In 2008, after spending months evaluating EHRs, six-physician, Elkhart, IN-based ophthalmology practice Boling Vision Center invested about $500,000 in an EHR that would allow the practice to meet CMS' "meaningful use" requirements and offer customizable modules. But while being able to create modules tailored to meet the needs of her practice was a fantastic perk, what CEO Hayley Boling didn't anticipate was the dozens of hours she and her administrative staff would have to spend re-doing modules every time the system updated.
"It was like the movie Groundhog Day," recalls Boling. "We continually had to rebuild templates for our practice every time there was an upgrade."
Quitting the new system and essentially throwing a six-figure investment down the drain would be a tough sell to the practice's medical team. But after conducting a cost-benefit analysis, everyone agreed that swapping the five-year-old EHR for a new one would be better in the long run. So in 2013, they switched to Nextech's specialty-specific EHR, opting for an on-premise, server-based system with mobile functionality that allowed physicians to access the EHR via their iPads.
"We do a lot of imaging in ophthalmology, so our goal was not only to find a system our doctors liked, but had a lot of capabilities," says Boling. "We were looking for a more functional, more usable, more portable solution. We wanted it to be built by ophthalmologists for ophthalmologists."
Sunk costs v. getting the most out of your investment
Like Boling Vision, many physician practices and larger healthcare organizations are finding that the EHR they fell for isn't as dreamy as they'd hoped. Or they find that their needs have changed. For example, they are seeing more direct-pay patients or want everyone to be able to use tablets. In some cases, practices decide that they can't manage clunky on-premises equipment, and would rather access a cloud-based system.
"Many physicians have switched or plan to switch EHRs or upgrade their entire practice management/revenue cycle management/EHR platform," said Tom Giannulli, chief medical information officer of health IT technology firm Kareo, in an e-mail message. "Studies have shown the top reasons [for switching] are lost productivity, regulatory compliance, improving quality of care, and qualifying for incentives/avoiding penalties."
A recent report in JAMA Internal Medicine found that family practice doctors reported losing 48 minutes of free time a day due to the use of electronic medical records. The study was based on a 2012 American College of Physicians survey of 411 physicians, using 61 different EHR systems. A 2012 report on Ambulatory EHR Buyer Satisfaction by EDC Health Insights found that more than half of ambulatory care providers responding to the survey were either unhappy or neutral about their experience with EHRs. The top two reasons for their dislike was increased time spent on documentation (85%) and not seeing as many patients (66%).
But deciding that an EHR sucks, at least for your organization, can be the beginning of an expensive and possibly daunting undertaking. And it's not a decision that should be made lightly: A new report published in the American Academy of Family Physicians' (AAFP) Family Practice Management Journal reveals that some doctors are forced to switch EHRs and when they do, widespread dissatisfaction results. According to the survey, just 39% of physicians are happy with their new systems.
How to know it's time to switch
With that in mind, Giannulli advises medical groups to look out for the following "signs" that your EHR isn't working out it (and that it may be time to switch):
1. You are doing double entry of scheduling and billing data from EHR to PM/RCM system.
2. You can't exchange data with other systems (e-prescribing, e-referrals, etc.).
3. Your vendor is not MU 2014 certified.
4. You don't have flexible anywhere-anytime access and ability to use the device of your choice.
5. You can't connect with patients via a web-based patient portal.
6. Your vendor stops responding to support requests in a timely manner.
7. Your EHR requires an outdated version of an operating system (DOS, Windows NT, etc).
In the case of Boling Vision, life is good after nearly 11 months since making the switch.
"Today, because everyone uses an iPad to access the EHR, the staff are able to walk out to the waiting room, and introduce themselves," says Boling. "It's a much more personal experience for patients as well. The iPad also looks and feels a lot like a paper chart, so physicians are not sitting with their noses stuck in a computer rather than interacting with their patients."
Still, Boling stops short of saying she would do anything differently when picking an EHR than she did in 2008.
"Sometimes you just have to say, 'You know what? The decision we made then is no longer the best for our practice,'" she says. "It wasn't necessarily the wrong decision, because we chose that system with the best information that we had at the time."