Switching EHRs is a Headache for this Practice

In four short months, we will be switching from the EHR system we've enjoyed since 2006 to a new system now required by our independent physicians' association (IPA). We have mixed feelings about the change. If it was entirely left to us, we wouldn't switch. That said, there are certain potential functions we are looking forward to using. The key here is the word potential. Perhaps it's the cynical times we're living in, but throughout the long process of selecting, preparing and training for the new epic ("epic" the adjective, not the noun, due to liability) system, it has felt like we're being pitched by a stereotypical luxury car dealer from both the technology vendor and our IPA.

To be clear. we are not luddites. When we opened our micro-practice in 2006, it was opened as, and remains to this day, a paperless primary-care office. It's not easy being a paperless office in an industry still in love with paper and with faxing, and refaxing, the same labs or progress notes repeatedly. Over the years we've devised a system where we translate data on paper into structured bits and bytes which our EHR organizes and analyzes. 

Our current system is very functional and reliable. In 2012, we added integrated online bill paying and a secure patient portal. The technology works for us. Most importantly, it's affordable having been designed for primary-care pediatricians (pediatricians always rank last on any published national average doctor salary list). The new system, on the other hand, costs three times as much as our current system monthly. THREE TIMES AS MUCH! To give you an idea as to how we feel about this, let us tell you that we both drive old cars with well over 100,000 miles on them and have no plans to upgrade them anytime soon. In other words, we have no business shopping for technology with new Mercedes-level luxuries. We're used Toyota people.

So, what could the new system possible have that justifies the price tag? In a word: interoperability. Today, we must manually pull and send data to our IPA; data that is necessary to determine if we're coding correctly per IPA rules, getting paid properly by IPA payer contracts, and prove that we are doing everything we're supposed to in order to meet quality measures required by the contracts. Add to this the foolishness that is the Accountable Care Organization (ACO) movement (we believe ACOs are bad economics and have high public-health consequences, but that's another blog for another day), the IPA voted to require all participating physicians to be on one system.

As we are going through this transition, the words of AMA CEO Dr. James Madera keep running through our heads. Last summer Dr. Madera made a bold statement that digital health products are modern-day snake oil. EHR interoperability sounds good in theory, and we want to believe coordinated care will magically lower the cost of healthcare, but the empirical evidence just isn't there. It doesn't really matter how well coordinated our care is, it does nothing to lower the cost of EpiPens. More importantly, we don't believe it does anything to impact our most vulnerable patients who are disadvantaged by their socioeconomic status, as demonstrated in The Atlantic's ground-breaking article on infant mortality.

We did consider leaving the IPA, but we know of no better option to both stay in our home-state of Massachusetts and remain somewhat, sort of independent. And so, we're switching EHR systems from the known and affordable to the unknown and salary-reducing expensive. You better believe we'll keep you all posted on how it goes!