EMR Switching Encouraged by Meaningful Use

For the past year or so I’ve been predicting that one of the top EMR and EHR related topics will be EMR switching. Yes, that’s right. A practice or doctor switching from one EMR to another EMR. At HIMSS it was suggested to me that meaningful use was a big driver in doctors switching EMR software.

I find the idea of meaningful use driving doctors to change EHR software quite interesting. It makes some sense when you consider that some of the EHR software that doctors currently use isn’t a certified EHR and/or will make it difficult for them to show meaningful use. More common is the HUGE number of physicians that have to upgrade their EHR software. This is a bit of a travesty to me. In any release of EHR software there’s always a mix of new features, security fixes and other optimization. Why a doctor wouldn’t want all of these things is hard for me to understand.

I guess part of the problem with staying updated to the latest EHR software has to do with the client server model that many EHR software companies use. Upgraded client server software isn’t always easy or fun. There’s some things you can do to streamline it, but it takes time. When the upgrade doesn’t offer a new feature that a doctor wants to get his hands on, it’s hard to justify the costs associated with the upgrade. I’m talking about time costs to upgrade, not software costs to upgrade. Unfortunately, most doctors don’t think too much about the security implications of not updating their EHR software.

Meaningful use has definitely gotten a lot of doctors to upgrade or replace their EHR software. This seems like something that should have happened naturally, but I believe it’s a good outcome of meaningful use.

Going back to switching EMR software, I’ve heard from a number of EMR vendors that some of their best EMR sales are to those that already have an EMR. I know I’ve done a much better job buying my second cell phone than I did my first. I knew what I really wanted when I bought my second one. The same seems to apply to doctors buying their second EMR.

Don’t get me wrong. I’m not advocating that doctors switch EHR in order to get a better one necessarily. It would be a really terrible thing if the way to get a quality EHR was to implement one first and then switch EHR. However, as time goes on there are going to be a HUGE variety of reasons to switch EHR software. Meaningful use might be driving EMR switching today, but there are going to be other factors driving doctors to change EMR in the future. Not the least of which could be a large number of doctors who focused too much on meaningful use and EHR incentive money and not nearly enough on the way the EHR selected will impact their practice. The other likely cause will be EHR consolidation and EHR software companies going out of business.

The real problem with all this EHR switching will be the lack of standards and flexibility around pulling the data out of the old EHR. I still have in mind some ways to hopefully help with this problem, but it’s a monumental task.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

12 Comments

  • We are transitioning to Practice Fusion and just transferred our patient data. We will have to manually transfer all the chart info which is the “monumental”task you mentioned. But we assume that Practice Fusion is worth everything we are going thru to get it working for us!

  • Wow, great leading headline.

    Whether that is EHR switching or EHR upgrading, Meanginful Use (also known as government regulations) is a driving force.

    It is quite easy to see why docs didn’t upgrade their EMRs before:
    1) They got tired of paying MX fees that don’t include upgrades
    2) No ROI
    3) Massive hardware costs as part of the upgrade
    …just to name a few.

    “…their best EMR sales are to those that already have an EMR.”

    No kidding – I’m guessing that by best sales, they mean easiest sales. Someone who already has an EHR already understands why to get one. But…they aren’t actually any better at picking one out.

    Yes, maybe they have a slightly better understanding, but when Mr. EHR sales-guy does his thing, look out.

    The last time a doc bought an EHR was probably at least 5 years ago…and things have changed…and they’ve probably forgotten the pitfalls of that purchase…so, previous buying experience doesn’t really help that much.

    Reality check for EHR vendors:
    Provide what a doc needs/wants, without ridiculous costs and you won’t lose business to another EHR.

    I have clients who switched to different EHRs because they would have to do major hardware updates, etc, and just weren’t thrilled with the current EHR.

    Also, I don’t (fully) buy the SaaS vs. server client simplicity argument.

    Having dealt with both, you have the same issues in different ways.
    Don’t forget that a web browser is client software.
    If it has to be updated (or more commonly NOT updated), you can still have issues.
    If a certain tool bar now interferes, you have issues.

    I’m speaking from real world experience, not theory.

    Done correctly (not sure any EHR has) whether a SaaS or client-server setup, these things should hum along with few hiccups.

  • Jane,
    That is indeed a monumental task. I hope you’ll come back and share more about your experience so that others can learn from you.

    John,
    Glad you like the headline. I’ve learned a little something about headline writing. Doesn’t hurt that I get a lot of practice doing it.

    I think previous buying experience helps more than you describe. Sure, they can still screw it up. Particularly when unethical EHR sales people get involved.

    I agree fully that if an EHR provided what a doctor wanted they wouldn’t switch. That’s the foundation of my idea for helping to solve some of the switching problems.

    Yes, SaaS can have some issues on browser version, toolbars, etc but that’s usually when the software was developed poorly. It’s still easier than client server imho. This comes from real world experience having to check a hundred or so computers that needed updating.

  • @John
    “…when the software was developed poorly.”

    Exactly.

    Whether you are checking 100 computers for client server updates or browser/toolbar updates…your are still doing a lot of ridiculous work.

    Well written software is the answer on both sides of this equation.

  • In my experience, the major reason organizations will switch a system such as a EHR, is functional disappointment. The unfortunate dynamic is that the “promises” made during the selection process, when not realized provide the motivation to make a change. Additionally, at that point, the organization will have been through the selection and implementation process, and are then a position to ask the right questions.

  • @RogerShindell,
    Can you describe more about functional disappointment? Are they features they were promised that aren’t there? Are they features that didn’t live up to what they thought they’d be? Was if functions they assumed would be there, but found out aren’t there?

    Basically, what do you think the most common cause of functional disappointment is and how do you think doctors can best avoid this disappointment?

  • John,
    It’s so true that converting from one EHR to another is not a matter of IF, but WHEN and AT WHAT COST? They’re switching not only to achieve meaningful use but also practical use, but the transition can be tortuous!

    We have built a solution that solves the problem of converting historical patient records from one system to another. In fact, we are in the middle of migrating 1.3 million patient charts from 5 legacy systems across 300 facilities in 5 states….all into one Epic platform! We can ensure that all patient records across the system are combined into one record in Epic, without duplicates, and we can stage and update them appropriately so that the records are 100% up to date on the day of go-live.

    Have I piqued your interest?

  • Lisa Pike,
    I do find that quite interesting. Will the data in the new system have the granular data elements still or will it just be the record in something like a PDF file?

    Since you brought it up, what’s the cost of doing something like you describe?

  • John,
    Yes, it will maintain the granular data elements. The granular data is dissected even further when extrapolation is done and posted in the same microgranular state. Additionally, each set of data is independently checked by a skilled technician to verify the integrity of the data.

    This process is a bigger effort than simply attaching scanned documents, but it allows the physician to more fully utilize the resultant chart. This produces significant benefits in both cost savings and physician satisfaction.

    The cost is a per-patient fee based on several factors, including volume, difficulty of extraction, etc. I could tell you what our current contract runs, but well….then I’d have to kill ya!

  • Lisa,
    I’ve heard someone call what you describe above as clinical data abstraction. I think it’s a great idea and the perfect term to describe what’s happening. I’ve been seeing more and more clinics interested in this type of service.

    Death isn’t necessarily a bad option. I’m not afraid of death;-) How about just a range of pricing then?

  • Yes, data abstraction is exactly what we’re doing, but in a unique and highly useful way to the healthcare entities. We’re very excited about what we’ve put together, but it is custom for each customer.

    Just so I won’t have to commit a felony, I’d be happy to discuss more details offline in a less public forum. If you woudl like to connect, my office number is 253.277.0505, or you have my email address.

    Cheers,
    ~Lisa

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