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Making the EHR Switch - Again

If your EHR system no longer works for your practice – or never did – a change might be worth the effort.

After reading this article you will know how to:

  • Describe critical factors for patient data transfer
  • Develop reasonable expectations for implementing a replacement
  • Identify a plan for winding down current systems
  • Verify service agreements

View related pearls

If it's true, then just admit it: You bought the wrong electronic health record (EHR). In the race to automate your practice, you may have opted for an EHR system that no longer works for your practice or, perhaps, never did. Maybe the problems lie in the workflow it generates or in the system itself. Maybe it is slowing cash flow or hurting customer service, or both. Regardless, at a certain point — certainly when cash flow and patient services begin suffering — it's time to stop struggling, take a deep breath and admit that it is time to switch.

Transferring to another EHR system isn't easy. It's actually now a routine occurrence among medical practices.  According to experts, it will remain so in the coming years. How commonplace is it? A survey in 2014 by KLAS, a healthcare information technology research firm, found that more than one in four medical practices using EHRs wanted a different system. Practices affiliated with health systems may have their hands tied when it comes to EHR decisions, but questions of performance, ease of use, integration and compliance with the government's EHR Incentive Program are causing more providers to consider switching their current EHRs.

Obviously, sun-setting a system means choosing another one — there's no going back to paper. Your first step is to assess what went wrong: was it the vendor, the system, or you? Chances are each factor played a role. As you start your search for a replacement, be realistic about the time commitment; EHR selection isn't likely to go much faster the second time around. Although newer systems may be more adept, there will still be sticker-shock. It's easy get discouraged when you've already sunk tens of thousands of dollars into your current system, but don't let a poor choice drag your practice into the ground.

Here are some of the issues to keep in mind when preparing to replace an EHR:

Scrutinize agreements. You may have purchased the EHR thinking it would last several years and signed onto a long-term service plan. Dig through the paperwork related to your current system to look for any contracts, leases, or service plans that may carry penalties for cancellation.

Remember the data. Data is the key issue in a system switch that includes all data: financial, clinical, demographic, insurance — everything. Migrating seamlessly from your current system to a new one will likely involve extracting your data and converting it to the new system's parameters. Talk to your new vendor about how to transfer data and map it accurately. For example, make sure that the old system's patient vitals data flows into the new system's area for vitals, not into fields for orders or allergies. Once you've ironed out the details related to the new system, inform your current vendor of your decision and work with their team to convert the data. You may have to compromise on data that is non discrete, such documentation that was scanned into a file. Although Adobe® and other companies offer routes to digitize scanned PDFs, the process isn't perfect so it requires careful checking. The key is to understand what data you're getting and in what form so there are no unpleasant surprises when you're in the exam room treating your first patient and using the new EHR. 

Don't tip your hand too soon. After picking a new system and determining how the data transfer will work, start the ball rolling on the purchase before informing your current (soon-to-be-former) vendor. A vendor that knows its days with you are numbered might not be as quick to return phone calls or deal with problems. You don't want to run any risk that a disgruntled vendor will ignore your support needs, worse, or hold your data hostage.

Get all of the data. You and other members of the medical team may be focused on the clinical elements of the EHR system, but many system transfers also involve the practice management component. From that perspective, a problematic system switch can significantly harm cash flow. For the sake of your accounts receivables, consider hanging on to the old system for three to 12 months after the switch so as to spin down open accounts. This is especially important if the new system will only accept account balances, but no other details. Transfer patient demographic and insurance information along with medical records to the new system whenever possible.

Don't forget the pre-nups. Getting that new system means it's a new day but recognize that this marriage may not last forever either. Products and needs change. EHR vendors may merge, switch direction or just go out of business. Take steps to avoid pain in the next system switch. Above all, nail down your ownership of your data, and your ability to seamlessly access and transfer your data as part of your legacy system exit strategy.

Switching to a new EHR opens new possibilities – but the process may also come with the proverbial can of worms. Keep your eye on the target – a new system that improves your ability to deliver quality care. Knowing that the pot of gold is coming soon will help get you through the challenges of the next few months.

Pearl: Game Plan?

Create a data extraction and conversion team composed of staff from multiple work areas, including clinical, administrative and billing. Their technical knowhow, subject matter expertise and cooperation are vital to success migration of patient data to a new EHR.

Pearl: Triple-D – Document, Document, Document

Compile detailed documentation of all EHR formats involved in both sides of a transfer to a new system. Create workflows and checklists of data transfer activities so that timelines are realistic, with padding unexpected issues.

Pearl: Whose Is It?

Before you opt in to a new EHR, make sure you know exactly what you are buying. Most importantly, nail down who 'owns the data' (be sure to define 'data' and 'own' in writing). Recognize the potential costs and other considerations that would arise in the future if you want to transfer your data to another system.

Pearl: Don't Trash the Old – Yet

Consider hanging on to your old EHR and practice management systems for several months after the switch.  This will allow you to wind down open accounts, track down transfer errors and other anomalies. This is especially important if the new system will only accept account balances, but no other details.

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