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EHR Do-Over? Eight Ways to Get it Right This Time
The rewards of successful electronic health records (EHR) implementations are well documented, but so are the risks. Half of all EHR implementations fail, and there’s ample dissatisfaction with many of the systems in production. Pain points include missing features, difficulty of use, stingy support, and hidden costs.
So if you believe in the benefits of EHRs, but aren’t happy with your system, you may be among the many hospitals or providers shopping around for a better option.
In this article, we’ll take a quick look at the disappointment that some organizations face with their current EHR and offer 8 ways to manage the thorniest implementation risks. The goal is to help you ace your EHR installation, whether it’s your second time around or your first, and quickly reap the promised benefits.
More than half the organizations that switch EHR software platforms are frustrated by a lack of features in their incumbent product. Voice recognition, for example, is in high demand among organizations contemplating a switch. The technology is handy for capturing clinicians’ notes and commanding the software while you use your hands to heal. Telemedicine, mobile apps, and medical dictionaries are other top requests.
Robust care coordination features are also valuable, especially for integrated healthcare systems that need easy yet secure data exchange among practices, care levels, and divisions. Collaboration features like chat, screensharing, and project management further help clinicians sync up with patients seeing multiple providers.
Switching EHR products is obviously a major decision, but so is inaction. Using a substandard, expensive, inflexible EHR is bad for revenue, productivity, and patient care. On the other hand, a new EHR can pay for itself in 10 months. And if it’s your second EHR, you have the added benefit of hard-won experience surrounding the features you need and proven success factors in system implementation.
Either way, if it’s time for a change, consider these 8 EHR implementation risks and how to mitigate them:
RISK #1: Initial chaos. To avoid confusion and mistakes, successful organizations attack the implementation challenge methodically. They start with defining goals, selecting key performance indicators, redesigning processes, mapping them, and anticipating resistance to change. That’s a lot of moving parts. A good place to start is with an EHR project implementation template, which institutes best practices for planning yet invites prudent customization. Another best practice in EHR change management is to set up committees for planning, implementation, and communication early on in the process.
RISK #2: Resistance to change. New EHR systems, whether your first or second, should disrupt processes in a good way, but disruption always entails pockets of initial resistance. The key to addressing them is communication planned thoroughly long before the new EHR goes live. First, consider the impact on different audiences: How will you keep everyone in the loop, including the C-suite, which will need continuous updates; clinicians, who lack the time for up-front training; and patients accustomed to a particular service experience? How difficult will it be to learn to use the new EHR? Change management is a science, and it’s important to look for a provider that can offer insight around communications planning.
RISK #3: Data migration glitches. Nearly 2 in 5 implementations run over budget or schedule, and trouble with data migration from the incumbent to new EHR system is one of the reasons. That’s not surprising given the enormity of the undertaking. Mitigate risk by anticipating challenges, planning your responses, and testing as much as possible prior to going live. One pivotal decision is settling on how much data migration to do manually and how much to automate. There are pros and cons for each in terms of completeness, timeliness, accuracy, labor, and cost. Other key decisions are identifying which data to extract, how far back to go, and when in the implementation process to extract it.
RISK # 4: Revenue loss. This is a particularly fraught topic in the EHR conversion process. Ensure you have revenue cycle management (RCM) subject matter experts on the implementation team, and perform a full revenue-cycle assessment up front. Identify and re-engineer any inefficient workflows that waste time and restrain collection yields. Validate that your fees for service are sufficient and compliant. Understand how new clinical documentation will affect charge capture. Finally, test all RCM processes from pre-access through charge capture to claims generation, validating that each outcome meets the acceptable criteria for a clean, complete, compliant claim.
RISK #5: User frustration. Training is a huge variable in EHR satisfaction, and a lot of people aren’t satisfied with it. More than 2 in 5 clinicians rate their initial EHR training as inadequate, and 95% think their ability to use their EHR could be improved. On the other hand, specialized training approaches have delivered substantial improvements in physician documentation and efficiency as well as time savings and a reduction in medical errors. The best practice in EHR training is role-specific instruction delivered, managed, and customized through a learning management system (LMS). That training should start approximately 3 to 12 weeks prior to your go-live date. However, clinician training should be different. Because finding time to train is the biggest challenge for clinicians, post-go-live support is likely to be the reality.
RISK #6: Software hiccups. Testing is an important function in the implementation process and should be conducted on real patient data, but in a non-production environment. A good approach is to segment testing into 5 parts: unit testing on each component of the software, system testing to ensure compliance with your organization’s requirements, integration testing to ensure the entire software solution is operating as intended, performance testing under different loads, and stress testing to verify stability and reliability.
RISK #7: Surprising fees. Many organizations feel nickel-and-dimed for their EHR implementation, paying 37% more on average than they expect, according to Capterra. They’re billed for each and every change or exciting feature. Because these enhancements can greatly improve the EHR process, and ultimately patient care, a quality EHR provider should be up front about its billing structure and outline the exact costs beyond just the monthly fees. Organizations should consider negotiating all-inclusive pricing.
RISK #8: Miscommunication. One of the most important functions of an EHR is to synthesize care information from every provider who sees a patient, and present salient information in the optimal form for every new encounter. Unfortunately, a classic disconnect is the failure of the EHR to foster coordination between behavioral health professionals and primary care providers in integrated health systems. Consider a patient whose substance use disorder stems from chronic pain, or the patient who is overeating due to unresolved childhood trauma. Failure to coordinate means inferior outcomes. Again, look for chat, screensharing, and project management features. Mobile communication apps are increasingly ideal for fostering collaboration.
The risks of switching EHRs are substantial, but the switch is often a critical need. The strategies for mitigating implementation risks are increasingly well documented and proven. Risk mitigation tees up a solid return on investment, high satisfaction, and improved outcomes for patients. When it comes to transforming the integrated healthcare experience, careful implementation planning will increase the likelihood of project success.
Khalid Al-Maskari is founder and CEO of Health Information Management Systems (HiMS).
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
Resenwitz C. EHR software industry user report. Capterra; 2015.
