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Fifty Shades of EHR

June 11, 2013
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The ONC recently announced two systems from EHRMagic decertified for Meaningful Use. These systems were not capable of performing certain functions deemed necessary for Meaningful Use. This not only impacts the physicians on this system, but is a shot across the bow for all systems that said they could capture and report Meaningful Use data, but really used smoke and mirrors.

The ONC has not announced plans for withholding payments to physicians using this system; however you can bet that they will be conducting audits to determine how they attested without the capability to properly capture the data. Which begs the question: When does a deal sound too good to be true? 

-No up-front costs!

-Minimal Training expense!

-We will host all your data at no cost!

-Free iPad!

What is the highest organizational cost of implementing an EHR? Is it software, hardware, or training? I don’t think it’s any of the above. It is the productivity loss and physician distraction during implementation. What I mean by distraction is the time the physician has to spend learning a computer system during a limited encounter time with their patient. They are often shifting focus from clinical troubleshooting to computer troubleshooting. This directly impacts patient satisfaction, quality of care and revenue targets. As a patient I can honestly care less about revenue targets, I want my provider engaged and focused on my issues, not spanking the side of a laptop because it will not do what they want.

This does not stop EHR selection committees from treating the EHR purchase like a used car. We want a decent product, with as many features as we can get for a low cost. Even if the selection committee makes the physician friendly EHR choice, how many times have you seen the CIO use their trump card to get the EHR from their personally preferred vendor?

So what happens when you purchase a lemon or you’re forced into a system you really didn’t want? In the case of a decertified EHR, you really don’t have a choice if you are submitting to government payers. The cost/benefit of maintaining the system is not there. For all other scenarios, you need to consider your Meaningful Use Scorecard as your “user adoption report card.”

 High Meaningful Use scores means that the physician is not only using the system effectively, but that they are capturing the data necessary to provide a high standard of care. Why mess with that? If it’s for system standardization you have interfaces for that. If it’s for additional functionality, it will come at triple the cost when you take your productivity hit and try to migrate the data to the new system.

An EHR purchase should never be a short term solution. You can’t purchase a physician friendly EHR if you know that 3-4 years later you will migrate to a standardized system with the same product name.

Here are four easy steps to make the right choice:

  1. Start with a comprehensive RFP from a list generated by physicians and screened for all the technical requirements, system integration, and CCHIT certification.

  2. Once the proposals comes back, and then a Provider Only panel selects the top three based on a scorecard.

  3. The top three selected systems provide an onsite demo and site reference visits are conducted.

  4. Finally, the scorecard from the demos and site visits are tabulated and the system is selected.

If this process seems alien to you, consider this: The EHR is a Provider Tool to be used during clinical encounters. You don’t tell them what stethoscope to use, don’t tell them what EHR they must have. It will directly affect EHR adoption and will reduce the time they spend smacking the side of computers.