- Those that ignore history are doomed to repeat it. Now, replacing an EHR is by no means dire, but it represents a significant investment if not in money (in light of “free” EHR or EHR donations) then in resources (e.g., time, energy). The hope of the EHR replacement process is that healthcare organizations and providers will take the lessons learned in their previous experiences and apply them to the task of selecting, implementing, and adopting a new EHR solution.
So what is the recipe for EHR replacement success? Well, you’ll need a few ingredients:
• Executive sponsorship
• Clinician buy-in
• Project management
• Change management
• Data selection and migration
• Proper training
• Suitable EHR vendor and solution
• Realistic expectations*
*These are optional but do make the experience more palatable
Having the right ingredients only accounts for half the task; the other half comprises having the right balance. What follows is a list of areas often overlooked or undervalued in the process of transitioning from one EHR system to the next:
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Identify key stakeholders: Executive sponsorship and clinician buy-in is key to any EHR adoption. When that adoption is an EHR replacement, avoiding previous shortcomings requires getting the right people around the table, most especially its power users (i.e., clinicians). That being said, the motivation to replace an existing EHR might be the result of an organizational imperative to streamline the business of the hospital or practice, says Todd Rothenhaus, MD, Vice President & Chief Medical Officer of athenahealth.
“In the old days, the administration picked the practice management system and they deferred to the doctors completely for the EHR,” continues Rothenhaus, “and then we all woke up, especially in the ambulatory world, to the fact that integrating practice management and EHR was a pretty important thing. Having two people on separate systems just is doable but not optimal.”
In this instance, stakeholders need to come from all departments whose clinical and administrative workflows will be affected by the new EHR system.
Appreciate the role of change management: People fear change. Clinicians are people. Clinicians, therefore, fear change. The challenge for healthcare CIOs and senior leadership is to mitigate the discomfort associated with making the switch. This was the lesson that Tripp Jennings, MD, System Vice President and Medical Informatics Officer for Palmetto Health, learned as he guided providers — some on EHR systems, others not — through the EHR replacement process:
It was like a crash course in change management. It’s very difficult but much more difficult from a human standpoint than it is from a technical standpoint. Technical challenges can be and have been resolved. It’s really the process of changing everybody’s workflows and taking a practice from a paper system to an electronic system. You have to stop and evaluate all of the clinical and workflow processes. You can’t just take a paper system and plug it into an EMR, no matter what the vendor. The real challenges are doing that while still keeping a practice performing at an acceptable level.
In short, the human element can’t be taken too lightly. That being said, the task of moving between EHR systems isn’t as daunting as moving from paper to electronic. “Most of the clinicians in a practice overestimate the work of learning a new EHR. The barrier between paper and any EHR is greater than from an EHR to EHR alone,” athenahealth’s Rothenhaus observes.
Determine appropriate data to migrate: If you put junk in, you get junk out. Junk data is no different. According to Caleb Anderson, Senior Sales Manager at Cerner Corporation, healthcare organizations and providers often overvalue certain kinds of data, believing that they cannot live without it in the replacement EHR system:
What do you realistically want to move over? I have a number of clients that we’ve done migrations for that would tell you, “We thought we needed to move everything and we moved everything, and we found out that all we did was clutter the new system with junk we had in the old system.” Look at it like you did when you moved into the electronic world from a paper chart. You probably didn’t scan every piece of paper. So do you really need to move everything? The docs will say, “Yes, I need it all,’ but then once you move it they’ll say, “Wow, why did you do that?”
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Determine rollout of the replacement system: Just as important as determining which data to move is how this information will be impacted by different go-live approaches. While this tends to be more pronounced for larger care settings with multiple departments or specialties, it’s a valuable reminder of the task of data reconciliation.
“To move a one-doc practice into a hospital environment is pretty simple versus moving 50 practices over. And do you do that with a big bang implementation or do you phase it? That’s usually the hardest discussion,” explains Anderson. “If I have a record in primary care, endocrinology, and cardiology and those maybe have different waves of go-live, do I migrate all at once or three times and what are the implications of doing it three times for just chart management?”
Choosing a big bang versus an incremental approach could mean less headaches down the line, but no implementation is without its share of problems.
Select an EHR product and vendor that suit your needs: The motivation for switching EHR systems could very well be the result of having chosen the wrong system or the wrong vendor. In the replacement EHR process, it’s important not to commit the same mistakes twice, particularly in comparing the needs of the practices with the capabilities of an EHR system.
“Prior to any migration, I would advise all physicians to look at the new system they’re considering moving to and ensuring that it has what they need,” Matthew Douglass, Co-Founder & Vice President of Engineering of Practice Fusion. “The reason they ended up with the system they didn’t like — they couldn’t customize it or it didn’t meet their needs — was likely because they didn’t do their due diligence early on.”
While suiting the EHR replacement system to the needs of the care setting is important, the system itself represents just one part of the business relationship between provider and EHR vendor.
“Our first EHR was not very user friendly, and customer service was really lacking,” notes Dr. Waseem Khan of Cancer Care of North Florida. “We just couldn’t get answers. We were at the point of hiring a consultant just to help us navigate the EHR. It was really anxiety-ridden. I think we had one or two days of support from our vendor, and then we were on our own, so that was really difficult.”
EHR adoption is an ongoing and evolving process. Choosing the right solution as well as the right vendor will ensure that adapting to new or emerging needs is achievable.