Thinking of Switching EHRs? Read This First

Ronald B. Sterling, MBA, CPA

Disclosures

December 11, 2018

In This Article

Don't Change EHRs Without a Plan of Action

Practices change their electronic health record (EHR) system for many reasons. A practice may have outgrown the capabilities of their current EHR, or the vendor may have failed to update their product or discontinued a particular EHR. Or a physician's practice may merge with a healthcare organization that requires a switch to a different EHR.

Regardless of the reason, these changes may be even more serious and challenging than the original move from paper. For example, the new EHR may have different checklists based on a different findings list from that in your current EHR. Or the clinical order feature in the new EHR may have different status tracking options from those in the current EHR. And there are many other possibilities.

When transitioning to a new EHR, it's the practice's or organization's responsibility to maintain the integrity, confidentiality, and accessibility of the patient medical record, under the Health Insurance Portability and Accessibility Act (HIPAA) security requirements and other medical record laws.

This responsibility is a major consideration for you, yet it may conflict with the goals of your EHR vendors. For example, some EHR vendors suggest replacing important and discrete care information from the legacy EHR with a PDF image in the new EHR. But that is typically not optimal. Establishing a functional patient record in the new EHR may require diligent planning and execution of a medical record conversion process as well as a process to deal with any requirements needed to set up the patient in the new EHR.

Strategic Considerations

The decision to change EHRs should be driven by long-term needs and goals. In some situations, practices change EHRs as part of an interim strategy, knowing that they'll have to make another change in a year or two. This is usually not advisable. Such changes are disruptive and create the risk for operational and patient service problems. For example, practices may have to record key information in the new EHR the first time a patient is seen.

Indeed, adjusting to a new EHR can take months, and learning to use important patient service features may take a year or more. For example, patient care alerts may not operate effectively until basic patient information, such as immunizations and procedure history, have been properly recorded and documented in the new EHR.

Many practices switch to a new EHR, only to be disappointed when they find that the new EHR isn't significantly better than the old one. A surprising number of practices change EHRs even though the practice or organization is not using even the basic capabilities of the existing system.

For example, practices have continued to route paper diagnostic reports, review printed lab results, send paper messages, track procedure scheduling with a paper form, and even maintain a shadow paper chart for each patient in addition to using the EHR. In most cases, the practice has not expanded the use of their current EHR to address the issues that are considered "EHR problems."

If a physician or practice is not using the features of the existing EHR, why should they invest the time and expense to move to a new EHR?

Before doing so, physicians and practices should ask the following questions:

  • What features of the current EHR are not being used, and why?

  • What paper documents are being used to manage patient care that are not in the current EHR?

  • Does the current EHR have features that could make it unnecessary to the move to a new EHR?

  • Why isn't the practice using the existing features of the current EHR, and how will a new EHR change that situation?

  • What are the key features and capabilities needed in the new EHR?

  • What changes will the practice or organization make to take advantage of the features in the new EHR?

  • Is the move to a new EHR justified by the additional capabilities that are in the new EHR but not available in the existing system?

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