Do I Need to Fire My EHR?

In the late spring of 2009, I got this crazy idea of opening up my own practice as a solo practitioner. I was sitting in my Friday morning clinic block at Hopkins, seeing somewhere between 8-10 patients a week, when I came into a room to see an interesting young woman with slightly buggy eyes. Turns out, she was a specialty physician working in private practice for her thirteenth year in a row and she later in the visit would tell me private practice was the best thing she ever did. I, on the other hand was in my first year of junior facultyship at an academic pressure cooker and still trying to come to a conclusion about being overworked and underpaid compared with my private practice colleagues. But I will save the rest of that conversation for another day. My doctor-patient turned out to be a pivotal figure in my life and soon I was carefully planning to open my very own practice in downtown Washington.

One of the things my practice manager and I wanted to do from the very beginning was to get away from paper charts and all the pitfalls I had previously experienced. From lost charts, to missing test results, to needing to constantly refile charts after visits, our motivation was pretty clear. In August of 2009, we started combing through blog after blog and website after website trying to find that perfect combination of price, form and function. We finally settled on a moderately-priced, middle of the road model and signed the contract on the dotted line. A server was bought. Thin-client dummy terminals were installed. And life was going to be organized and GOOD without paper charts!But the best laid plans of mice and men are, of course, not always so easily pulled off. For three months from November 2009 until the beginning of February 2010, we struggled with unfinished training sessions, broken software links, and a multitude of things just plain not working. These issues were followed by an outsourced team in India telling us that all problems would be solved to our complete satisfaction. We tried to be patient, listening to the software vendor’s excuses and promises. Day after day of frustration went by, and soon it was up to month after month. At the beginning of February 2010, we decided to fire the company and go with a different one. We initially demanded all of our money back for product misrepresentation. Fortunately, depending on how you look at it, we had only paid half of the complete bill earlier on, citing that payment would only be completed when we had a completely functioning product. This never happened. And so we finally settled for a partial refund minus $2000. Talk about insult to injury! But we needed to move on as quickly as possible, and we had patients to see and take care of, after all. Could we have won in court? In a nanosecond.

As far the company we fired, we agreed to sign a gag order in order to get any money back, and so they remain carefully hidden in the shadows. But if you can read the details above, it probably won’t be difficult to stay away from this one. In retrospect, nevertheless, we should not have let our EHR disaster get so far. As soon as promises were made and not kept more than once, we should have read the writing on the wall and gotten out. Lesson learned!

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

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11 Comments

  • Just out of curiosity what EHR solution are you currently using? How big is your practice? We have a few clients we are working with and I would love to hear more about your experiences.

    Thanks,

    Matt

  • I am sorry you had to go through that, but as a provider in this arena it does not surprise me.
    In my blogging you always hear me refer to the Hooplah surrounding EHR. Unfortunately this is where it leads.

    A couple things to keep in mind.
    ANY proprietary system will result in fees that will grow over time
    ANYONE that suggests a product that requires hardware will be more difficult to get online and keep online.
    THese solutions dont make an organized office an organized office will make these solutions look good.

    To coin a phrase, at the end of the day think about what you are trying to accomplish. I think if you look closely, you’ll see all systems come with a process overhaul. Everything has a price and in this case getting swept away in some of the hooplah was your price to determine your real needs.

    Again sorry you had to experience this but as a company who provides a great service to bridge the gap to full EHR I run across hundreds of doctors that want to believe the larger suppliers are safer, have better solutions etc… MY only advice would be to quit considering all the rhetoric, and reallye valuate your needs and clearly define the goals for your practice. Then do whats best for you.

  • Matt, we are using Practice Fusion and love it. A few minor speed issues when logging in for security/encryption needs. But I am also logging in and out about 50 times a day as I move from room to room. I am a solo subspecialist practitioner (endocrinologist).

  • Dr. West… good post and aren’t you glad you discovered the limits of your application before you had stuffed it with 2 or 3 years of patient data?!

    Lots of practices view sunk costs (either hardware or software) as an impediment to making the move to a new solution. Tough decision to make when the time comes and was tough for you too … but knowing far better what your needs are across the entire practice processes gives you a whole lot better position the second time around than the first.

    Makes a good case for cheaper solutions first time around and then reach further when the current application demonstrates its performance at the next level. Then you ought to be able to walk your data across to the new platform far easier than trying to negotiate getting your data back from one vendor so you can reload it in another vendor’s construct.

  • Hi Dr. West,

    Practice Fusion is gaining a lot of momentum in the market so it is good to hear that it is a viable solution. You certainly can’t beat the price! Do you use a tablet PC of iPad to access Practice Fusion. Just wondering how you are using it to record you data. My guess is that many Physicians will see the patient and then return to their office to record the notes from the visit. I would be curious to find out how you are using the EHR to enhance your practice and find out any tips for avoiding any pain points and how to optimize your office to increase productivity. Where have you found the greatest gains in productivity and the greatest loss of productivity? Thanks for the feedback.

    Matt

  • Matt,
    Most physicians that I know are charting at least some of the data in the exam room. Not to mention, putting in orders, creating scripts, etc. Then, they might do some of the objective sections of a note in another room after the fact.

  • Dr West,

    I certainly can understand your pain with your original EHR. I think one thing that needs to be addressed is healthcare practitioners need to have clear requirements of what they need and expect. They also need to be able to convey that to the vendor they choose. The practitioner also needs to have realistic expectations of a system. I believe that some people get a system and they want to change everything about it. Most vendors will try to accommodate, but when it doesn’t happen, the practitioner is upset. I believe in really researching the EHR, getting plenty of demos, and using a score card with the practice’s criteria. All the bells and whistles in the world can’t change a program that doesn’t fit your needs.

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