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EHR Swapping: A New Approach for Effective EHR Transitions – Breakaway Thinking

Posted on September 16, 2015 I Written By

The following is a guest blog post by Todd Stansfield, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
The trend to swap electronic health records has been gaining momentum in recent years. A 2014 KLAS report surveyed 277 large US hospitals, half of which indicated plans to replace their current EHR system by 2016. That number marks a significant wide-scale investment, since the cost of an EHR implementation may range from millions of dollars for a standalone hospital to hundreds of millions for a regional health system, according to a Becker’s Healthcare article. Organizations are increasingly swapping systems to gain needed functionality, achieve interoperability, leverage analytics and more. As the EHR market continues to consolidate, this development begs the question: are organizations ever fully adopting their EHR systems and overcoming problems uncovered during the initial go-live?

A new survey may provide insights. The American Academy of Family Physicians (AAFP) surveyed 305 physicians to uncover the challenges and outcomes associated with EHR-to-EHR transitions. While 59 percent agreed their new EHR provided useful functionality, only 39 percent reported being satisfied after transitioning. In fact, 49 percent disagreed that their new system improved productivity, and 41 percent considered their new EHR overly complex to use. These numbers suggest that changing applications does not always improve outcomes related to the EHR, especially since a majority of respondents had been using the application for a year or more.

The challenges being reported around EHR transitions are similar to those we have observed for years when the EHR isn’t fully adopted. Research published in Beyond Implementation: A Prescription for Lasting EMR Adoption identified how often organizations overestimate their adoption of an EHR system, a factor that can have significant consequences as organizations transition between applications. These organizations are likely to overlook problems impeding adoption and underestimate the resources and focus needed for the new system. Disengaged leaders, poor education, inadequate end-user support—all are inevitable if unresolved in the original system. The result is a continuation of an organization’s current headaches—from poor usability, to decreased productivity, to end-user dissatisfaction.

There are other potential pitfalls in transitioning EHR systems. For instance, leaders tend to underestimate the need for strong communication, physician alignment, and governance for upcoming changes. While they may have focused on these areas during their initial implementation, they may perceive them as unnecessary for the new system, a decision that puts adoption at risk over the long-term. Organizations should expect the EHR-to-EHR transition to bring the same, if not more significant, challenges as their original implementation.

Organizations may also struggle to anticipate end-user resistance to the new system, which is greater than the switch from paper. While end users may be dissatisfied with the current system, they are often not willing to face the challenge of learning a new system, requiring them to relearn the workflows and keyboard shortcuts they worked so hard to learn. Additionally, end users might question the value of an electronic-to-electronic switch. This is especially true when the transition is due to a merger or acquisition, as shown by the AAFP survey.

Organizations must rely on the tried-and-true methods to achieve EHR adoption, whether moving off paper or an existing electronic system. Beginning with leadership engagement, organizations must communicate, ensure physician alignment, and create governance to ensure accountability and ownership of the new system. End users should receive consistent and effective education. Education is most effective when it is scenario-based, repeatable, readily-accessible, and provides hands-on experience completing workflows in the EHR system. To understand the education and support needs of end users, organizations must track and measure performance. And lastly, they must sustain adoption efforts over time to ensure they remain relevant despite application upgrades and workflow improvements.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Open EMR’s Death, Collaborative Health Record, and Improving EMR

Posted on December 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


It seems a little ironic that an EMR vendor would write about wanting an open source EMR to die. Although, I couldn’t help but read the irony that this person chose not to be involved in the open EMR community because people weren’t getting involved in the community. A good old chicken and egg problem. Instead of contributing to the community so that it would be more vibrant, they chose to go out and develop EVERYTHING. The reality is that this person just wanted to build an EMR business. They didn’t want a real open source EMR community. There’s nothing wrong with wanting to build an EMR business, but it’s very different than contributing to a great open source EMR community and build a business.

As the author mentions, the Open EMR community isn’t going anywhere. In the hospital space, the Vista community isn’t going anywhere either. I will be interested to see how Open EMR handles MU. They did stage 1, but future stages are still a question mark from what I’ve seen. Of course, they could go radical and not worry about meaningful use. It will be interesting to see.


I’ve always loved the idea of the collaborative care record. Unfortunately, I don’t see much movement by the healthcare industry to make it a reality.


A lot of people are going to start asking this question. I believe it will be a couple years before this discussion really goes mainstream in hospitals (possibly post-MU), but it will be an important discussion. Of course, this isn’t a new discussion. It’s always a question of whether it’s best to improve the software you have or rip and replace. In the ambulatory side I predict we’re going to start seeing a lot of ripping and replacing of EHR software.

What’s Pushing EMR Switching?

Posted on September 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a chance to talk with Sean West, VP & GM of HealthPort Data Conversion Services, about the hot topic of EMR switching (or EHR switching if you prefer). I’ve written about EMR switching many times before and even predicted it would be a hot topic a year or two ago. I assure you that it is going to become and even more important topic going forward.

During my discussion with Sean, I took note of a number of drivers behind all the EMR switching. Here’s what I consider to be the top three drivers:

Hospital Acquisition – I’ve written regularly about the trend of hospitals acquiring ambulatory practices and hospitals acquiring or merging with other hospitals. In one hospital system, I found that they were moving newly acquired practices onto the hospital EHR before they even moved their existing practices from paper to the hospital EHR. In many cases the acquired practices already had an EHR and so they had to make an EHR data conversion plan. Most current hospital acquisitions or mergers are also moving to one unified EHR software system. I could see this changing as larger more established hospitals are acquired, but right now these hospital acquisitions are driving a lot of EMR switching.

EMR User Dissatisfaction – There’s a broad range of EMR user dissatisfaction that prompts an EMR switch. Sometimes the healthcare organization is on a legacy EMR system that’s no longer being updated and so the user experience suffers. Other times we are talking about a newly implemented EMR system which doesn’t live up to the users expectations.

Not Meaningful Use Ready – The other large driver of EMR switching is when an EMR vendor isn’t or won’t be ready for meaningful use. The EHR incentive money and EHR penalties are a powerful incentive for many healthcare organizations. If an organization’s current EHR system isn’t ready for meaningful use, many have no choice but to switch EMR.

Of course, EMR switching can be a real challenge and every EMR switch is unique. You have to consider what you want to do with your old data. Do you have a way to transfer it to the new EMR? Can you get the EMR data out of the old system? Do you want to transfer all or part of the data? Do you not want to transfer the data to the new EMR, but you still want to keep the old EMR around to access the previous EMR data?

Many of the answers to these questions are heavily influenced by your original EMR contract. Sadly, many organizations did a poor job evaluating their EMR contract before they signed it. This can often lead to the old EHR vendor holding the EHR data hostage. It’s not pretty, but there are sometimes workarounds. Just be sure that you don’t make the same mistake with your new EHR vendor. My e-Book on EHR selection has a whole section on EHR contracts (starts on page 30) that you should consider.

EMR switching is never a fun experience, but it’s often a necessary evil. Plus, it’s going to continue to become more and more common. In fact, the next wave of EMR switching might be driven by EMR consolidation.

The Golden Age of EHR Adoption is Over

Posted on June 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m ready to call the Golden Age of EHR Adoption Over. We’re not getting ready to enter the nasty, ugly, dirty, swamp filled waters of EHR adoption. If you’re an EHR vendor you likely already know this to be the case. That’s not to say that there’s not still real opportunity in the EHR space, but it will take on a very different form.

I think this image of the adoption lifecycle describes the EHR adoption cycle really well. I’m sure it will be familiar to many of you:
EHR Adoption Lifecycle

It’s very clear to me that we’re somewhere in the middle of the Late Majority cycle of EHR adoption. This plays out well since we’re somewhere between 50-84% EHR adoption. While the chart shows a downhill slope, the ride to get the Late Majority and Laggards on EHR is going to be anything but a downhill ride. I’d say it’s going to be more like climbing Mount Everest. It’s possible, but it’s going to take a lot of work.

The reality is that those who wanted to adopt EHR already have adopted EHR. That means we have left a group of practices and hospitals that for the most part aren’t EHR convinced. However, there is one advantage for those wanting full EHR adoption. Almost all of those who haven’t adopted EHR see the writing on the wall. They’re just going to take their time and make a deliberate choice based on the experiences of those around them.

EHR vendors will now start to focus on creating what I call Smart EHRs. Doing so will be how they battle each other in the next wave of EHR switching. Plus, this will usher in the next EHR Golden Age: Use.

Future Golden Age of EHR Use
While the golden age of EHR adoption is over, we’re entering a new EHR Golden Age. It’s the golden age of amazing EHR use. It’s still very early in this new cycle, but the innovators are going to really surprise us with the innovation that’s going to be possible on the back of an EHR.

Many of the changes will be subtle and we’ll take them for granted almost instantly, but they will be amazing in aggregate. Take for example, Jennifer’s recent post on EMR and EHR about her child’s well visit. How beautiful is it that her child’s record was available at a new clinic with no effort on her part. We’re not there yet, but we’re going to get there. Although, we wouldn’t get there if we were still at 25% EHR adoption.

Jennifer’s example is a simple, but powerful one. No doubt there are going to be much more complex and much more powerful examples to come. Many of which will actually save people’s lives.

The Golden Age of EHR Use is going to bring about dramatic benefits that would have never been possible without massive EHR adoption. The Golden Age of EHR Use will be so good that even the EHR adoption laggards will finally want to change.

Does Patient Interaction Lock a Doctor In to an EHR?

Posted on March 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been thinking a lot lately about EHR vendor lock in. I think this was prompted by some stories I’ve heard of EHR vendors holding clinics EHR data “hostage” when the clinic chooses to switch EHR software. I heard one case recently that was going to cost the clinic a few hundred thousand dollars to get their EHR data out of their old EHR software. It’s a travesty and an issue that I want to help work to solve this year (more on that in the future).

I think it’s such a failed model for an EHR vendor to try to keep you as their EHR customer by holding your EHR data hostage. There are so many other ways for an EHR vendor to keep you as a customer that it’s such a huge mistake to use EHR data liquidity to keep customers. EHR vendors that choose to do this will likely pay the price long term since doctors love to talk about their EHR with other doctors. If a doctor is locked into an EHR they dislike, then you can be sure that their physician colleagues won’t be selecting that EHR.

There are a whole series of better ways to lock an EHR customer in long term. The best way being providing an amazing EHR product.

I recently considered another way that I think most EHR vendors aren’t using to create a strong relationship with their physician customers. Think about the strength of a company’s relationship with a doctor if a doctor’s patients are all familiar with their connection to the EHR. If a physician-patient interaction occurs regularly through the EHR, then it’s very unlikely that a doctor is going to switch EHR software.

The most obvious patient interaction that occurs is through a patient portal that’s connected to a provider’s EHR. Once a clinic has gotten a large portion of their patients connected to an EHR patient portal, then it makes it really hard for a doctor to consider switching from that EHR. It’s one thing for a doctor to change their workflow because they dislike their EHR. Add in the cost of getting patients to switch from a portal they have been using and I can see many doctors sticking with an EHR because of their patients.

Of course, from a doctor perspective, there’s some value in selecting an EHR that uses a 3rd party patient portal. That way if you choose to switch EHR software, then you can still consider keeping your interaction with patients the same through the same third party patient portal. Although, there’s some advantage to using the patient portal from the EHR vendor as well. It’s not an easy decision.

New EHR Selector Website

Posted on March 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As long as I’ve been blogging, I’ve been quite interested in the various EHR selection tools that are available out there. For a while, it seems like there was a new EHR selection tool coming out every week. The frenzy of EHR selection tools has mostly stopped and only a few major ones remain. One of those is EHR consultant (Full Disclosure: Has been an advertiser on EMR and HIPAA for many years) which has been doing this as long as anyone and has one of the most comprehensive EHR databases out there. The other that has lasted all this time is EHR Selector. Then, to round out the various EHR selection websites, there are the websites out there like Medical Software Advice and even the AAFP offers a tool to help in EHR selection (only available for AAFP members).

As I suggest in my e-Book on EMR selection, I think you should take advantage of multiple EHR selection tools. I call it triangulating the data since none of them are comprehensive with the EHR world changing so quickly. So, you take all of the data and triangulate down to the best EHR possible.

Many might wonder why I’m talking about EHR selection anyway. Well, if you’re being generous, we’re somewhere around 50% EHR adoption. That’s still a lot of doctors who haven’t adopted EHR. Add to that the number of clinics that are looking to switch EHR software, and there’s still a big need for great EHR selection tools.

The reason I started this look at EHR selection websites is because EHR Selector has rolled out an Open Beta with new features. The best feature they’ve rolled out is that EHR selector is now free for everyone to use. I was pretty harsh on EHR selector in the past for charging doctors to use their service. That business model just didn’t make sense to me. Ironically, Carl Bergman (one of the people behind EHR Selector), has since become a regular reader of this site and we regularly exchange emails about the EHR world. So, I’m glad that he converted the service to a free service for everyone to use.

I tried out the new release of EHR selector and I have some mixed reviews. It is a beta release so that’s partially to be expected. I was a bit overwhelmed by the number of fields I had to complete to get into the tool. I imagine that could be streamlined some to make it a better experience for the user. Although, I expect the data is part of the reason the service can be made free. Plus, the more data you offer, the better customized experience the EHR selection tool can offer you.

What I do love about EHR Selector is that it’s always had a deep set of data available. I wonder if this will backfire for some users thanks to the paradox of choice. Although, as a data lover I really love all the data. Plus, they could help solve this issue with how they choose to display the various EHR and their data with a beautiful UI. I don’t think the UI is to that point yet, but having the data is the first step in that process.

My favorite feature of EHR Selector is the Compare EHR feature. I love seeing the features of multiple EHR’s compared side by side. This is where all the EHR data points becomes really valuable as well. One thing I do wish is there was more than just a check mark for each EHR data point. I’d love to have some qualitative description or images of each data point so you could really compare the EHR features that matter most to you.

One of the other shortcomings of EHR Selector is they haven’t yet gotten the data for all 300+ EHR vendors. No doubt that’s a daunting task and you have to start somewhere. I expect they’ll work to resolve this over time. Plus, they need the support of the EHR vendors to be able to get the data as well (not always an easy task).

Certainly EHR Selector isn’t perfect yet, but with its new Free feature it’s worth taking a look at if you’re in the market for an EHR. It’s another nice data point in the EHR selection process.

EMR Switching Encouraged by Meaningful Use

Posted on March 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For the past year or so I’ve been predicting that one of the top EMR and EHR related topics will be EMR switching. Yes, that’s right. A practice or doctor switching from one EMR to another EMR. At HIMSS it was suggested to me that meaningful use was a big driver in doctors switching EMR software.

I find the idea of meaningful use driving doctors to change EHR software quite interesting. It makes some sense when you consider that some of the EHR software that doctors currently use isn’t a certified EHR and/or will make it difficult for them to show meaningful use. More common is the HUGE number of physicians that have to upgrade their EHR software. This is a bit of a travesty to me. In any release of EHR software there’s always a mix of new features, security fixes and other optimization. Why a doctor wouldn’t want all of these things is hard for me to understand.

I guess part of the problem with staying updated to the latest EHR software has to do with the client server model that many EHR software companies use. Upgraded client server software isn’t always easy or fun. There’s some things you can do to streamline it, but it takes time. When the upgrade doesn’t offer a new feature that a doctor wants to get his hands on, it’s hard to justify the costs associated with the upgrade. I’m talking about time costs to upgrade, not software costs to upgrade. Unfortunately, most doctors don’t think too much about the security implications of not updating their EHR software.

Meaningful use has definitely gotten a lot of doctors to upgrade or replace their EHR software. This seems like something that should have happened naturally, but I believe it’s a good outcome of meaningful use.

Going back to switching EMR software, I’ve heard from a number of EMR vendors that some of their best EMR sales are to those that already have an EMR. I know I’ve done a much better job buying my second cell phone than I did my first. I knew what I really wanted when I bought my second one. The same seems to apply to doctors buying their second EMR.

Don’t get me wrong. I’m not advocating that doctors switch EHR in order to get a better one necessarily. It would be a really terrible thing if the way to get a quality EHR was to implement one first and then switch EHR. However, as time goes on there are going to be a HUGE variety of reasons to switch EHR software. Meaningful use might be driving EMR switching today, but there are going to be other factors driving doctors to change EMR in the future. Not the least of which could be a large number of doctors who focused too much on meaningful use and EHR incentive money and not nearly enough on the way the EHR selected will impact their practice. The other likely cause will be EHR consolidation and EHR software companies going out of business.

The real problem with all this EHR switching will be the lack of standards and flexibility around pulling the data out of the old EHR. I still have in mind some ways to hopefully help with this problem, but it’s a monumental task.