By Susan Clark, HIT Solutions Executive, eHealthcare Consulting Inc.
Twitter: @ehealthcareorg
Thinking about switching EHRs? This is a really big decision. Much bigger than choosing between the red patent pumps and snakeskin peep-toes, or your salsa selection at Chipotle. So before you rush into making a move, consider the following:
- Why am I even considering switching in the first place?
Is the vendor sunsetting your product or not keeping up with ONC (Office of National Coordinator) certification?
Or does your staff report that it is no good (probably using much stronger language), that there are too many clicks, or can’t get desired reports? - Analyze your needs
Map your workflow. Carefully consider WHY each step occurs – is there a clinical or regulatory reason? If not, get rid of it. Taking bad processes into a new system will not make you any happier with the new technology than the old. Sometimes an outside set of eyes can help shed light on these waste points. There is a pretty forest out there if you stop looking at the beetle-infested trees. You may not even need the following steps if you can improve how you use your current system. - Assess your infrastructure and security
Along with mapping processes, you should also have an inventory and map of hardware and networks. Assuming you are maintaining an up-to-date security risk assessment, this may be a good place to start. - Do your research
I know, many of us do not want to re-live college research projects without the reward of more letters after our name, but you will not regret this. Resources include the ONC, HIT.gov, and KLAS. You may also consider a consultant who is familiar with many EHRs and regulations. - Make a comprehensive list of your needs and shop
A key step that is often not given enough attention is to delineate your requirements in complete detail. These requirements can then be used to create a Request for Information (RFI) or Request for Proposal (RFP) to any potential software vendor. There are hundreds of products out there and they all may dazzle you with a demo. Get under the hood and test drive when possible. Seek out as many organizations that you can who use the product for a balanced opinion. - The price tag is not always straightforward
Sure, the monthly subscription, setup fees, yearly fees, may be clearly spelled out in the contract, but what about internal costs or future upgrades? Ask the vendor about their upgrades and additional modules processes, as these items will be inevitable with changes in technology and regulation. Are these generally associated with additional fees? Will your current hardware be sufficient or do you need to purchase new? Costs of servers, tablets, and wireless networks should be factored in to your overall cost. What about training for staff or additional IT resources to manage the application? And, as with everything, cheaper is not always the way to go. It may save you a few dollars now but the long range price may be high. - Due diligence complete. I am ready to switch
Read your contract carefully. Make sure you know your level of support as to the hours, turnaround time, and go-live. Make sure they were clear with an implementation schedule and assumptions.
Server, web, yearly/monthly fees - They can just move all my current patient information into the new system, right?
Um, not so much. Data mapping and migration is difficult, time consuming and costly.
There is no 1 to 1 map from any system to each other. If you choose to migrate data, consider only active patients with a critical subset of their information, such as medications, problems, diagnoses, etc. Another alternative is a data archiving service where you can have access to view your data at any time. - Many perfectly good EHRs have failed due to bad implementations
The vendor will have a project manager and an implementation plan. However, you need to have both of your own as they will not account for every aspect of your workflow and organizational needs. If you have not implemented a technology solution before, it is highly suggested you get help from an experienced implementation specialist or project manager. Planning and detailed checklists should be a critical part of your implementation. During the design and build process try to customize as little as possible. It will take several months to know what the system can do and is best optimized at a later date. You can also not have too much training or at-the-elbow support for weeks after go-live. These are often the highest complaints heard.
Now, given all that, is it still feeling hot in the kitchen or are you using your frying pan for the best meal you have ever had?
About the Author: HIT Solutions Executive at eHealthcare Consulting Inc. With a 20-year career that includes health information management, project management, ambulatory operations, quality improvement, managed care, and regulatory/accreditation compliance, Susan Clark, BS, RHIT, CHTS-IM, CHTS-PW seeks to create health information technology solutions to improve compliance, efficiency, data integrity, revenue, along with patient and staff satisfaction. She serves at a national level with the AHIMA House of Delegates and advocates for providers, practices, hospitals, and HIM/HIT professionals while keeping abreast of developing regulations and industry trends.