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Why healthcare providers aren't happy with EHR systems

Brian Eastwood | July 2, 2013
The U.S. government is giving the healthcare industry billions of dollars in incentives to use electronic health records. Most organizations have EHR software in place, but as many as 35 percent wish they could switch systems. Are EHR vendors to blame, or are deeper forces at work?

EHR Implementation Is Too Difficult
Simply put, EHR adoption is hard. A recent study summarized by Becker's Hospital Review listed 10 common mistakes. These include undertraining staff, using shortcuts or other workarounds, entering too much data into the electronic record and failing to analyze clinical workflows before EHR system implementation.

Assessing workflow is critical, Safavi says. Again, this is less of an issue for large integrated delivery networks, which have been doing large-scale IT implementations for decades, and more of a problem for smaller physician offices. Not only must these practices deal with the conflict between the way information flows through an electronic system as compared to the familiar paper-based workflow, there are also challenges as granular as who answers the phone if everyone is now entering data into an EHR system, he says.

Providers also ignore the financial implications of EHR implementation at their own peril. In May, the Maine Medical Center revealed a $13.4 million operating loss for the first half of its fiscal year, a loss attributed in part to the "unintended financial consequences" of its $160 million Epic Systems EHR implementation. ( High price tags for Epic EHRs, it should be pointed out, are nothing new.) These consequences include reduced productivity as users learn the new system, unforeseen investments in training, software add-ons and billing delays as EHR and financial systems learn to play nice.

Amid the furor, physicians may be tempted to pick up the clipboard. Unfortunately, going back to paper isn't the answer; reports suggest that Hybrid EHR-paper workflows contribute to medical errors, especially medication errors, largely due to miscommunication and poor documentation.

Lessons From an EHR Vendor That Users Actually Like
Not all hope is lost. There are, in fact, EHR systems that physicians do like-they just tend to come from EHR vendors with fewer customers (based on how many have successfully completed meaningful use attestation) and therefore a reputation for better customer support.

One such vendor is Watertown, Mass.-based athenahealth, which recently topped the usability rankings for ambulatory EHR systems in a KLAS Research survey. The firm touts itself as a service company, not a software company, CTO Jeremy Delinsky says, and in that spirit emphasizes a culture that aims to help physicians file claims faster.

To avoid customer churn, athenahealth sends out post-implementation monitoring teams who "proactively intervene" when things don't go well, Delinsky says. Call center staff are also specifically trained to handle inquiries from physicians, who often need assistance outside normal business hours and can be a bit embarrassed to admit that they need help.

In addition, all users run the same instance of the cloud-based athena Clinicals and receive software updates monthly. This makes it easier to address customers' needs, Delinsky says. It also helps athenahealth avoid the common EHR usability pitfall of adding functionality that users expect but don't actually need. Some of this stems from the company's measurement of how much time users spend in the system, which showed that physicians were spending far too much time documenting patient encounters.


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