The Successful EHR: Provider Input is an Integral Part of Development, Selection, and Implementation

By Ravi Raheja

A recent nationwide survey of physicians revealed that many believe the benefits of electronic health records (EHRs) and electronic medical records (EMR) do not overcome the high investment of finances, time, and frustration. The survey, conducted by athenahealth, found that while 68% of physicians believe that EHRs improve patient care quality, only 49% believe that the financial benefits of implementing EHRs outweigh the costs.

The federal government has spent more than $15.5 billion in EHR incentive program payments to adopt EHR technologies, and money continues to drive EHR initiatives. However, there are three main areas that keep them from being fully adopted and accepted by healthcare providers:

  • Lack of provider centric design
  • IT complexity
  • High initial investment

Provider Needs: Scientific and informal surveys of physicians using EHRs indicate common complaints regarding the usability of EHR programs. This is because many systems were initially developed as billing or practice management systems instead of full EHRs. Every office has a unique workflow and specific needs. Most companies do not have the flexibility, or the expertise, to understand the practice workflow and configure the system to meet their needs. As a result, the practice is forced to adapt to the infrastructure of the EHR, which leads to frustration and inefficiency.

One of the key benefits EHRs are supposed to bring to healthcare is the efficiency of having patient health information readily available to all appropriate healthcare practitioners. Unfortunately, due to the incompatibility of various systems and the lack of standardized integration capabilities, we are a long way from reaching this goal. Many EHRs were developed based on billing needs and, therefore, do not take into account the workflow of the physicians and providers using them.

In addition to the lack of interoperability, HIPAA is a big responsibility for any practice that has electronic information. Ensuring that the company providing a hosted solution or maintaining their own in-house servers requires a lot of time and expertise. This adds another expense to practices that are already allocating resources to billing, referrals, and patient management.

Business Needs: EHRs do not come cheap. Hospitals can expect to pay millions. Large systems, such as Duke University Health System, are shelling out up to $700 million for their EHR programs. Consequently, during the initial implementation of a new EHR system, which can last more than a year, most providers need to reduce their patient appointments and either increase staff time or bring on additional staff. From a business perspective, EHR integration is not something to take lightly.

Unfortunately, even the most prudent planning cannot take into account all potential obstacles. Some providers have found themselves stuck with EHRs that have lost their credentials, leaving the hospital with a system that is no longer qualified to receive government incentives. Other providers are stuck with EHRs from companies that have gone out of business. The only solution available is to invest in another EHR.

Starting Right: The road to a perfect EHR is a long one, but it is not an impossible goal to achieve. The natural development of technology will take care of some of the current issues. However, there is also much that can be done to increase the friendliness of EHRs by both the manufacturers and the implementing providers.

Engineers and End-Users: Great software and technology companies understand the importance of designing with the end-user in mind. Doing that correctly involves bringing together the software engineers and the people they are developing for, the end-users. EHRs created with input from physicians and other program users could minimize, if not eliminate, the common usability issues that have many providers complaining.

Input Teams: EHRs require adjustments in multiple areas of a practice. As such, creating a multi-discipline team with clinical and non-clinical representatives can help select, review, and implement a system that will be more likely to address the needs of all involved. In addition, the added input helps create support for the changes in procedures and can help reduce employee aversions.

Champion Providers: With initial implementation of EHRs lasting up to one year, it is helpful to have some providers from the selection team who serve as champions of the project. Their position is to help roll out the new program, introducing it to other team members and serving as a liaison between staff and administrators, as well as between administrators and the EHR company. Selecting a team of project champions who can rally the rest of the troops through the trials and tribulations of learning and using a new EHR system is an integral part of EHR acceptance and success.

Conclusion: All frustrations, finances, and growing pains aside, EHRs have the potential to revolutionize healthcare on numerous levels. While there are many obstacles to overcome, focusing on the benefits of the completed project and creating working partnerships to productively address issues, we can continue to move EHRs in the right direction.

Ravi Raheja, MD, is the director of sales and technology at The TriageLogic Group. He can be contacted at 855- 887-4243.

[From the October/November 2013 issue of AnswerStat magazine]