Wednesday, June 17, 2015

Rethinking the Decision to Replace Your EHR

Small and medium sized physician groups are faced with an overwhelming number of EHR solutions.
There are several groups for medical practice defined by their size and history of EHR usage. Large medical clinics and integrated health systems  have adequate HIT resources to study this question. Unfortunately small practices do not have adequate HIT resources, and must outsource this to a consultant or their software vendor.

About ten years ago the impetus for EHR Early adopters jumped on the  train purchasing early software/hardware configurations.  At the time cloud computing was a little known option.  Most EHR providers did not offer that solution.  Providers were suspicious about data stored offsite (and with good reason as experience has shown.)

Changing to a new EHR system is becoming a more common choice, but is it always the right one? Beyond the question of whether a new system will deliver actual improvements, practice leaders must consider two other key factors – cost and time – before making a switch. Moving to a new EHR system may be far more expensive than optimizing your current system, and finding and implementing a suitable vendor may take up to two years. Instead of investing time and money in a new EHR system that may or may not offer better performance, organizations should make sure that they maximize the value of their current system. This session will provide guidance on determining whether optimizing an existing EHR or pursuing a replacement system is right for your practice.

MGMA 2014 Annual Conference session

This session will provide you with the knowledge to:
  • Articulate the impact of EHR system replacement
  • Assess the viability of exiting EHRs
  • Identify options for optimizing existing EHRs

Practice needs for EHR evalutation into replacement or upgrade of present EMR. Thesee fall into several categories

1. None. These practices rely upon paper-based records
2. Adopting early word processing EHR for making records more legible. These systems may or may not interface with a practice management system
3. Early  EHR. These often combine practice management, billing, and electronic medical records
most of these are not interoperable for exchange of data between disparate EHRs.  These systems did not have standards from ONCHIT since they were in the earliest phase of development.  While ONCHIT led the effort to standardize and harmonize systems the task was left to providers and new organizations, some local, some regional and some state-wide.  In additioin to the multiplicity of organizations, they were often in competition with each other as to who would gain the most market-share. Organizations would appear and disappear according to how long their government grants lasted. This was due to a lack of sustainable business models.
3.Mid-term EHRs have a variety of advances, which may or may not include meaningful use stage I, stage II or stage III. The deadlines for  adoption include reward incentives for adoption within a  certain time period and penalties for non-compliance with the mandate.
4. Late term adopters. This group may be in the best position and may not need to  convert to a newer EHR.  (a sub-category also includes those with more recent EHRs which can be upgraded according to the individual vendor and the cost of such upgrades.

Perhaps those in the best category are those whose EHR is cloud-based. Cloud based applications can be updated instantly for thousands of users at the same time, very cost effectively.

So the answer is:

Early EHR...........replace
Mid term EHR......depends upon cost of upgrade
Late Client server application .......dependent upon extent of revision required, and how it affects user functionalitiy.

Cloud based.......vendor upgrades the software.

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