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The host of problems associated with electronic health records (EHRs) are well reported, and although you might accept that they are a time-consuming and definitely-not-user-friendly part of everyday life, your EHR system may be keeping you from meeting clinical and financial goals. A change to a different EHR may be costly, but the right EHR will ultimately save you time and money. So how do you know if you need to switch?
Holding you back
Recent figures show that around 75% of hospitals have at least a basic EHR, and EHRs are now commonplace in small-to-medium-sized accountable care organizations (ACOs), yet the full potential of EHRs is probably not being harnessed. Meaningful Use 2 placed the focus on health information exchange between providers to improve care coordination for patients, but estimates show that less than a third of providers use EHRs to communicate with physicians at other institutions.
The problems aren’t just that physicians are failing to exchange information, it’s more an issue of the technology. EHR vendors are struggling to address interoperability — a 2014 study identified 615 errors and data expression variations in 21 stage 2-certified EHRs. In fact, many EHRs are still unable to send complete patient data without the need for manual entry. And although this may seem like a minor hindrance, the financial implications for not abiding by Meaningful Use are huge — an estimated $1.15 billion in payments for those dependent on Medicare reimbursement.
The problem is that, while physicians see EHRs as a cruel necessity, they’re big business for the vendors. Previously, the necessary interfaces for interoperability were associated with high fees, but after a crackdown by the Office of the National Coordinator for Health Information Technology on the practice of information blocking between EHR vendors earlier this year, this has changed with some of the biggest vendors waiving their previously high record-sharing fees.
Considering a change
In January 2015, a survey on EHR switching found that key reasons for switching included better functionality, usability, support, training and achieving meaningful use. Interoperability through consolidating multiple EHRs was also high on the list. Finding the right EHR to satisfy these criteria sound awfully daunting and it is a very time-consuming activity, so much so that 80% of physicians view this as the biggest challenge in changing EHRs. In order to make sure that the time you invest in a new EHR is well spent, careful prior consideration is needed.
There is no one-size-fits-all EHR, so your first step is prioritizing your practice, hospital or facility needs and goals. You shouldn’t have to change your workflow to make a new EHR fit you; rather, the system you choose should be customizable to your workflow, frequently seen conditions and diagnoses, and documentation needs. If the costs of a server have become onerous — or you simply don’t want to shoulder them — choose a cloud-based provider. Have prospective vendors walk you through the upgrading process — the simpler, the better.
Even though your staff are the ones who will be using the EHR system, think about the needs of your patient population. For example, if you’ve joined an ACO and are involved in preventive medicine and a population health approach, look for an EHR with an automated messaging system, to remind forgetful patients of their appointments and home-care tasks. Other items that may be on the wish list: US-based helpdesks, easy sharing with other providers in your area, and data exchange with laboratory or diagnostic systems. But everything on your checklist must move you towards the goal of meeting meaningful use criteria. After all, you want your new EHR to save you money, not cost you in penalties.
Although a change in EHR will no doubt improve functionality and help achieve the goals of meaningful use, a new system may not be the only answer to physician happiness. Most users are already unsatisfied with EHR systems, and it may surprise you to know that almost half of physicians say switching did not improve their productivity .
It seems that productivity may be a constant challenge in the modern practice of medicine. If efficiency can’t be solved with a switch, hospitals, facilities and practices may have to look elsewhere to achieve that pre-EHR-era productivity. A recent study on the impact of scribes on physician productivity and revenue in a cardiology clinic revealed an approximately 10% increase in physician productivity when scribes were used, equating to an additional annual revenue of around $1.3 million.
If you find yourself asking whether you need a new EHR, the answer may be yes. But before pulling the trigger, examine your needs and priorities. It may well be that a switch is right for you, but you could find yourself making cost savings and increasing revenue with an entirely different approach. At the end of the day, your EHR has to be working for you.