- With EHR adoption nearly ubiquitous across inpatient and outpatient hospital settings, many healthcare organizations are now in the position of considering EHR replacement.
The decision to replace an existing EHR system is a serious one based on a variety of factors. The EHR replacement system must provide improvements over the previous system, and it also must meet the needs of both the organization and its providers to ensure longevity.
Most commonly, dissatisfaction with an organization’s current health IT company or product motivates the decision to switch. However, with interoperability topping the list of priorities for federal agencies such as ONC in 2017, streamlining health data exchange across provider networks has also begun to influence EHR replacement decisions.
Providers have also made the decision to replace existing EHR systems based on changes in the health IT landscape and the healthcare industry as a whole. New areas of care management (e.g., population health) are influencing healthcare provider and practice expectations for their EHR systems and their purchasing decisions in the future.
Each of these potential drivers presents a different set of considerations for healthcare providers.
Choosing the right replacement EHR technology involves taking a close look at the particular capabilities of a certain system and measuring them against the most pressing needs of an individual practice.
Dissatisfaction with an existing EHR is one of the more common motivators fueling the decision to cease attempting to optimize a certain system and instead consider investing in a full EHR replacement.
If a healthcare organization reaches a level of EHR dissatisfaction troubling enough to initiate the process of finding a new EHR technology, prioritizing specificity is the key to avoiding further disappointment.
Not all EHR systems are created equal.
Some health IT companies, such as CPSI, focus specifically on enabling secure health data exchange for community healthcare centers in rural communities. Others, such as Epic Systems, specialize in large health systems but have recently launched affordable product packages to fit the needs of smaller hospitals.
While knowing the specialties of a certain health IT company can be helpful, healthcare organizations also need to do further research on their own to ensure the system is a good fit for their clinical workflows.
Seeing the technology in action at a practice similar to a provider’s own facility increases the likelihood a system will work well in a certain environment.
At the Value-Based Care Summit earlier this summer, Epic’s Vice President of Interoperability Peter DeVault argued that site visits are the best ways to judge if a certain system or vendor can meet a practice’s specific needs.
“The best advice for a provider buying health IT is not just to rely on the certification and on responses to the RFP the vendor provides, but to do site visits and reference calls,” he said. “You have to see it in action.”
The Sequoia Project CEO Mariann Yeager echoed this sentiment.
“It’s about taking that technology and making it real in a real environment — seeing the proof,” Yeager said. “Look where there’s a high degree of connectivity and production exchange in existence and a high utilization, and you’re going to see some winners.”
Officials from Maryland-based hospital Meritus Health recently did just that when making an EHR selection for their health system. The EHR implementation process is projected to take five years and will likely cost the health system almost $100 million. With such a costly and time-consuming project ahead, Meritus took time to weigh its options and seriously considered six different vendors before ultimately settling on an Epic EHR system.
Torn between two potential vendors, Meritus officials decided to visit a hospital mirroring their own and observe how Epic technology suited the community’s needs. The similarly community-based health system Meritus officials visited had 250 to 300 beds and was in a non-urban area. Officials noted that the technology seemed to be a good fit for their specific culture and hospital size and chose Epic for its ability to meet the needs of the environment.
"We preferred Epic over the two. [Our] clinicians particularly preferred Epic," President & CEO Joseph P. Ross told Herald-Mail Media.
Site visits offer deeper insight into an EHR system’s capabilities and actual performance than EHR certifications or vendor reputation alone.
Especially with providers recently losing faith in the legitimacy of health IT certifications, seeing a technology in action is a healthcare organization’s best bet when choosing a replacement EHR.
As health data exchange becomes more pressing, some providers want EHR systems that are either similar or identical to the systems of other hospitals and facilities in their networks to streamline the flow of information.
One prominent example of this trend is the recent EHR replacement decision by the Department of Veterans Affairs (VA).
VA picked Cerner as the vendor to support its new commercial EHR to replace the previous homegrown system VistA.
One of the most significant factors driving this decision was the EHR being supported by a Cerner platform at the Department of Defense (DoD).
The decision falls in line with VA’s main goal of ensuring the new EHR system would be an integrated EHR with DoD that is also interoperable with the private sector.
Similarly, a New York hospital recently chose Epic for its own EHR replacement in an effort to enable streamlined health data exchange between all hospitals in its health system.
Jones Memorial Hospital (JMH) is one of three hospitals part of the UR Medicine health system. Upon receiving a $5.7 million grant from the state, JMH decided to use the funds for a multi-year project to replace its MEDITECH and LSS systems with an Epic EHR mirroring that of the other hospitals in its network in an effort to improve interoperability.
“These funds will provide us with the resources to work more effectively and more efficiently with our partners,” JMH CEO Eva Benedict told the Wellsville Daily Reporter. “Not only will migrating to a common EMR with the UR Medicine and the other affiliates of UR Medicine be beneficial when recruiting specialists from UR, it will — most importantly — enhance the communication of patient medical information across the system and improve patient safety.”
Choosing an EHR system already in use at other hospitals within a hospital’s health system is also advantageous during the implementation process itself.
Hospitals implementing the same system as an affiliated facility can benefit from the insights and experiences of other health IT experts and hospital staff that have already successfully completed the process during their own EHR replacement.
“One of the most exciting aspects of the project to transform Jones Memorial to the EPIC system that is currently in use by UR Medicine and our regional affiliates, is that we will have partners with years of experience available if we have questions or need to trouble shoot,” said IT Director Alicia Johnson.
Replacing a disparate system with an system on the same platform as other in-network hospitals for improved interoperability can be enough to justify a costly, long-term EHR replacement project.
New developments in healthcare
Hospitals and physician practices sometimes decide to replace their EHR systems as a result of new developments in models of care and reimbursement.
New product offerings from health IT companies and new methods of patient care management can motivate providers to make a change.
Specifically, some leading health IT companies — Epic, Cerner, and Allscripts — have begun dipping into new areas of practice and patient management, including revenue cycle management and population health management.
These companies have extended beyond merely offering EHR databases and now equip providers with health IT offerings capable of stratifying risk and tracking patient movement across the continuum of care.
According to a Black Book survey earlier this summer, Epic and Cerner are presently leading the market for population health management platforms.
Black Book Manager Partner Doug Brown predicted that these new offerings signal a shift in what providers will come to expect from their EHRs and how healthcare organizations will make EHR purchasing decisions.
Brown surmised that comprehensive platforms with a wide breadth of functionalities will soon outpace and outperform best-of-breed health IT systems consisting of technologies and solutions from several different vendors.
In line with Brown’s prediction, JMH in New York abandoned its patchwork MEDITECH and LSS EHR system in favor of a comprehensive single solution Epic EHR complete with software for health records management, billing, prescription authorization, and patient portal functionalities.
"Single solutions will likely continue to merge, be acquired, or be usurped by integrated technologies within comprehensive platforms that are natively integrated at the point of care and accessible by patients and community-based organizations," he said.
"Systems like Epic that were developed from the start as a single, longitudinal patient record spanning inpatient, outpatient, post-acute and billing will have the advantage,” Brown added.
While almost all healthcare organizations have live and operational EHR systems in use at their facilities as of 2017, EHR purchasing decisions will continue in the form of EHR replacement.
Whether a practice is seeking a replacement EHR as a result of provider dissatisfaction, the push for interoperability, or new developments in the healthcare industry, choosing the right EHR requires selecting a system with demonstrated benefits as opposed to EHR certifications.