Five Reasons to Ditch Your EHR

When Joseph Robison's practice purchased its second EHR several years ago, the orthopedic hand surgeon and his colleagues at Celebration Orthopaedic & Sports Medicine Institute looked forward to a long and prosperous relationship.

And when CMS released meaningful use standards in 2011, the Celebration, Fla.-area practice hoped that its new companion would not only help the practice attest for monetary incentives, but help physicians improve efficiency.

But instead, signs of trouble started to emerge.

It was difficult to customize the templates for the provider notes, and "very" difficult to customize how the system worked, Robison recalls. "We realized that in a 10-provider practice, we only had two doctors who could stomach the EHR, and we had two doctors who went back to our [original] legacy system," says Robison. "After two and a half years of paying significant cash outlays, we began to get to the point that we had charts literally lining the halls of our office. We had three different systems all functioning and it was creating more work for our practice."

The practice finally reached the breaking point in early 2013 and made the decision to switch to SimplifyMD after looking at a few EHRs that offered two key things the old EHRs didn't: Microsoft Word templates that were easy to customize, and all-around ease of use.

Although the practice has only been using its new EHR for a few months, Robison says doctors are much happier.

"Every specialty, whether it's surgical or internal medicine, we all have a way we like to do our notes," says Robison. "The SimplifyMD product is very flexible and very customizable, and it was easy to adapt the system to the work flow of each physician."

Perhaps, like Robison was, you're having trouble making things work with your EHR or you've just lost your love for the technology, but you're not sure you should give up on it. Here are five good reasons for kicking it to the curb.

Reason #1: It's too hard to use

As Robison's practice knows, an EHR is only as good as it is able to make physicians more productive and better equipped to manage patients and coordinate care.

That's why internal medicine physician Amy Patel opted for a more streamlined, Web-based (also referred to as "cloud-based") EHR when she opened her solo practice, Jersey City Medical Care in Jersey City, N.J., in May, in lieu of the EHR she had worked with for several years in her previous practice.

"The old one requires the physician to make a lot of different templates for one note," says Patel, who now uses a CareCloud EHR. "With the CareCloud system, everything's right there. You can just input it and save one main template, and when your patient comes in, all your meaningful use data is there for the visit."

Family physician Jason Mitchell, director of the American Academy of Family Physicians' Center for Health IT, says work flow compatibility problems are among the main gripes he hears from members regarding EHRs.

"Some change is inevitable, but when you just can't get done what you need to [so you can] take care of patients, that's just a bad deal," says Mitchell. "And there are a number of systems where that's a problem."

Reason #2: It's too high maintenance

Software upgrades are inevitable for all EHRs, but if upgrading technology costs too much money, or takes too long, your system can become more of a nuisance than an asset.

"As you know EHR systems often have support costs, and sometimes those support costs become unsustainable," says medical practice technology consultant Bruce Kleaveland.

An EHR can also feel too high-maintenance if your practice is getting headaches just trying to get it to integrate with other technology, such as a practice management system.

"In many practices they may have bought a standalone EHR that is not connected to their practice management system," says Kleaveland. "You really get efficiencies having a fully integrated system, having an EHR and practice management system on one platform."

For practices currently EHR shopping that want something low maintenance, Mitchell cautions against picking something that is too customizable.

"Systems sell themselves as customizable, but unfortunately, that means a lot of the times it comes out of the box with nothing built, and you have to start from scratch," he says. "You want to have a system that is basically built out, or built out in a model way, that you can make adjustments to, rather than starting from scratch."

Reason #3: Your vendor is unsupportive

When you have a question, how long does it take your vendor to get back to you? If it's more than an hour, consider moving on.

"A reasonable standard of support is when you call in with an issue using the tool ... the issue gets resolved," says Kleaveland. "Sometimes vendors become unresponsive because, for whatever reason, their operations are compromised, they don't have enough people, [or] they have too many issues to deal with all at once, therefore you end up at the bottom of the pile."

Even if physicians are used to waiting several hours to get IT issues resolved, they should expect more from their EHR vendor, says Mitchell.

"[Waiting] should be minutes to an hour," he says. "You can't wait around; 24 hours is not a reasonable turnaround time to get support."

Reason #4: Your needs change

You're moving to a smaller practice. Or, perhaps, you want an EHR you can access easily on your iPad. Or one that works well with your new patient portal. The bottom line: If your needs change, so might the kind of EHR you need.

When Patel opened her solo practice, in addition to an easier-to-use EHR, she needed an EHR she could access at all hours of the night.

"I can jot down some notes and run with it, and later on when my children go to sleep, I can log on and finish my work," says Patel. "The reason I chose not to go with [my old system] is it's catered for a larger practice. It was only accessible when I was there at work at the practice. And that was a big problem. A lot of times physicians are so overwhelmed that we don't always finish all of our documentation in one day. I would have to physically be there in the office [and] stay later."

Reason #5: Your EHR vendor is acquired (and this makes you unhappy)

Big EHR vendors acquiring smaller vendors is an industry trend, but it can be a pain if the acquiring vendor's system is significantly different, or worse, doesn't make sense for your organization (for example, if a specialty practice's vendor is acquired by a vendor that typically provides services to primary-care practices).

If your practice does decide to move on, fortunately, say experts, implementing an EHR is usually a lot easier the second time around. (For more on picking a new model, see http://www.bit.ly/EHR_shop_tips).

"I think it's an opportunity to look and be sure it's the best option out there," says Mitchell. "It's time to look at whether switching to a new system is the right thing to do."

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the January 2014 issue of Physicians Practice.