EHR systems continue to be controversial. Rather than EHR installations, these days industry expert and consultantMark Andersonfinds himself specializing in DE-INSTALLS –thousands of them to be precise. “It seem that almost 80% of practices that bought EHR systems over the last 2-3 years are shopping for new systems for 2015” says Anderson. “Lack of Physician ease-of-use and workflow flexibility are the main culprits”.
With the emergence ofMeaningful Useand the ‘great rush’ toward electronic health records, most of the market went with names they recognized. But these were often older technology, or “legacy” systems as they’ve come to be known.
A few of these were systems were actually in process of being retired or sunsetted during the time of contract negotiation. “I’ve sat as an expert witness on no less than three class-action lawsuits where doctors won against industry giants for selling software that was slated to no longer be supported when sold,” says Anderson.
However, a smaller group of practices were fortunate enough to select flexible, user-friendly systems. These physicians have made the necessary adjustments to their processes and are now seeing the promised benefits of streamlined data entry, improved coding, and quicker access to patient information. (The results of the MRI Mrs. Smith had two years ago are a mouse click away rather than 30 pages back, and her medication list is up to date, including the blood thinner she began taking after last week’s hospital stay.)
Another culprit, perhaps even bigger states Anderson, are systems that were originally designed for general medicine, but that were then sold to specialties such as orthopedics. These modified systems struggle to deliver their promised value. Like wrong sized shoes that no matter how hard you push, they just don’t fit. Many specialties, like orthopedics and cardiology, are significant bodies of medicine that merit their own unique system designs.
Rather than reducing workloads, improperly appointed EHR’s force practices to change the way they work. They then leave providers playing catch-up at the end of the day. Hiring MA’s and PA’s have helped larger organizations overcome this implementation barrier, but these kinds of workarounds aren’t feasible for most practices.
The big motivator to adopt EHR today isn’t Meaningful Use. In fact large numbers of physicians are vocally resistant to ‘big government manipulation’ of being forced to adopt technology that has yet to demonstrate a substantial improvement in clinical outcomes. No matter how reasonable the augment, after a decade, EHR still has not shown the observable benefits, of say for instance, e-prescribing.
REVENUE CYCLE MANAGEMENT
At this point, EHRs are about much more than how encounters are recorded. If you’re looking for a smoking gun, think revenue management. Without a fully unified practice-wide system, you’re in danger of failing to create the type of efficiencies and revenue management you’ll need to compete in today’s value-based healthcare. Athenahealth has proved this point to the entire industry with their indisputable technology driven revenue cycle management model.
In fact a recent survey shows that now, 90% of the practitioners surveyed will only consider a cloud-based system – one that offers end to end “evergreen” technology.
So, whether you’re installing your first EHR or de-installing a failed system, here are five critical EHR attributes you might use to vet your next practice-wide solution:
1. Usability.As the top failure point of all failed EHRs, it makes sense to have a pilot program with your forward thinkers and early adopters before making a group wide purchase. Although no physician feels they have the time to do this, look at the downside of wasted time, money, and energy that accompanies the implementation of a system that ‘really demonstrated well at the convention’.
EHR’s have come the distance since they were introduced.
Some systems now make it easy for clinicians to find information and enter new data during or after an encounter: Quickly ticking boxes with a stylus on a tablet, entering longer notes through dictation or a keyboard, scanning documents directly into the system, or notating images and diagrams – these can be done on a good system within seconds without leaving the patient record.
Most importantly, you want to be able to adjust the medical content in the EHR on the fly, hiding fields you don’t use, populating ones you do need, and easily modifying the ones that aren’t just right for your style of charting.
2.Single-screen functionality.Everything you need to chart an encounter should be on a single screen, so you don’t have to open and close windows just to complete a note. This include flowcharts, histories, previous notes, and document management –all without changing screens so that the entire patient record and encounter entry is easily navigable on a tablet.
3. External interoperability.Many physicianshave not yet met the criteria for Stage I Meaningful Use, which requires a 2014-certified EHR and 90 days of reporting before October 1. They’re in danger of seeing a 1% cut in Medicare reimbursements. Stage 2 Meaningful Use is an even tougher nut to crack. It requires interoperability with outside systems, including the ability to securely exchange patient data with other healthcare systems. Look for an EHR that is Stage II Certified for Meaningful Use – one that is simple to use.
4.Internal interoperability.An EHRthatdoesn’tseamlessly exchange information with your other systems (i.e., practice management, billing, andrevenue cycle management) is a huge liability in today’s environment. Billers need automatic charge creation and full access to patient data and encounter notes. Physicians need clinical data to identify at-risk patients and those due for procedures. Management needs a 360-degree productivity and financial view of the whole organization –preferably on management dashboards.
5.Subscription based.One of the worst problems providers experienced with EHRs wasbuyinga system. Some even found out afterwards that the system they purchased was slated to be sunsetted and no longer supported. In a cloud based system there’s no danger of that because its usage is subscription-based, meaning that the software provider is responsible for maintaining, updating, and supporting both software and hardware infrastructure; which has historically represented the largest cost of enterprise EHR systems.
In a subscription based solution, there are no licenses to purchase, no software to install, and no servers to purchase or administrate or maintain. Cloud software is automatically updated behind the scenes, and more importantly it is backed-up every five minutes without your staff ever having to touch their computer. Cloud software is also browser-based, which means it can be securely accessed from any internet connected device –Mac or PC, Tablet or iPad, Safari or Firefox, Chrome or IE –and this type of open-source browser-based software is platform independent, making it evergreen by definition.
Regardless of how controversial EHRs have been, practices cannot successfully compete without them today. But simply comparing features from several vendors, checking references, checking off a checklist, and then succumbing to the best sales-pitch is not a working methodology. Rather, practice leaders must test the system in their own work environment, and then ask themselves the tough question of whether or not the software they’re considering will ensure their systems are still cutting edge and state-of-the-art three, five, or even twenty years from now.
Evergreen software is cloud based technology that not only has been around for the last twenty years (linux, apache, java), but that is driving far reaching change into the future. Think IBM rather than Microsoft. Think Google rather than American Heritage. Think Athenahealth rather than GE.
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