We all know that maintaining an EHR can be a massive drain on your resources, eating up huge amounts of both money and staff time. In fact, over the long term, it’s a commitment on par with investing millions on the EHR system itself.
Unfortunately, the impact of maintenance requirements may be even greater than you think. A new study suggests that the costs of EHR maintenance could extend far beyond the demands placed on IT operations and development teams.
According to a paper appearing in the January 2019 issue of the American Journal of Managed Care, maintaining an EHR’s clinical functionality alone could pull resources from the entire healthcare organization.
To look at the extent and impact of clinical changes to health system EHRs, the research team studied changes to the Epic system at a 21-hospital health system (Kaiser Permanent Northern California) between 2010 and 2015. The changes came from diverse sources, including clinician requests and feedback from clinical technology, safety, risk, or reporting areas.
The research team grouped the changes within larger functional areas such as orders, alerts and customization, surgical and emergency department, data review reports and health information management.
Upon analyzing the data, the researchers found was that during the six-year period studied, the health system made 5,551 changes to its Epic platform or a median of 72 changes per month. By the way, the researchers note that this represents only the changes that were actually pursued, as not all requests were ultimately implemented.
The changes most frequently targeted orders, which appeared on the 44.7% of change documents, and order sets, which appeared on 29.9% of documents. Other common changes targeted surgical emergency department areas. Overall, these changes affected 135 EHR functions.
In addition, the changes had an impact on roles well outside the direct IT sphere, affecting 151 unique user roles, led by nurses (30.6%), physicians (26.6%) and other clinical staff (22.7%).
The net of all of this, the researchers said, was that the effect of maintaining an EHR’s clinical functions was “substantial and varied with pervasive impacts, requiring persistent attention, diverse expertise, and interdisciplinary collaboration.” Not only that, they suggest that given the study’s focus on clinical changes, their findings are likely to be a significant underestimate of the overall resource costs of maintaining the EHR.
There’s so much to unpack here that I hardly know where to begin. However, perhaps the strongest impression this research left with me was that health systems may need to do some significant research as to the indirect costs of maintaining their EHR platforms. If this study is reflective of other health systems, those costs may ripple out from the IT department to an extent that they hadn’t considered.