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Pulling the Plug on an EHR

August 20, 2009
by David Raths
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How common is it for clinics or physicians' offices to pull the plug on EHR implementations?

Some numbers from a recent survey by the National Association of Community Health Centers jumped out at me. The report states that "a surprising number of health centers responding to the survey have actually installed an EHR and have gone through a de-installation process."

NACHC got survey responses from 362 community health centers in 2008. Of the 176 health centers that identified they had an EHR in place, 18 (10.2 percent) had gone through a de-installation process. That seems like a high number to me! The respondents didn't give reasons, but the report speculates that it could be due to factors such as lack of appropriate clinician involvement in the initial planning phase and lack of clinical leadership.

The survey highlighted other IT challenges safety net clinics face. Obviously, most mentioned that a lack of funding to invest in EHRs is a barrier. But clinic administrators also express concern about loss of productivity during implementation, lack of support from physicians and lack of project management staff. Indeed, 37 percent of respondents said they have no dedicated IT staff. Imagine trying to do an EHR implementation in an overburdened clinic with no IT staff.

On the positive side, the report notes that the Health Center Controlled Network model, which provides management, financial, technology and clinical support services to multiple clinics, seems to be working well.

It is likely that serving these safety net clinics will be one of the important goals of health IT regional extension centers, once they are up and running. Providing more support for clinicians and administrators in these crucial clinics will be key to avoiding more de-installations.



In my experience with EHR saves and "do-overs" I am constantly reminded that the magnitude of process and culture change is generally glossed over by vendors wanting to get a contract signed. In practices where there is no on- site IT support, someone's job changes and it is usually a very stressful realization for both staff and provider. This translates into percieved unhappiness with the actual system purchased and the possiblilty of a de-install. MDs and staff need to have a thorough workflow and staff analysis performed and know upfront what to realistically expect as far as their part in build, test, train and support are before implementing

Cathy Annulli,
Medical Staff Informatics Liaison
The Hospital of Central Connecticut
email cannulli@thocc.org

There are EHRs and there are 'ehrs'. Perhaps EHR systems should be given the label until it is fully functional, including interoperability. Anything less serves as nothing more than an expensive data capture.
Of those 176 claiming to have an EHR, that might be better stated as having purchased an EHR rather than having one in place.
My guess is that of those who think they've finished with their EHR implementation, less than 40% 'work', and as the size of the implementation increases, that 40% decreases dramatically.

I appreciate Cathy's comments, too. The hearing I was watching that prompted this initial blog posting featured several speakers, including someone from the city of Philadelphia office in charge of public clinics. She gave a reality check to a lot of us about the kind of conditions their clinicians are working under. With the current economy, their work loads have become even greater, with lines out the door and around the corner. To talk to them about EHRs and quality measurements, first you have to deal with better telecommunications and office facilities. Then they have to have the IT support to convince them that EHRs will make their work procceses easier, not more difficult or time-consuming.

I think you make a great point Catherine. I'm sure the policy wonks that wrote HITECH with its ridiculous timelines didn't realize the work involved with clinical IT system implementations either, and I think we'll unfortunately see the price paid for that in about 6-12 months.

It's not about the EHR, it never was. If that's where the focus is, they're dead in the water. Quoting Dirk Stanley, the system was only 20% of the work.

not to mention the fact that an EHR is largely a transactional system, it is only after really understanding data management and analytics that the EHR can become a tool to improve care.

the key phrase is "when they are up and running." unfortunately the legislative timelines indicate that payments will start going out BEFORE the regional centers are operational, so they may be of little use to institutions that want to collect all the dollars they might be eligible for.