21AMGA.ORG JANUAR Y 2019
Healthcare organizations are undergoing a flurry of activity in electronic health record (EHR)
replacements and upgrades as
they look to onboard new solutions
and modernize existing tools to
address current opportunities (i.e.,
population health, value-based
care analytics). Many implemented
their EHRs a decade or more ago
in response to the federal government’s Meaningful Use program.
Those platforms are leaving
many dissatisfied as they were not
designed to deliver the functional-ities needed from today’s EHRs.
At the same time, health systems
and medical groups are increasingly
consolidating (through mergers and
acquisitions) prompting consolidation of their EHRs. After all, it is not
efficient or effective to have multiple EHR platforms within the same
health system. Moving toward one
unified system is the best way to
promote inter-organization alignment
and clinical integration. As a result,
organizations nationwide are looking
to transition to a new EHR platform
or upgrade to a new version.
Taxing and Costly
Unfortunately, EHR transitions can
be taxing and costly. They can also
disrupt providers. These highly
complex projects are becoming
increasingly unwieldy as organizations adopt enterprise-wide
systems that affect multiple workflows across varied settings at the
same time. There are countless stories of health systems that struggle
to effectively onboard a new or
retooled EHR, spending significant
resources and incurring substantial
financial losses. 1
For example, one Texas health
system reported a 56.6% decrease
in adjusted income due to its
large-scale EHR implementation,
while a California-based organiza-
tion revealed that one-time EHR
Another reason for the difficulties
is that most of these EHRs are not
designed with specific end-users
in mind. Physician practices vary
greatly—their workflows, pain
points, patient care philosophy,
and so on—and most healthcare
organizations typically onboard a
“vanilla” solution meant to work well
enough for the majority. This leaves
many (if not most) providers less
than satisfied with the technology.
Overcome the Obstacles
It is possible to have a successful transition in terms of financial
outcomes, performance metrics,
and patient and provider satisfaction. Below are key strategies for
smoothing the process and ensuring end goals are met.
Seek outside assistance.
Physicians are appalled when a
patient tries to self-diagnose and
self-treat a complex condition.
In many ways, that is the same
as trying to implement a large-
scale EHR on your own. There are
nuances to this process that most
implementation costs contributed
to the health system’s 31.5%
decrease in operating income.
The year of the deployment, the
organization reported an operating
income of $287 million, compared
to $419 million the prior year.
In reality, most health systems
have already invested significantly
in EHR (hundreds of millions if not
billions), but most have fallen short
of optimizing their EHR’s ability to
efficiently and reliably improve care
and streamline operations, which
was the hope and promise of the
EHR for healthcare.
Why Is Transition So Hard?
Evolving an EHR—whether a
large-scale upgrade or a system
replacement—is multifaceted, with
complex moving parts. Most organizations don’t have the expertise
and bandwidth to tackle this kind
of project on their own—at least
not without substantially disrupting
end-users and patient care.
Organizations’ internal infrastructures are not set up to handle the
extra work involved in an undertaking of this scope and scale, and
their budgets may not accommodate hiring the level of expertise
needed on a full-time basis.
Many organizations aspire to
eventually focus on optimizing an
existing EHR, which means answer-
ing the question, “How do we allow
providers to use the platform effec-
tively and with customization?”
Unfortunately, many organi-
zations have not evolved to this
phase, as they are still stuck in the
implementation stage. With con-
solidation of medical groups and
hospitals, their priority is simply
to get the platform up and run-
ning quickly. The idea is to make
things “good enough” so provid-
ers can use the tool right away,
and optimization will come later.
Unfortunately, in many organiza-
tions, providers are still waiting
Massachusetts General Physicians Organization (MGPO) saved more than 30,000 physician
hours because the outside company’s clinicians
reviewed more than 300,000 patient records to
capture the necessary information. MGPO experienced no downtime during the migration.
In contrast, another organization in the region—
using its own physicians and nurses to transfer
patient data—decreased patient access for more
than seven months after the switch, affecting
patients and physicians alike.