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Healthcare Practice Strategies - Spring 2014 - Extricating Yourself From a Bad EHR Contract

After five years of struggling to make your Electronic Health Record (EHR) system work, you've hit a brick wall. You've tweaked, trained and customized to no avail. The system simply doesn't meet the needs of your practice. Worse, your implementation budget has been burned through.

Communication with your EHR vendor has broken down, and your calls and support tickets go unanswered. With providers and staff so frustrated, the idea of scrapping your system is gaining traction – despite the inevitable financial hit and challenges of starting over with a new EHR system.

Unfortunately, more and more physicians are finding themselves holding their last straw with their EHR systems. In fact, technology market research firm Black Box is calling it the "Great EHR Switch." In a survey of nearly 17,000 active EHR users last year, the company found that 23 percent of those surveyed said they were planning to switch EHR vendors, and a full 8 percent wanted to switch but couldn't afford to make the move.

Topping the list of reasons for dissatisfaction was unmet expectations – EHR systems simply were not meeting the unique needs of the practice. Interestingly, respondents didn't put all the blame on their EHR vendors – a whopping 79 percent admitted that they had not adequately assessed their needs before making their EHR purchase.

Breaking Up Is Hard to Do

Of course, your EHR contract includes a warranty that addresses defects in the software, and many also include a "failed implementation" clause that spells out remedies if the vendor cannot successfully implement the system. But the reality is that, despite their best efforts, EHR vendors sometimes can't fix the problem because the software simply doesn't match your practice workflow.

It may be time to extricate yourself from an EHR contract if your situation has moved beyond annoyance and is now impacting the practice in terms of inefficiency, lower patient volume, higher patient dissatisfaction, increased expenses and decreased profits.

The good news is that there are plenty of EHR systems available on the market today. It may be easier to find one that better matches your clinical workflow than sticking with an inefficient system. And breaking up with your EHR vendor doesn't have to be an ordeal. As with most things, the key is clear and open communication. Consider these five steps:

Step 1: Get everyone on board. Ensure buy-in from key players in the practice. Make sure everyone understands what is going on and why it is happening – from physician owners and organizational leaders to clinicians and other staff. If you meet resistance, thoroughly outline the problems the current system is causing and their resulting impact on the practice.

Step 2: Review your contract. Go through your EHR contract line by line. Were you guaranteed certain services that were not delivered? Are there any restrictions or termination penalties written into the contract? There will no doubt be plenty of fine print, so consider having the contract reviewed by an attorney with experience in the healthcare IT field.

Step 3: Look inward. Spend some time evaluating what went wrong in the last selection. Any EHR switchover is pointless if you don't address the root causes of the initial failure. Was the problem with implementation? Was it an organizational issue? Was there a snag with the software? Or, more typical, were the challenges more of the human variety, such as getting buy-in from a few foot-dragging providers?

Step 4: Start the search. Before contacting your current EHR vendor, get all your ducks in a row by researching some new EHR choices. Yes, you'll basically be starting over from the beginning – but this time, you'll hopefully know exactly what will work for your practice. Collect pricing information and options. And ask any new vendors for the names of 5-10 of their clients who match your practice's specialty, size and workflow – and then contact a few.

Step 5: Contact your current vendor. Here's where it may get a little dicey. You'll need to let your vendor know in no uncertain terms that you wish to switch to another vendor. A key point of discussion will need to be the handling of your "legacy data" (see the sidebar above for options on transferring practice data from one EHR system to another).

Discuss any penalties involved in terminating the relationship and document everything. Software provider SRSsoft suggests on its EHR & EMR Insights blog that practices can sometimes negotiate an addendum to the current contract waiving the termination penalty in return for a non-disclosure agreement (for example, agreeing not to bad-mouth the current vendor's product to peers).

Seize the Moment

The right EHR system can substantially improve practice workflow and productivity while enhancing patient care. And now may be the time to take advantage of innovation in the market. Mergers and acquisitions are creating powerhouse EHR providers, and new vendors are introducing improved EHR technology, including systems that utilize cloud-based technology that can be used from a variety of devices.

Smoothing the Transition

Transitioning to a new EHR system is never simple. Consider these three steps for making a complex situation manageable:

  1. Determine your exit strategy. Hopefully, your contract spells out a legacy data process (i.e., how patient data will be transferred from one software to another). Vendors typically have special transfer pricing to migrate the data over to the new system. A reputable vendor will not prohibit access while you work through any contract issues – although a vendor may restrict access to read-only, thus giving you access to patient history but not allowing any new patients to be entered.

  2. Budget the funds. Dr. Ira Kirschenbaum, author of The OMG EMR Template Book – Orthopaedics, notes that switching to a new system should be about "half as painful" as the switch from paper records to an electronic system. But he says the pain will be directly related to the resources you commit to the deployment. Here, he recommends that organizations budget 25 percent of their purchase cost for training and deployment over a three-year period.

  3. Factor in some time. It's important to develop a realistic timetable for such a complex endeavor. Allison Viola, vice president of policy and government affairs at the nonprofit eHealth Initiative, says it can take up to one year or longer to go through the entire implementation life cycle. This typically involves "workflow analysis, custom development, training, testing, data conversions, go-live, go-live support and more."

Healthcare Practice Strategies - Spring 2014

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