According to the 2014 Exclusive EHR Study conducted by the MPI Group and Medical Economics, 70 percent of clinicians said their EHR investment has not been worth the effort, resources and costs. Widespread dissatisfaction with electronic records systems is casting an unfortunate shadow over the great potential they hold for making today’s medical practices more efficient and for improving healthcare delivery. However, practices can help avoid future disappointment with their EHR decision and save time and resources by understanding how to avoid common implementation pitfalls.
1. Choosing the wrong EHR
The intuitiveness and ease of use of your EHR will affect every area of your practice. If you don’t consider yourself to be technologically savvy, finding an intuitive solution should be at the top of your list. (After all, presumably you’re a clinician, not an IT expert.) Was a clinician was involved with the development of the EHR system? If a clinician wasn’t involved, chances are your idea of “usable” won’t line up with that of the vendor’s.
Another aspect to consider is cost, which can vary across a wide spectrum from free to several thousand dollars a month. Decide on the maximum price that you are willing to pay. This will reduce the list of vendors for consideration. Oh by the way, beware of the word “free.” Your biggest hidden cost is not the dollars spent on software, but the hours of lost productivity from a system that impedes you with banner ads and other annoying distractions.
To be certain that the EHR you choose is the right one for your practice, do everything in your power to expose yourself to the software prior to purchasing. It is worth asking the vendor whether they offer free trials. If not, consider watching video tutorials, attending webinars and shadowing another clinician using the EHR.
2. Underestimating the importance of an implementation plan
To ensure the smoothest transition possible, develop an implementation plan that will introduce you to your new EHR and also help you identify specific questions to ask the vendor. Your EHR vendor will likely have one to give you – just ask.
At a minimum, a useful implementation guide should tell you how to do the following:
While the final 50 or so percent of ambulatory physicians decide whether to implement electronic health records and others re-evaluate their technology plans, which may include switching the systems they use, it seems like as good of a time as any to continue the series I started about the steps that need to be considered when selecting an EHR.
At this point in the process, you’ve obviously gained the understanding that it’s an arduous process and requires a great deal of planning. But, you know that. You’ve done the planning and you’re beyond examining how implementing the system will affect your practice’s workflows.
So, when you’re gearing up to finally take the plunge, or if you’ve decided to get out of the water and dive back in, the Office of the National Coordinator provides the following guidance for moving forward with these EHR implementation tips.
Here’s a concise breakdown:
Get to know as quickly as possible how vendor and its products will help you accomplish your goals. Test drive the product and never take the word of a salesperson without vetting it with other professionals using the product. You might also shy away from vendor-provided references as they tend to receive incentives from the vendors for giving them. And, according to ONC, “Provide the vendor with patient and office scenarios that they may use to customize their product demonstration.”
Clarify pricing of the entire implementation prior to signing the dotted line. You want complete pricing for all things including: hardware, software, maintenance fees and upgrade costs, interfaces for labs and pharmacies, cost to connect to health information exchange (HIE), customized quality reports, etc. If it’s offered, ask for the price and get it in writing. Every time the deal changes, get a new written quote.
Like pricing, define implementation: amount of time, schedule of completion, and availability of trainers and what’s included in the training.
Ask lots of questions about data migration and how much it’s going to cost. Ensure a structure for the data rather than simply allowing for a dump of information. “Clarify roles, responsibilities and costs for data migration strategy,” the ONC suggests. The amount of data you need to transfer, the more complex the process will be.
Know whether you’ll be better off with on-site server or a hosted, Saas solution.
Can the system be integrated with other systems easily? If so, ho much does it cost?
Privacy and security capabilities and back-up planning: are there any?
Is your proposed vendor stable? Will it be sold or divested? Does the vendor have a strong local presence? Are those practices leaders in the local market? Do you hear good things about said vendor?
Can the system connect to an HIE? How much does it cost?
Is the length of the initial contract much too long – like a five or seven year lock in – and does it potentially keep you from exploring alternative options should you need to make an earlier exit?
Finally, according to the ONC, though it may seem a little off topic, “Consider costs of using legal counsel for contract review verses open sources through medical associations.” Nevertheless, seek legal counsel before accepting the vendor’s agreement.
The best time to protect yourself from a poor decision involving the vetting and purchase and an EHR is during the shopping and review process. Take time at the beginning of the process to ensure you know what you’re getting, what you’re paying for and, ultimately, what type of vendor partner you’re going to get once the ink on the contract has dried.