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Survey: EHR Switches Resulted in Higher Than Expected Costs, Layoffs

April 29, 2016
by Heather Landi
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Four years after what market research firm Black Book calls the inpatient electronic health record (EHR) “replacement frenzy,” surveyed clinicians expressed many doubts about the benefits of switching systems.

Black Book crowd-surveyed 1,204 hospital executives and 2,133 user-level IT staff that had experienced at least one broad inpatient EHR system switch and found that “present satisfaction outcomes reflect on mild successes balanced with higher than expected costs, layoffs, declining patient revenues, disenfranchised clinicians and doubts about the benefits of switching.”

The survey results found that while the high total cost of ownership of EHR replacements was not a barrier for some struggling hospitals to buying a new system, 87 percent of those financially threatened hospitals now regret changing systems.

And, 14 percent of all hospitals that replaced their original EHR since 2011 were losing inpatient revenues at a pace that wouldn’t support the total cost of their replacement EHR.

“It was a risky decision as hospitals were facing the fact that they would not be back to their pre-EHR implementation patient volumes, inpatient or ambulatory, for at least another five years,” Doug Brown, managing partner of Black Book, said in a statement.  “No other industry spends so much per unit of IT on the part of the business that is shrinking the fastest and holds little growth as did inpatient revenues.”  

The survey also found that IT leaders and staff have different opinions on the impact of EHR replacement on their communities.

Among IT non-managerial staff, 62 percent claim there was a significantly negative impact on healthcare delivery directly attributable to the EHR replacement initiative. Ninety percent of nurses reported the EHR process changes diminished their ability to deliver hands-on care at the same effectiveness. And, 96 percent of nurses in last year’s usability survey claim they had no input or inclusion in hospital EHR replacement planning activities.

In contrast, very few hospital leaders responded that the EHR replacement process impacted care in any negative way, only about 5 percent.

“In our experience polling, most executives will not admit they were oversold or that their IT decisions had adverse bearing on patient care,” Brown said. “On the other hand, workflow changes and productivity issues may have added to the disappointment nurses felt after being left out of replacement EHR product evaluations.”

And many survey respondents believe that hospital EHR replacement cost jobs, as 63 percent of executive level respondents stated they, or their peers, felt in employment jeopardy through the EHR replacement process.

At the manager lever, 19 percent of survey respondents said intermittent or permanent staff layoffs were directly caused by implementation delays, cost overruns, budgets under estimated, or trained personnel unavailable.

Two-thirds of respondents reported that interoperability and patient data exchange functionality declined resulting in problematic connectivity in 2016

Many survey respondents also reported that EHR salespeople exaggerated the buy-in of physicians and other clinicians for certain replacement EHR brands. Specifically, 78 percent of non-physician executives admit the clinical buy-in they were oversold never materialized after a replacement launched.

Eighty percent IT staff said they felt they had to coerce network physicians into adopting replacement EHRs via the hospital IT department, according to the survey results.

And, the Black Book findings also indicated that 88 percent of hospitals with replacement EHRs could not report any competitive advantages to attract doctors based on their new system.




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