How Practices Can Recover From a Bad EHR Implementation

You and your management team have practiced due diligence throughout the selection and implementation of your new EHR. You've done everything by the book. So what's wrong?

Melding technology and people is a complex process, involving many moving parts.

Is your clinical team talking to your IT support team? Is it responding in an appropriate way? Do you have a strong project leader?

Carolyn Hartley is president and CEO of Physicians EHR, Inc., a Cary, N.C.-based consultancy that assists practices in EHR selection through
detailed implementation and preparedness for quality incentives.  Hartley also serves as consultant to the 62 Regional Extension Centers operated under HHS.

Physicians Practice recently spoke with Hartley about her Medical Group Management Association Annual Conference presentation, "Seven Symptoms
of a Troubled EHR Implementation and What to Do About It." Her session is scheduled for Monday, Oct. 7.

Q:Why is it that so many practices have troubles with EHR implementation?

A: We don't get calls from practices that say, "Boy, I love my EHR." We get calls from people who are so angry, that their practice is just about ready to implode. One of [our] physicians said, "Purchasing a system is like having a car delivered to you in a box. There's a car in there if you can figure out how to put together the pieces, but we forgot to include the manual."

Q: There's a lot written about interoperability as many systems don't work together. For example, hospitals are using one system and practices are using another. Do you feel that this is part of the problem?

A: You know, the message from the vendors changes almost every year, on why [practices] should purchase systems. Two years ago, the message was, "You have to buy our system if you want to be interoperable with all the other people in your community." Now the message is "Guess what? We are willing to work with anybody." The problem is you have to have a middle-ware. And by that I mean an algorithm or list of components - first name, last name - [that] when combined creates the patient's identity. We don't have a standard for that yet.

Q:So, practices have bought a system and they are not particularly happy with it - what are the signs of a bad implementation?

A: No.1 in our book is finger pointing. [We hear] "The vendor didn't tell us that," or, "We have one EHR system and one [practice management] system from the same company, and I'm telling you, there are things that are dropping, and we don't know where to go for help."

Another is finger pointing from within, and that is the most dangerous one. We try to get into these as quickly as possible, when the physicians are just mad at each other. If they are mad at each other, then the practice is ripe for getting sold. It's ripe for having key people leave the practice.

Q:What are some things that people can do to recover from this?

A: Well, the good news is that an EHR can be stabilized. There are best practices and they provide a pathway for stability and profitability. We're kind of the bee that's pollinating the forest. We're saying, "Guess what? This worked with these guys in nephrology with this particular system." But we need to take a look at what's best in that practice. Because one of those physicians has figured it out.

Q:Can you talk to me about stabilizing the practice/vendor relationship?

A: Vendors generally know how the system works. …There's a huge rush to get so much market share during meaningful use incentives. So we have this massive market acquisition to say, "Get my system in place." But there wasn't enough backup to support those installs. The vendors know, going forward, they've got to stabilize their clients. Because they are facing anywhere from 35 percent to 75 percent of users at risk of going to a different system.

I coach the regional extension centers [RECs]. They've tried to be consistent in selecting the [EHR] systems. They tried to vet the systems for their primary-care providers. They also responded to the vendors saying, "We're good for primary care." But those vendors are also kind of costly. So, if those primary-care physicians had to go outside of the REC recommendation, and many of them did [because of cost constraints], they go outside and purchase something that is more affordable for them. Now, as we are going into Stage 2 [requirements] of meaningful use and [some] certified vendors cannot meet [requirements for Stage 2] … You have to be a pretty ambitious vendor in order to meet those requirements. So, some of them have huge user databases, [and] they are going to continue. But those that don't have a huge database have to figure out, "What am I going to do in 2014?"