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Study: System Functionality, Cost and Reporting Requirements Top Reasons for Switching EHRs

April 27, 2018
by Heather Landi
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System functionality and cost are the two largest deciding factors in healthcare providers’ decision to switch electronic health record (EHR) vendors, despite the significant cost associated with a new EHR purchase and implementation, according to a study published in the journal Perspectives in Health Information Management.

Researchers, led by Alberto Coustasse, DrPH, M.D., a professor in the Healthcare Administration Program at Marshall University in South Charleston, West Virginia, sought to examine reasons why healthcare providers are switching EHRs vendors, assess user satisfaction with replacement systems, and evaluate the cost and implications of transitioning to a new system. For the study, the researchers conducted a systematic literature review of studies related to physicians and health systems that switched EHR vendors, including their reasons for replacing their current system and the barriers to doing so. The researchers evaluated a total of 26 research articles in their literature review.

The researchers note that providers are choosing to switch EHRs for many reasons, including inefficient workflows, lack of reporting capabilities, mergers and acquisitions with larger health systems requiring more complex systems with greater interoperability, and the need to interface with other systems. Shifting regulatory standards require new functionality to fulfill quality reporting measures, including MU (Meaningful Use) requirements and the Physician Quality Reporting System. And, despite the costs associated with switching EHR vendors, many physicians and health systems have decided to switch to receive additional functionality, improve reporting capabilities, and increase platform benefits, the study authors state.

The study authors note that most providers began using EHRs to fulfill government mandates and receive the financial incentives offered for utilizing the software. By 2013, the EHR adoption rate was 78 percent in ambulatory settings and 59 percent in acute care settings in the United States. A 2010 survey by the Medical Group Management Association (MGMA) found that only 41 percent of EHR vendors reported that their systems had the functionality requirements to allow providers to fulfill Meaningful Use (MU) criteria. Many vendors have remedied these gaps by providing add-ons and new modules to enhance their systems, however, these add-ons and new modules has led to problems in interfacing with other health information systems, according to the study.

Additionally, mergers and acquisitions have resulted in software vendors phasing out older products and replacing them with more complex systems, and this has led to health systems replacing the systems originally purchased with more advanced software. According to the Healthcare Information and Management Systems Society (HIMSS) Analytics Database, 305 hospitals switched EHR vendors and 62 hospitals changed their EHR systems in 2013.

The study authors conclude that switching can result in positive and negative outcomes, with cost being the most obvious negative outcome and a significant barrier to adoption related to switching. “The cost of switching systems can seem excessive, often in the millions, when the cost of the new system is coupled with the cost of its implementation; however, health systems must remember that the benefit to the patient is the main priority. Some practices have found that the functionality of the new system increases the level of care the patients receive by speeding up communication. Others have seen benefits for the hospital in terms of a reduction, often by half, in rejected claims,” the study authors wrote.

The study authors also contend that the cost involved with health systems switching from legacy systems to new EHR systems has significant implications for the U.S. healthcare system. “Switching costs include not only software and hardware upgrades, but also repeat training for staff and initial loss of productivity due to unfamiliarity with the system. The incentive monies are not high enough to cover the expense, and as a result the cost of care may rise. In order to meet the data-sharing requirements and other requirements still being defined by CMS (The Centers for Medicare & Medicaid Services), provisions of $44,000 per eligible health provider, paid out in stages, were established and may be paid out upon successfully meeting the requirements of the legislation. These costs could lead to higher copayments and higher premiums for patients and may make it more difficult to receive care,” the study authors wrote.

Despite the costs involved with switching EHR vendors, the study authors contend that there is one practical, beneficial implication of healthcare provider organizations switching from legacy systems to new EHR systems—the better likelihood of interoperability. “With more health systems switching to some of the more widely utilized EHRs, the interoperability issues of the past may be easier to overcome with more interfaces being built and potentially with the new FHIR (Fast Healthcare Interoperability Resources) standards being implemented by the vendors,” the study authors wrote.

“Switching has proven to be a costly endeavor, but in view of the lack of value provided by their former EHR systems, many healthcare systems have chosen to move forward with switching vendors despite the possibility of not receiving an immediate return on the investment,” the study authors concluded.

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Study: Many U.S. Hospitals won’t Reach HIMSS Stage 7 Until 2035

August 14, 2018
by Rajiv Leventhal
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Unless the healthcare IT ecosystem experiences major policy changes or leaps in technological capabilities, many hospitals will not reach Stage 7 of HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) until 2035, according to new research.

The study, published in the August edition of the Journal of Medical Internet Research, analyzed Healthcare Information and Management Systems Society (HIMSS) Analytics’ EMRAM data from 2006 to 2014.

HIMSS Analytics is the research arm of the Healthcare Information and Management Systems Society (HIMSS). HIMSS Analytics developed the EMRAM in 2005 as a methodology for evaluating the progress and impact of electronic medical records on health systems around the world. Tracking their progress in completing eight stages (0-7), hospitals can review the implementation and utilization of information and technology applications culminating with Stage 7, which represents an advanced electronic patient record environment. Other Stage 7 requirements include: leveraging an external HIE (health information exchange); use of a data warehouse; and having robust data analytics functions.

The researchers of this study noted that the meaningful use (MU) program has promoted electronic health record (EHR) adoption among U.S. hospitals. And while studies have shown that EHR adoption has been slower than desired in certain types of hospitals; generally, the overall adoption rate has increased among hospitals.

However, the researchers continued, these studies have neither evaluated the adoption of advanced functionalities of electronic health records (beyond meaningful use,) nor forecasted EHR maturation over an extended period in a holistic fashion. “Additional research is needed to prospectively assess U.S. hospitals’ electronic health record technology adoption and advancement patterns,” the researchers stated.

The HIMSS EMRAM data set was used to track historic uptakes of various EHR functionalities considered critical to improving healthcare quality and efficiency in hospitals. A technology diffusion model was then used to predict the technological diffusion rates for repeated EHR adoptions where upgrades undergo rapid technological improvements. The forecast used EMRAM data from 2006 to 2014 to estimate adoption levels to the year 2035.

In 2014, more than 5,400 hospitals completed HIMSS’ annual EMRAM survey (86 percent of total U.S. hospitals). Back in 2006, the majority of the U.S. hospitals were in EMRAM Stages 0, 1, and 2. But by 2014, most hospitals had achieved Stages 3, 4, and 5, the study noted.

The researchers found that in 2006, the first year of observation, peaks of Stages 0 and 1 were shown as EHR adoption precedes HIMSS’ EMRAM. By 2007, Stage 2 reached its peak. Stage 3 reached its full height by 2011, while Stage 4 peaked by 2014. This forecast indicates that Stage 5 should peak by 2019 and Stage 6 by 2026, according to the data revealed in the study.

The researchers noted, “Although this forecast extends to the year 2035, no peak was readily observed for Stage 7. Overall, most hospitals will achieve Stages 5, 6, or 7 of EMRAM by 2020; however, a considerable number of hospitals will not achieve Stage 7 by 2035.” They concluded, “These results indicate that U.S. hospitals are decades away from fully implementing sophisticated decision support applications and interoperability functionalities in electronic health records as defined by EMRAM’s Stage 7.”

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HHS OIG Fines eClinicalWorks $132,500 For Violating Corporate Integrity Agreement

August 1, 2018
by Heather Landi
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The Health and Human Services (HHS) Office of Inspector General (OIG) fined electronic health record (EHR) vendor eClinicalWorks $132,500 for failing to report patient safety issues to the regulatory body as reportable events in a timely manner.

According to the OIG website, eClinicalWorks paid the fine July 18. The EHR vendor is required to report these patient safety issues to OIG as part of its corporate integrity agreement (CIA) with the agency.

eClinicalWorks entered into a CIA back in May 2017 as part of a settlement with the U.S. Department of Justice to resolve a False Claims lawsuit. According to the DOJ’s case, the company allegedly violated federal law by misrepresenting the capabilities of its software and for allegedly paying kickbacks to certain customers in exchange for promoting its product, according to the U.S. Department of Justice. As part of that settlement, eClinicalWorks also paid a $155 million settlement over the allegations.

The five-year CIA requires, among other things, that the company retain an Independent Software Quality Oversight Organization to assess eClinicalWorks’ software quality control systems and provide written semi-annual reports to OIG documenting its reviews and recommendations. The company must provide prompt notice to its customers of any safety related issues and maintain on its customer portal a comprehensive list of such issues and any steps users should take to mitigate potential patient safety risks.

Further, the agreement also requires eClinicalWorks to allow customers to obtain updated versions of their software free of charge and to give customers the option to transfer their data to another EHR software provider, without penalties or service charges. The vendor must also retain an Independent Review Organization to review its arrangements with healthcare providers to ensure compliance with the Anti-Kickback Statute.

 

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Survey: Physicians Cite EHRs as Biggest Contributor to Burnout

July 31, 2018
by Heather Landi
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A recent survey on physician burnout and stress found that, perhaps unsurprisingly, physicians cited electronic health records (EHRs) as the top factor contributing to stress, followed by dealing with payers and pre-authorization and then regulatory compliance.

Reaction Data, a market research firm focused on the healthcare and life sciences industries, surveyed 254 physicians across the country in a wide variety of specialties about what factors contribute to physician burnout. Twenty-one percent of respondents cited EHRs, followed by payers/pre-authorization (19 percent), regulatory compliance (18 percent) and internal bureaucracy (17 percent). And, these factors all have a common theme: they are time consuming and prevent the physician from providing care for the patient.

Other burnout factors cited by respondents included work/life balance (11 percent) and malpractice risk (6 percent).

Patients, not surprisingly, were only mentioned by 2 percent as causing an undue burden. The survey report cites one orthopedic surgeon who commented, “Our current healthcare non-system needs to be radically changed. Way too expensive and chaotic. Profit must be eliminated.”

Across different specialties, EHRs were consistently cited as a top burnout factor, although, surgeons and physician leadership cited payers/pre-authorization as a bigger burden (22 percent and 24 percent, respectively) than EHRs (20 percent).

When asked how EHRs could be improved to reduce the burden, one-third of respondents (34 percent) cited improving user-friendliness. According to the survey report, one pediatrician suggested that EHR vendors “Create one by and for physicians, not administrators and technogeeks.”

Another respondent, an orthopedic surgeon, commented, “Develop a better and more user friendly EMR. It shouldn’t take 20 minutes to do something that dictation takes three minutes.”

Seventeen percent of respondents would like to see vendors add dictation and scribe features to EHRs, 13 percent would like to spend less time documenting in the system, and 9 percent suggested replacing or getting rid of EHRs. Other suggestions to reduce EHR stress included reducing clicks (7 percent), more physician input (7 percent), focus on patient outcomes (6 percent), improve interoperability (4 percent) and additional training (3 percent).

Overall, the survey results indicate that physicians want an easier system with dictation features that reduces the time required in the system. “They want more face to face time with the patient, rather than staring at a monitor and a keyboard,” the report authors noted.

“The nurses and medical assistants need to be able to put more of the data into the EHR, permitting the doctor to spend more time with the patient,” one gastroenterologist and survey respondent said.

The survey results also indicate that EHR stress appears to know no brand name loyalty. Of those who said EHRs are one of their main causes of stress, 39 percent are using Epic, 18 percent use Cerner, 11 percent use Allscripts and the remaining respondents use athenahealth, Meditech, NextGen, eClinicalWorks and GE.

One respondent, an emergency medicine physician, commented, “EHR seems to be predominantly a billing tool, secondarily a compliance tool. Start over and design EHR for patient care. Too many boxes to click, too many irrelevant alerts, soft or hard ‘stops’ (best practice alerts in Epic), create alert fatigue. Very little useful clinical decision support.”

Physicians also cite regulatory burdens as a contributing factor to burnout and stress. Thirty-seven percent of respondents would like to see fewer rules, 32 percent would like to see more simplification and 15 percent said more physician input was needed.

According to the report, one chief medical officer recommended shifting reporting to an automated system that retrieves data from the EMR rather than manual reporting. A CMIO added, “Get rid of what seems to be unnecessary regs that don’t contribute to patient care or quality of care.”

 

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