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What’s Behind the EHR Backlash?

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Healthcare providers are switching electronic health record systems at a growing rate, prodded by government incentives and a maturing market

After eight years, Women’s Care Florida recently switched from their original electronic health record vendor to an EHR system from eClinicalWorks.

Alistair Madle, chief operating officer at the west central Florida-based practice, said the first EHR offering wasn’t able to meet the requirements for Meaningful Use and the specific needs of an OB/GYN specialty.

“What we could live with from a compliance or a specialty viewpoint five or six years ago is not necessarily what you can live with now days,” Madle told HealthBiz Decoded.

OB/GYN specialties may have special needs, but the story of Women’s Care of Florida is not unique. It’s a scenario that is repeating itself across the country as providers increasingly replace their first, second, and even third EHR systems with a new one.

“The increase in the number of replacements was quite shocking to me,” said Mark Wagner, senior director of clinical and ambulatory research at KLAS, an Orem, Utah-based health IT market research firm.

Wagner was lead author of a report last spring that found healthcare providers were replacing EHR vendor systems at a rate of 50 percent, compared with 30 percent a year earlier. The KLAS survey of 300 prospective ambulatory EHR buyers also revealed that vendors were replaced primarily due to customer support or product development issues.

eClinicalWorks is seeing almost 30 percent of its business coming out of customers on existing systems that are moving to a next-generation EHR, said Girish Navani, chief executive and co-founder of the Westborough, Mass.-based EHR vendor.

EHRs Not Ready for Prime Time

Some top industry insiders suggest that among other things, Meaningful Use has created an artificial market for undeveloped EHR products.

“The approach that the government used to incent the use of health IT has shown that it may not have been ready for prime time and that many of the systems that came up and blossomed underneath the CMS rules for incentives and Meaningful Use also were not ready for prime time,” said Bob Brown, vice president of professional services at Mosaica Partners, a Seminole, Fla.-based consulting company.

Brown, also the co-founder of New Health Networks, said that while some EHRs are more integrated than others, they can cause clinicians and team members to interrupt the work that they are doing with patients in providing health services. What is needed, said Brown, is a more holistic view of what clinicians and team members were doing with their patients at the point of care.

“We are seeing dissatisfaction and backlash because the quality of the systems that the clinicians and their team members are using are not even neutral in their impact – they are negative in their impact,” he said. “The systems are getting in between them and their patients.”

As the inadequacy of some stand-alone “point solution” EHRs is becoming more apparent, people are deciding that they want to upgrade to something better.

“For the most part what they are upgrading to are more capable applications, but I would still put them primarily in the point solution category as opposed to the integrated health IT category solution,” said Brown.

Dan Bedrosian, a strategic consultant with Xerox, said there are several factors that are driving EHR replacement – including product limitations and lack of training and support.

“As I’ve gone out to clients and interviewed people, there are certain physician practices that have a very difficult time using any sort of EHR system,” said Bedrosian.

Switching Systems a Daunting Task

Replacing an EHR system can be hard on end-users in terms of productivity issues and cost. For instance, if the provider already has a system in place and there isn’t a way to upgrade or enhance it, it could take several months to identify another system.

During the implementation process, you often have to pull people off of their job to get them trained, build the system, and then do a conversion from the old system to the new one, said Bedrosian.

“The first few months after implementation, productivity really gets hammered. It takes a while before end users get used to the system and start integrating in with their daily tasks,” he said.

Will the replacement EHR trend continue?

Some industry experts predict that over the next few years the market is going to continue to consolidate. And while there is no clear market leader on the ambulatory care side, there are still a lot of appealing products on the market.

Brown expects small, incremental improvements to continue over the next few years in the current generation of stand-alone EHR systems. A bigger shift could come once the incentives expire and the healthcare community assumes more responsibility for helping to develop the specifications they need.

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