With the Economic Stimulus bill recently enacted into law by President Barack Obama, and recent relaxation of the Stark Rules allowing hospitals to subsidize up to 85% of implementation costs of EHR, many are renewing their interest in an EHR purchase. But while many are excited about the encouraging subsidies available, others are still fearful of undertaking such a complex project after hearing about others “horror stories”.
Many health organizations are wondering what is fact and fiction when it comes to EHR failures. What are the true factors that contribute to the de-installations and or lack of return on investment on EHR? In this article we will be reviewing the common factors to most EHR implementation failures and expose what can be done to avoid these pitfalls.
The following are the top 10 biggest contributors to an EHR failure for some of the products available in the market place today:
Lack of strong follow-up from the EHR vendor:
After Go-live date, some practices begin to sense that the honeymoon period is over. Faced with new work-flow challenges and staff not always sure what to-do, most resort to a guess on how to perform certain tasks. This results into a growing frustration and lack of confidence of the product begins to show.
Lack of training:
With a constant reminder of budgets and economic downturn, some practices often resort to reducing training hours and utilize more self discovery. With some computer illiteracy, many realize that they are still not comfortable with the product and don’t know enough to resolve some of the obstacles they face with the EHR.
While many of the subsidies have reduced actual implementation and licensing costs of an EHR, weak and unreliable IT infrastructure tends to sabotage the success of the project. In many cases, the system’s slow response, unreliable wireless and reoccurring outages leave a terrible after taste of the EHR when it should be the fault of the lack of infrastructure.
Not very user friendly:
While all care providers and clinical staff understand that when they are seeing patients all their attention is rightfully given to their patient, but too often they fall victim to the overwhelming screens, 2 dozen buttons to click or all the flashing indicators reminding them that they have more work to follow-up on.
Lack of interoperability:
It is clear that interoperability is “essential” for coordination of care and reduction of medical errors. Unfortunately many software makers lack the capital and expertise to arm their products with the ability to enable practice to participate in exchanging electronic health records within their community or just simply with a nearby hospital or IDN. In addition, it has been stated time after time that one of the ARRA’s goals is to promote exchange of healthcare information to improve patient care.
Slow and painful ROI:
Statistic after statistic show us that adoption rates for EHR have been slow, despite the growing enthusiasm. In some cases, incentive payments can provide a boost, but often we find that citing a positive ROI is largely anecdotal. While upfront costs can range from 10,000 to 25,000.00 per provider in costs, it can take from 3 to 4 years before an actual positive ROI is seen in some cases.
Same problems under the hood with a new coat of paint:
As a developer I am guilty of trying to recycle my own applications. For some cases I would perform a face-lift on the interface still utilizing the same core engine. Unfortunately this trend has contributed to lack of new functionality and features for some of the EHR / PMS products being used today. By simply changing a 10 year old product screen from black DOS screen to a “Windows” based program does not promote much innovations or fixes for problem areas. Many practices are still facing outdated functionalities and lack of new and much improved and newly discovered efficiencies.
Lack of insufficient data visualizations:
Whether a healthcare organization is looking to identify the most common CPT codes used, performing internally RAC audits, or simply identifying trends in patient outcome measures, medical organizations are looking to EHR vendors to answer the calling. But with very few able to provide access and usable data, many are faced with the reality that data visualization is nothing but a dream. It is hard to truly understand the power of information, but as stated in a recent article in the BusinessWeek written by Maria Popova: “Ultimately, data visualization is more than complex software or the prettying up of spreadsheets. It’s not innovation for the sake of innovation. It’s about the most ancient of social rituals: storytelling. It’s about telling the story locked in the data differently, more engagingly, in a way that draws us in, makes our eyes open a little wider and our jaw drop ever so slightly. And as we process it, it can sometimes change our perspective altogether.“
Lack of or unreliable integration:
In the current healthcare environment, there are many connecting devices, entities and stakeholders. Whether you are ordering blood work or waiting for a pathology report to be downloaded integration is the glue that holds it all together. In certain cases, missing labs, down interfaces and failure of communication can lead to dangerous and risky outcomes for the practice. Many of these situations lead to frustration and mistrust of the technology and products.
Loss of confidence:
At the center of it all, lack of staff buy-in poses the most common management mistake made that leads to complete EHR implementation failure. Many leaders discover after working hard in making sure the right product was selected for the right price, they find that their staff is not confident in the adopted direction of the management. This leads the practice to face significant struggles. Ultimately, every staff member needs to buy-in to the change and for this to occur successfully it is important to involve everyone in the process and ensuring they are part of the solution.
It is commonly cited that the practice should hold most of the blame for the failures of EHR projects and implementation. But who are we kidding here; it is like asking an IT engineer to manage a busy restaurant’s kitchen just because they watched few episodes of Hell’s Kitchen. The burden of an unsuccessful EHR should be shared amongst the product vendors who have far more experience in project management and technology as well as the team effort of an EHR committee from within the practice. Both parties must commit to proper education up front, continued education and follow-ups to ensure that the product is being used the way it should be. The success of the project will benefit both the vendor and customer.
In conclusion, while many of the indicated struggles above are contributing factors of some failures of some of the EHR implementations out there, it is important to know that many can be resolved by taking the appropriate corrective measures. When in doubt always contact your vendor or a qualified healthcare IT expert to assist you and your organization to ensure that you are on the right path.
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