The tides have shifted quickly in the EHR marketplace. As adoption several years ago surpassed fifty percent, dissatisfaction began rising sharply. According to a 2012 KLAS research study, more than half of EHR systems sold are replacement systems.
I can attest to the cost of selecting the wrong EHR. When my practice selected our first EHR in 2004, our intent was to be an early adopter — to be the first on our particular block to reap the benefits of electronic health records. While implementing an EHR was the right thing to do, we made several critical mistakes with the system we selected.
We were relatively satisfied with our practice management (PM) system, and erroneously believed that an EHR from the same vendor would perform similarly. We assumed since they were from the same company, both systems would integrate seamlessly. Unfortunately, that was not our experience and we learned the hard way that this approach can have serious flaws. In short, a reasonably good PM system does not equal a reasonably good EHR system.
The system proved to be inflexible, forcing all users to conform to a single workflow and use a single template. Most physicians are not big fans of conformity. We discovered that there needs to be an appropriate balance between consistency and configurability, and our system did not provide for that.
After two years of struggle, we had spent more than $400,000 on an EHR that only three physicians — the most tech-savvy of the group — were even using, and no one in the office was happy. The final straw came when the EHR vendor informed us that in order to get the system to do what we really wanted it to do, it would require an additional $80,000 investment.
Our decision to stop throwing good money after bad and scrapping the first system was the best move we made. Armed with insight from our first unsuccessful implementation, we knew what to look for and what to avoid. We found what we considered to be an ideal system, and within three months, had all twelve of our cardiologists and 60 employees up, running, and productive on the system.
The new EHR company described its approach as minimally invasive. Their approach minimizes practice upheaval, and the system is accessible, interoperable, flexible, and affordable. We experienced minimal invasiveness to our workflow — a welcome change from our previous EHR.
My best advice for others who are looking to replace their EHR is to look for systems and vendors that are:
• Responsive: Questions, concerns and required modifications should be addressed on your schedule — not theirs.
• Nimble: Change is constant. The system should be able to evolve and adapt.
• Collaborative: Think partnership, not purchase. Look for a relationship where your input is invited and welcomed.
And, be sure to avoid these common assumptions:
• Do not assume that your EMR and PM should come from the same company.
• Do not assume that bigger is better.
• Do not assume that the more you spend, the more you get.
I am living proof that there is life after a bad EHR choice. The good news is that we were able to recover . . . and you can, too.
