After spending thousands of dollars on an EHR system, computers, IT infrastructure, installation, and staff training, most providers hope that they never have to go through the EHR implementation process again. But after the explosion of growth following the 2009 HITECH Act, and a stampede of providers rushing to take advantage of first-generation practice management and clinical documentation offerings, many practices are realizing that their EHRs can’t grow and mature with them as the systems age and meaningful use requirements continue to ramp up expectations.
EHR replacement is the new normal in the healthcare software market, and providers who are unhappy with traditional server-based offerings are turning to an emerging trend: cloud-based, web-accessible EHR suites that cost little to use, are quick to set up, and put the burden of security, upgrades, and data storage on the vendor instead of on an individual provider’s IT staff.
“Cost and setup are the two key factors when it comes to a physician thinking about switching from a server-based EHR to a web-based one,” explained Emily Peters, VP of Marketing Communications at popular cloud solution Practice Fusion, to EHRintelligence. “If you want electricity in your house, the odds of you setting up your own wind turbine or solar panels in the back yard, wiring it up and maintaining it is pretty small. It’s a ton of time, and you’re much more likely to have a better experience if you’re just going to use what’s coming out of the plug in your house. So when we talk about the cloud, I think it’s the same thing. People are looking for something that’s very convenient, very secure, and that they can get started with in a few minutes.”
“That’s always been a challenge for a client-server system. That’s not to say that server-based software isn’t ‘good’, it’s just that the inherent nature of stagnant software is to be stagnant,” adds VP of Corporate Communications John Hallock of CareCloud. “They make the user responsible for making sure that they’re on the latest version, that they’re training their staff, and that they’re using best practices. And if they don’t, then the outcome may not be what they want. And if that’s the case, it can hurt not only their clinical care, but running the business itself.”
One of the chief complains for providers dissatisfied with their first EHR vendor is a lack of customer service and commitment from the vendor to ensure their software is doing what the provider needs it to do. “Our first EHR was not very user friendly, and customer service was really lacking. We just couldn’t get answers. We were at the point of hiring a consultant just to help us navigate the EHR,” said Dr. Waseem Khan of Cancer Care of North Florida, discussing the reasons he left his first EHR in favor of a specialty system. “It was really anxiety-ridden. I think we had one or two days of support from our vendor, and then we were on our own, so that was really difficult.”
An additional growing concern is data ownership. Stories about providers losing access to their data after terminating a contract are becoming more frequent as providers feel freer to voice their dissatisfaction with legacy systems and take their business elsewhere. Poorly negotiated contracts can leave providers feeling robbed of their patient data when the EHR they’re leaving refuses to transfer data in a proprietary format to a replacement system. The ONC has even gone so far to address data conversion and contract negotiation concerns in a provider guide intended to mitigate future wrestling matches over the most critical aspect of patient care. Cloud-based systems, with their focus on data liquidity and interoperability, are a little less likely to play finders keepers with patient information.
“A lot of EHRs have gag orders written into their contracts, so even if you have a really terrible experience, you’re not allowed to talk about it with anybody. But we give people full access to all their records, and we’ll do an export of their data if they want to leave Practice Fusion,” Peters says. “It’s many DVDs full of data, and it’s kind of a big process for us, but we will absolutely let anyone have their records if they want to leave us. Thankfully, we’ve only had to do it a few times. But we see that a lot on the other side. We have a team of specialists here who are experts at getting the data out of other systems, especially when they’re not really set up to do it. The average turnaround time for an import is about two hours, because we’ve been able to crack the code for a lot of systems.”
“Data conversion is a big issue,” Hallock agrees. “We have projects underway to make it even easier. There are always these difficulties in getting information off one system and on to another. We’re working on ways to convert the data from one clinical system to ours. I think that’s a key trend that has to get easier and better. It’s a real challenge providers face. They need that information to do their work, to deliver patient care, and make sure they’re billing correctly and that the overall health of the business is there. And if we don’t do that, then we won’t be successful either.”
“With the software as a service (SaaS) model, they pay as they go, the cost of ownership is much lower, there’s more of a partner-like relationship with the vendor and user,” Hallock says. “That level of flexibility is only available with cloud-based technology.”
The idea of a partnership between vendor and client is growing with the proliferation of cloud-based solutions now available in a crowded, ever-changing market, but cloud wasn’t always as common and accepted as it is today, in the era of Gmail, Dropbox, and iPhones synced with laptops, tablets, and desktops at the touch of a button. “When we started in this business, everyone thought we were crazy,” recalls Peters. “There were stories about whether or not the cloud would ever be right for healthcare, and doctors are concerned about putting data online.”
“What we see now is that the whole sector has realized that the cloud really offers stability and connectivity that we really need in healthcare, especially with all the connectivity that’s coming under Stage 2,” she explains. “Having a web-based EHR makes that a lot easier for a physician, as opposed to having a server-based system where you need to have a technician come out every time you need an upgrade.”
But with connectivity comes concerns about security. Healthcare data is some of the most sensitive information ever trusted to a hard drive, and the sheer shocking number of breaches that happen every day, exposing patients to identity theft and potential embarrassment when their conditions or procedures are revealed is staggering. While many of these incidents have nothing to do with whether or not an EHR is cloud or server-based, and can be traced back to simple human error involving misplaced USB drives, improperly discarded paper records, or lost laptops, providers get jittery when they think of personal health information (PHI) floating in the ether.
“We’re going to manage the security for you,” Peters assures prospective clients. “We have a massive team that’s used to protecting very large and high-stakes projects. We have a single point that we can monitor and ensure compliance. If we spot a problem, we can shut it down right away. Doctors don’t really have to worry about it.”
“Our business model is designed for that,” agrees Hallock. “Some of the more traditional EHR vendors will say, ‘Okay, here’s the software. We think it’s really good. Good luck. Here’s the hardware we think you need, and we recommend that you read the manual.’ That’s a little daunting, especially in healthcare. It’s personal health information, or financial information, and we all want that to be secure.”
“If you had looked at paying your bills online years and years ago, people weren’t that comfortable with it,” he continued. “People didn’t know if the payment would go through, or if it would be matched up in the system. But as people get more comfortable with it over time, and they see that it works, and see that it’s secure, they become better with it.
“Healthcare is a huge, huge industry, and it takes a long time for change to be seen. What’s exciting is that we’re starting to see people getting more comfortable with cloud-based technologies and that’s what’s going to allow us as an industry to move online, like the way we all want to. It’ll let the information flow the way we want it to flow.”
The exchange of information will become even more important as Stage 2 of meaningful use starts to emphasize coordination of care and data sharing. EHR systems will need to go through a newly revamped certification process, holding software to higher standards. The process can be slow and difficult for some legacy systems, and some provider groups are worried that certified ER technology (CERHT) won’t be ready in time to help providers attest to the new benchmarks. Practices are starting to get nervous about the deadlines, Peters says, and many of them are making the leap to a new EHR before it becomes an issue.
“We’re seeing about one in four of our new customers switching from an Allscripts system,” she says. “Allscripts is sort of dealing with a double whammy right now. Not only are they server-based and quite expensive, but they also recently discontinued their primary system designed for small practices. They have offered to switch their users, but a lot of physicians are looking at the time and cost around switching, and they’re looking at the Stage 2 meaningful use deadlines coming up pretty fast, and they’re deciding to go with something different.”
“As we’re going into Stage 2, I think we’re going to see a lot more situations like MyWay. There are going to be a lot of EHRs that aren’t going to get certified for Stage 2 on schedule, or even at all, and there are going to be a lot of doctors out there stuck with a system that can’t carry them forward.”
Stage 2 hits early EHR adopters at nearly the same as ICD-10, the new medical coding set slated to go live on October 1, 2014. ICD-10 has been causing headaches for providers, payers, and vendors alike. Vendors are starting to step up to the plate and outline their responsibilities to customers, who are still waiting on ICD-10 compliant software upgrades.
“We’re just getting into ICD-10 now,” Hallock explained. “Our role involves a couple of things. We do practice management at CareCloud, so the software has to be compliant and it has to have all the codes and everything. From a billing standpoint, we need to be sure that the people we’re doing business with are up to date. There’s testing involved with that, and it takes some time. It involves building out infrastructure to make sure that come next October, our clients are fully able to do business as usual. That takes a lot of back-end work to make sure the system is working. But remember, when we do that, we do it for everybody. It’s not a one-off, as opposed to the client-server world, where many one large client gets a little more attention and you don’t know where you stand in the line.”
“In the next few months, we’ll be in communication with our clients about where we stand, and we’ll have a bigger communication effort. A lot of the initial work is being done now. It’s a big, big, big change, as you know,” he says. “You’re dealing with the entire healthcare supply chain. It’s payers and labs and patients and your own staff, so that takes some time. But again, because we’re a cloud-based technology, we can do that faster. And if it’s not going right, then we can fix it faster. Because it doesn’t always go right. But we need to fix it as close to real-time as possible.” Source
