If you are a physician unhappy with your current EHR system (surveys suggest 2 out of 3 are), and you do have the ability to switch, this article is for you. Our COVID-19 pandemic may place you in a bad financial time for this, but it’s also placed you in an excellent time to plan for it. In 2010, with my then-current EHR software vendor declaring bankruptcy, my private practice, like many, then partnered with our local hospital to switch to one they would host and support. In our urgent need to switch, we entered a contract to use a system that was a daily hindrance. By 2017, most of us in my multispecialty practice had become frustrated enough to be willing to risk change, and I was appointed to the position of transition manager. By then, many newer and smaller companies had entered this competitive market with progressive software designed for the users. Companies were now beginning to involve their users in their designs. Though this rapidly changing market is still marked with closures and merger risks, many of the better companies are gaining ground through innovation. The result is we can now better predict a competitor’s health and longevity based on their client loss rates and advances seen or missing in their software updates. So, where do you begin in a transition? The most difficult task is recognizing the strengths and weaknesses of EHR products as it applies to your office and not trusting the internet for answers. Online ratings are often written by techs without clinical expertise or even by the companies themselves. Salespeople don’t understand the clinical process. Most of the highest-rated EHRs I found for practices like mine in 2017 were a terrible fit for us. Over two years, through my own research, I learned more than I can share here, but below is my outline for starting: Step 1: Define your problems Identify the biggest problems with your current system. It helped me to write out a list of the advantages and disadvantages of switching. I identified eight major unfixable problems associated with staying, and could only come up with two advantages (no extra first-year costs and no retraining). Do the unfixable problems cause you financial losses, psychological stresses — or both? Some losses are easy to quantify: dropped claims, costs of people you hire to correct problems specific to your EHR. You should also financially quantify how much the system slows you down. In my case, the switch removed 30-60 minutes of daily charting per provider, resulting in extra daily visits after we changed. Psychological stress is harder to pin down; the only quantifiable factors here are associated with complaints, burnout episodes, and lost provider counts. Is everyone unhappy? Providers, administrators, billing, other employees? Who will protest, and how will you convince them or compensate if they quit? Can we afford it? The transition will, at minimum, double your EHR overhead in the first year unless you’re going from a very expensive to a much cheaper system. Building a proforma to calculate this once you’ve looked at some specific systems helps. Who are your leaders? Depending on your size and complexity, you may need more than just a project manager. Step 2: You’ll find oil by knowing where to drill There are over 300 companies with products on the market. These questions will help you narrow the choices: Am I looking for a system for a hospital or a private practice? There is a spectrum of 2 types of systems: those primarily designed for hospitals (Epic and Cerner) with lots of administrative oversight and restrictions versus those designed specifically for private practices (Elation and DrChrono). Do I need a system designed for primaries, specialists, non-physician extenders, or all of them? While most companies today cater to both, there can be disadvantages trying to please too many types of physicians. How big am I? Consider both providers and employees. The bigger your practice, the more that can go wrong with scheduling, documentation, and claim processing; some systems have more oversight to prevent this. Do you handle your own scheduling and billing? Are you looking for a great chart or an all-in-one system? Do you have reasonable wi-fi internet access? Cloud hosting for lower maintenance or on-premise for data control? Step 3: Now refine your oil The devil is in the details: Do I want to get rid of faxing and scanning? Again, size matters. Digitizing faxes can save time, space, and paper, but at a price. Flexible chart design and note building? Building a chart or note your own way sounds great, but it takes time to build these individually, can cost extra, and may leave you with a headache trying to decipher other providers’ unusual note design. Writing that infernal SOAP note: template, type, dictate, copy and paste or click fields? Population health: What can be queried? Do you just need the whole group’s diabetics list or a more detailed query? Reminders: Are you tired of post-it notes or calendars to remind you of needed tests and follow-ups on specific dates? Will you survive the inevitable withdrawals? You can lose items that won’t map across some systems like family history, OTC meds listed without NDC numbers, or appointments pending after the go-live date. Welcome to manual repopulating. Is it Mac compatible? Some of us, like it or not, just hate Windows. My step 3 list is longer, but the list above contains the most universally important items. Building this helped me navigate the internet clutter and the circumnavigating of salespeople who only want to show you the best of their system. There is, of course, no perfect EHR — but there is a definable line somewhere between those that help you and those that obstruct. Through thoughtful planning and investigation, you can find one on the better end. Dave Gallatin is an internal medicine physician. Source
