decision that will, or should, happen overnight.
Healthcare leaders must consider the overall enterprise budget and if their existing EHR system could achieve better results with additional optimization. On the other hand, they must also be willing to admit if their system’s fragmentation is beyond repair and will only cost them more in the long run as the industry moves toward greater interoperability and value-based care.
In weighing the monumental decision to switch EHRs, a healthcare organization must take these seven considerations into account.
- Return on investment: The purchase of a new EHR system is often the largest, most significant spend for a healthcare organization. No hospital or practice wants to make a selection only to go down the same path a few years later. Vendor choice must make a lasting return on investment for better patient care and overall operational efficiency. Also, consider if your organization is in the right financial state to begin with before risking such a major undertaking.
- Data analytics: Does your current system capture data needed for you to apply business analytics? Data analytics is fueling the shift to pay-for-performance reimbursement and outcomes improvement. As competition (and demand) for more efficient healthcare continues to grow, organizations need every competitive advantage they can get. Patient data will eventually need to come from both within the organization and outside sources in order to provide the best competitive financial and clinical insights for decision making. However, many EHRs fall short because data isn’t leveraged to achieve insights; for example, it sits in the silo of a physician practice’s clinical notes. The right EHR marries clinical and financial information to obtain the best results, highlighting data trends and predictability. Without the ability to capture critical patient data and derive analytics to effect meaningful change, an EHR is only a data repository — and only provides one piece of the puzzle.
- Interoperability: Does the system share and play well with others? Proprietary systems are fine as long as they are not closed. If you can't extract data without costly and time-consuming maneuvers you are limiting advantages having the information provides. You are also potentially limiting best practice in clinical care. According to a recent ONC data brief, the biggest barrier to healthcare interoperability “shared information is not available to clinicians in their EHRs” (53 percent), followed by “difficulty integrating the exchanged information in an EHR” (45 percent). How will your new system push care forward for patients and population health needs?
- Security and ownership: What holes exist that put you at risk as an organization? Sometimes this goes beyond the network. Will your new EHR system and its third-party vendors make you vulnerable? In an independent Ponemon Institute survey, three-quarters of businesses said cybersecurity incidents with vendors were on the rise; half of these organizations experienced a data breach because of a vendor. Consider who will own and store your data: what agreement will you have in place for access to that? If data is cloud-based, healthcare providers must often pay an access or maintenance fee on a regular basis or risk losing access to patient data.
- Staffing and resources: In switching systems, who will support your customers while you focus on a new system? Will the vendor provide support? If so, what does that entail and for how long, at what price? Morale, skill set, and adaptability needs to factor into the decision. Next, your operational budget after the implementation must be considered. Some vendor systems require more staff than others to run smoothly and this can significantly increase spend. Who will support legacy systems and help desk services during the transition to clear up internal staff focus? The industry faces a skilled labor shortage, and the IT talent shortage hits healthcare the hardest as more than half of HIT professionals are constantly stressed.
- End-user customization: If your current system is highly customized or there are certain things your end users are not willing to give up, make sure these features are incorporated into the design and build of a new system. Ease of use is paramount in an effective vendor transition and future end-user adoption. Consider input from all stakeholders, especially patient-facing nurses and other clinicians.
- Vendor pitches vs. contracts: Although wish-list items and negotiations may be addressed in vendor site visits, what actually goes into contracts may differ. Make sure you get it all in writing and have unbiased advisors or legal aid review as well. Don’t blindly accept initial documents; negotiate contract terms that are mutually beneficial, specific in payment terms and measurable for success. Think about the future as well. As seen with many physician practices during ICD-10 and Meaningful Use transitions, if future software updates are not guaranteed within vendor contracts, the vendor is not obligated to change.
Above any other consideration, do your research. Know the current EHR market, including typical pricing, service terms, major competitors, and end-user satisfaction. Identify the ins and outs of your own organization as well, including current applications, workflows, care locations, volumes, and key statistics. Without a current state analysis and priority checklist, an organization can easily be swayed by vendor presentations, losing track of organizational goals while jeopardizing what is often the most significant spend in the history of a healthcare system.
About The Author
Sheri Stoltenberg is founder & CEO of Stoltenberg Consulting, Inc.