EHR Swapping: A New Approach for Effective EHR Transitions – Breakaway Thinking

The following is a guest blog post by Todd Stansfield, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
The trend to swap electronic health records has been gaining momentum in recent years. A 2014 KLAS report surveyed 277 large US hospitals, half of which indicated plans to replace their current EHR system by 2016. That number marks a significant wide-scale investment, since the cost of an EHR implementation may range from millions of dollars for a standalone hospital to hundreds of millions for a regional health system, according to a Becker’s Healthcare article. Organizations are increasingly swapping systems to gain needed functionality, achieve interoperability, leverage analytics and more. As the EHR market continues to consolidate, this development begs the question: are organizations ever fully adopting their EHR systems and overcoming problems uncovered during the initial go-live?

A new survey may provide insights. The American Academy of Family Physicians (AAFP) surveyed 305 physicians to uncover the challenges and outcomes associated with EHR-to-EHR transitions. While 59 percent agreed their new EHR provided useful functionality, only 39 percent reported being satisfied after transitioning. In fact, 49 percent disagreed that their new system improved productivity, and 41 percent considered their new EHR overly complex to use. These numbers suggest that changing applications does not always improve outcomes related to the EHR, especially since a majority of respondents had been using the application for a year or more.

The challenges being reported around EHR transitions are similar to those we have observed for years when the EHR isn’t fully adopted. Research published in Beyond Implementation: A Prescription for Lasting EMR Adoption identified how often organizations overestimate their adoption of an EHR system, a factor that can have significant consequences as organizations transition between applications. These organizations are likely to overlook problems impeding adoption and underestimate the resources and focus needed for the new system. Disengaged leaders, poor education, inadequate end-user support—all are inevitable if unresolved in the original system. The result is a continuation of an organization’s current headaches—from poor usability, to decreased productivity, to end-user dissatisfaction.

There are other potential pitfalls in transitioning EHR systems. For instance, leaders tend to underestimate the need for strong communication, physician alignment, and governance for upcoming changes. While they may have focused on these areas during their initial implementation, they may perceive them as unnecessary for the new system, a decision that puts adoption at risk over the long-term. Organizations should expect the EHR-to-EHR transition to bring the same, if not more significant, challenges as their original implementation.

Organizations may also struggle to anticipate end-user resistance to the new system, which is greater than the switch from paper. While end users may be dissatisfied with the current system, they are often not willing to face the challenge of learning a new system, requiring them to relearn the workflows and keyboard shortcuts they worked so hard to learn. Additionally, end users might question the value of an electronic-to-electronic switch. This is especially true when the transition is due to a merger or acquisition, as shown by the AAFP survey.

Organizations must rely on the tried-and-true methods to achieve EHR adoption, whether moving off paper or an existing electronic system. Beginning with leadership engagement, organizations must communicate, ensure physician alignment, and create governance to ensure accountability and ownership of the new system. End users should receive consistent and effective education. Education is most effective when it is scenario-based, repeatable, readily-accessible, and provides hands-on experience completing workflows in the EHR system. To understand the education and support needs of end users, organizations must track and measure performance. And lastly, they must sustain adoption efforts over time to ensure they remain relevant despite application upgrades and workflow improvements.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.