What if Your EHR Isn't Certified for Meaningful Use Stage 2?

Neil Chesanow


November 05, 2013

In This Article

Rip the Bandage Off?

Should you get a new EHR, even though you probably paid a fortune for your current EHR just recently?

"There's an economy lesson here on first movers' disadvantage," Peters offers by way of perspective. "The people who invested in EHRs early, all the way up to a Kaiser Permanente putting billions of dollars into a system, are seeing a bit of a challenge: 'Okay, I bought this Model T car and now everyone else is driving around in Honda Accords.'"

But it isn't just early adopters who are finding that their old EHRs are suddenly obsolete. A group of doctors in small practices is in the midst of suing the largest EHR vendor, Allscripts Healthcare Solutions, for failing to upgrade the EHR they were sold and then trying to force them to switch to a far more complex server-based system, with an entirely different architecture, that they were initially told by the firm was designed for large physician practices, not small ones.[6] Some practices purchased the now-defunct Allscripts EHR in 2012.

Server-based systems, at least for smaller practices, are on the way out, Peters is convinced. "It's a technology platform problem," she says. "Over the past year in the EHR sector, more and more vendors are moving to cloud- or Web-based rather than server-based EHRs, because you eliminate the upgrade problem."

With server-based systems, a consultant has to physically visit your office to do the upgrade. For a vendor with thousands of customers, that's a major production, with a price tag to match that gets passed on to those customers. With a cloud-based EHR, "you just roll out an update and all of your users are on it," Peters says. "It's a much easier technical solution."

"What the sector is doing with this meaningful use stage 2 culling activity is flushing out a lot of the server-based solutions and moving to the cloud," she says.

Sterling, the EHR consultant, has reached the same conclusion about the likely need for many practices to switch products: Many vendors will not have the ability to upgrade their systems on time -- or possibly ever -- leaving their customers little choice but to look for a new EHR.

But Sterling cautions that moving to a new system is not a quick fix. On the contrary, transferring patient data from one EHR to another can be daunting. It's labor-intensive, time-consuming, error-prone, and expensive for practices making a switch. However, as EHR vendors gobble each other up and the industry continues to consolidate, many doctors will face the same problem that the doctors who purchased the Allscripts product now face.

"A number of other products out there were acquired by someone else, and their doctors were told, 'We're going to move you to our latest and greatest, next-generation product," Sterling says. "And then you're stuck trying to compensate for the differences between those products" -- a trend expected to continue.

With the clock ticking, "I'm of the thought that you rip off the bandage," Peters says. "Stage 2 is coming fast, and Stage 3 is right behind it. An extension won't necessarily help. If I were a doctor in a small practice today, using an EHR that was looking a little unstable, I would say, 'OK, it's now Q4. Between now and December, I'm switching to a different system.'"

But how do you rationalize walking away from a $50,000, $100,000, or even larger investment and starting over from scratch? One way to view it is that you're probably looking at a significant expense whether or not you switch.

"Should you throw good money after bad? It's not just your initial massive investment that will continue to smart," says Peters. "In most situations, that vendor is coming back to you now and saying, 'Can I have another $10,000 to upgrade you? Can I have $1500 to connect you to each of your labs? Can I have another couple of thousand dollars to set you up with a patient portal?"

"It's a very difficult conversation that you have to have," she concedes. "'Do I want to spend another $30,000 on the system I already have, or do I want to look elsewhere and see what else I can do?'"


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