Challenges in EHR Conversion: A Roundtable Discussion with Several Healthcare Leaders

Recently, Datamark, a provider of digital mailroom, data entry and document processing services, sponsored a webinar hosted by Creative Healthcare, a provider of performance improvement solutions including Six Sigma, Lean and ISO 9001, who gathered together several healthcare leaders to discuss data management and the use of electronic health records and how those systems are changing the way their hospitals practice and administer care.

Though the group shared a variety of experiences about the use of EHRs, the comments – both good and bad – seemed to reach a consensus among the group.  As such, each of the comments about ease of use and even innovation are hard to ignore. Nor can we dismiss the fact that the issues shared by this group are not experienced by many of their colleagues at hospitals throughout the country.

However, there were some surprising candor from the participants of the roundtable. One of the most surprising opinions expressed was by Shawn Shianna, MD of FHN Healthcare, of Freeport, Ill.: “Most of us feel we’re being forced to this (implement and use EHRs).”

Being pushed into an EHR through meaningful use has led to a certain amount of displeasure among hospital caregivers and administrators, but the move toward technology is not turning all organizations off. On the contrary, at least one of the participating hospitals, Somerset, of Pennsylvania, has embraced the move to electronic health records.

“We went live with Practice Fusion in 2009 and physicians didn’t want to go back, but are going forward, shutting off the paper,” said Jonathon Bauer, CIO.

But like most healthcare organizations making the switch, it has been anything but easy.

For example, according to the Kevin J. Helmrick, MD and CMIO at Methodist Healthcare, San Antonio, the transition to an electronic environment has been a major undertaking. With more than 1,500 caregivers, the health system implemented a full EHR across eight facilities in 2012.

“It’s a major transition for any healthcare organization to convert from paper,” said Helmrick. “It’s a disruptive change, especially for our physicians.”

Mike Williams, CIO of FHN Healthcare, said his organization addressed the transition to EHRs in a more measured fashion – about 55 percent of the company’s physicians use a full system while the remaining 45 percent use a “lite” version as a way for them to become more acclimated the software and while learning from their colleagues.

Using another approach all together, Somerset uses a hybrid approach: Paragon for its inpatient system and Allscripts for its outpatient. The hospital has taken a stayed approach, Bauer said, and for the small hospital, it has caused some problems, especially when the two systems do not correlate. In fact, some physicians simply switch back to paper when the two systems don’t correlate. The back and forth from electronic to paper records stymies the hospital’s mission and continually sets the hospital’s agenda back.

However, given this, Somerset is preparing for Stage 2 meaningful use.

There continue to be major concerns with the systems though, said several members of the roundtable; primarily, lack of ease of use and impact on productivity.

At Holy Family Health, Manitowoc, Wis., an organization that attested for Stage 1 and is preparing for Stage 2, EHRs definitely affect workflow and take away from the overall process even though the hospital has used a Meditech system since the early ‘90s, said Theron Pappas, CIO.

However, EHRs have not meant everything has been bad. Meaningful use and reform has brought about a certain level of innovation as it relates to quality; innovation that would never have happened otherwise, said Helmrick.

But, more innovation is needed, he added. “Vendors need to improve the user interface. Our health IT vendors are slow to embrace new, emerging tech,” he said. “I’d like to see them support clinical workflows, not just reporting. The vendor issues we face include not providing a seamless user experience.”

The biggest challenge healthcare leaders face is the aggressive meaningful use schedule, said Bill Spooner, CIO of Sharp Healthcare of San Diego. “There’s a pretty heavy ownness on all of us. A two-year implementation is pretty aggressive; we’re racing against our own deadlines.”

Given the overwhelming change ahead, regulation and requirements and the desire to create more efficiencies, even with the challenges the technology continues to pervade with no obvious signs of relenting.

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