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Has Electronic Health Record Replacement Failed?

Posted on June 23, 2016 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Galen Healthcare.
Justin Campbell
A recent Black Book survey of hospital executives and IT employees who have replaced their Electronic Health Record system in the past three years paints a grim picture. Respondents report higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits of switching systems. Specifically:

  • 14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive level respondents admitted they feared losing their jobs as a result of the EHR replacement process
  • 66% of system users believe that interoperability and patient data exchange functionality have declined

Surely, this was not the outcome expected when hospitals rushed to replace paper records in response to Congressional incentives (and penalties) included in the 2009 American Recovery and Reinvestment Act.

But the disappointment reflected in this survey only sheds light on part of the story. The majority of hospitals depicted here were already in financial difficulty. It is understandable that they felt impelled to make a significant change and to do so as quickly as possible. But installing an electronic record system, or replacing one that is antiquated, requires much more than a decision to do so. We should not be surprised that a complex undertaking like this would be burdened by complicated and confusing challenges, chief among which turned out to be “usability” and acceptance.

Another Black Book report, this one from 2013, revealed:

  • 66% of doctors using EHR systems did not do so willingly
  • 87% of those unwilling to use the system claimed usability as their primary complaint
  • 84% of physician groups chose their EHR to reach meaningful use incentives
  • 92% of practices described their EHR as “clunky” and/or difficult to use

None of this should surprise us but we need to ask: was usability really the key driver for EHR replacement? Is usability alone accountable for lost revenue, employment anxiety and buyers’ remorse? Surely organizations would not have dumped millions into failed EHR implementations only to rip-and-replace them due to usability problems and provider dissatisfaction. Indeed, despite the persistence of functional obstacles such as outdated technology, hospitals continue to make new EMR purchases. Maybe the “reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data,” wrote Dr. Donald Voltz, MD in EMR and EHR.

Interoperability is linked to another one of the main drivers of EHR replacement: the mission to support value-based care, that is, to improve the delivery of care by streamlining operations and facilitating the exchange of health information between a hospital’s own providers and the caregivers at other hospitals or health facilities. This can be almost impossible to achieve if hospitals have legacy systems that include multiple and non-communicative EHRs.

As explained by Chief Nurse Executive Gail Carlson, in an article for Modern Healthcare, “Interoperability between EHRs has become crucial for their successful integration of operations – and sometimes requires dumping legacy systems that can’t talk to each other.

Many hospitals have numerous ancillary services, each with their own programs. The EHRs are often “best of breed.” That means they employ highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between these departments is compromised because they display data differently.

In order to judge EHR replacement outcomes objectively, one needs to not just examine the near-term financials and sentiment (admittedly, replacement causes disruption and is not easy), but to also take a holistic view of the impact to the system’s portfolio by way of simplification and future positioning for value-based care. The majority of the negative sentiment and disappointing outcomes may actually stem from the migration and new system implementation process in and of itself. Many groups likely underestimated the scope of the undertaking and compromised new system adoption through a lackluster migration.

Not everyone plunged into the replacement frenzy. Some pursued a solution such as dBMotion to foster care for patients via intercommunications across all care venues. In fact, Allscripts acquired dBMotion to solve for interoperability between its inpatient solution (Eclipsys SCM) and its outpatient EMR offering (Touchworks). dBMotion provides a solution for those organizations with different inpatient and outpatient vendors, offering semantic interoperability, vocabulary management, EMPI and ultimately facilitating a true community-based record.

Yet others chose to optimize what they had, driven by financial constraints. There is a thin line separating EHR replacement from EHR optimization. This is especially true for those HCOs that are neither large enough nor sufficiently funded to be able to afford a replacement; they are instead forced to squeeze out the most value they can from their current investment.

The optimization path is much more pronounced with MEDITECH clients, where a large percentage of their base remains on the legacy MAGIC and C/S platforms.

Denni McColm, a hospital CIO, told healthsystemCIO why many MEDITECH clients are watching and waiting before they commit to a more advanced platform:

“We’re on MEDITECH’s Client/Server version, which is not their older version and not their newest version, and we have it implemented really everywhere that MEDITECH serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years to get the ambulatory interface for the providers. It should be very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it,” but we’ll decide when the time is right, she says.

What can we discern from these different approaches and studies?  It’s too early to be sure of the final score. One thing is certain though: the migrations and archival underpinnings of system replacement are essential. They allow the replacement to deliver on the promise of improved usability, enhanced interoperability and take us closer to the goal of value-based care.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

EHR Data Extraction and Clinical Conversion

Posted on July 5, 2011 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 think it’s quite easy to predict that 3-5 years from now, one of the top topics on this blog and in the EHR world as a whole is going to be around EHR data extraction or if you prefer EMR data conversion. I’ve previously predicted that by the end of the EHR stimulus money we’re be lucky to achieve 50% EHR adoption. So, you’d think that in 3-5 years we’d still be talking about EHR selection and implementation. Certainly, that will still be a topic of discussion. Not to mention, which EHR vendor they should go to for their second EHR. However, I am certain that 3-5 years from now we’re going to see a mass of doctors switching EHR vendors.

As part of my EHR blog week challenge (if you’re a blogger, you should participate too), today I’m going to highlight one of the foremost EHR professional and technical services company’s blog, Galen Healthcare Solutions which focuses on EHR data conversion.

I know I’ve written about EMR data conversion a number of times before. Although, I haven’t written about it much for quite a while. I guess meaningful use and the EHR incentive money has kind of dominated the conversation. However, there’s much that can and should be said about EHR data conversion.

The first thing anyone should know about EHR data conversion is that it’s not easy. In fact, it’s quite frankly an incredibly painful experience in almost every regard. Just take a look at this blog post summary of the EHR Clinical data conversion process by Justin Campbell of Galen Healthcare Solutions. He summarizes the steps as follows:
* Data Extraction
* Data Analysis: Cross-Referencing
* Design: Data Filtering, Matching (Provider, Patient Item), and Exceptions/Errors
* Testing
* Go-Live

I believe the most challenging item on this list is likely the Data Extraction. Sure, the data analysis and design are a pain to do and do well. However, the data extraction is often the most difficult part of an EHR data conversion, because you’re often working with an unfriendly EHR vendor that has lost you as a customer. Unfortunately, many EHR vendors haven’t heeded my call for EHR data independence, and so it can be a miserable experience trying to get the information and access you need to do an EHR data conversion. In some cases the EHR vendors will try and hold that data hostage.

The key for those selecting an EHR software is to be sure that the process for exporting your data from the EHR is part of your EHR contract. If it’s not, then add it to your contract. If they won’t add it to your contract, there are 300+ EHR vendors to choose from. Certainly it’s a part of the EHR contract that you hope to never have to use. Don’t take that risk.

Justin Campbell has also posted a few different data conversion success stories on the Galen Healthcare Solutions blog. Obviously, Galen has a lot of experience with the Allscripts Professional EHR software and so you’ll note this bias throughout the blog. However, the experience of the conversion is very interesting.

Here’s a paragraph from one of their data conversion success stories: Azalea Orthopedics.

To facilitate this conversion, flat-file extracts were obtained from MedManager for dictionaries, demographics and appointments. However, instead of using these extracts to import into Allscripts PM, an alternative approach was taken in which real-time appointment and demographic interfaces were deployed from the client’s existing Allscripts Enterprise EHR to the new Allscripts PM environment. This offered the flexibility of having the PM data populate real-time. Interfaces were also required from Allscripts PM to Allscripts Enterprise EHR. Thus as part of the go-live, existing reg/sched interfaces from MedManager to Allscripts Enterprise EHR needed to be deployed.

I have to admit that this kind of complexity in healthcare is what drives so many doctors nuts. I’m sure there were some functional reasons that they had to do all these interfaces between the systems. What I don’t understand is why the interfaces need to stay in place after the conversion is complete (at least if I understand it correctly). Did Galen really have to implement an interface between Allscripts PM and Allscripts Enterprise EHR? I’m sure there’s some long history for why this has to happen, but it’s such a terrible design. Certainly this isn’t Galen’s fault, but Allscripts. Interfaces are really great….when they work. When they don’t work, they drive a clinic, the IT person and even the EHR vendor absolutely nuts. I’ll be interested to learn more from Galen about why they did what they did.

I did find their report on the number of transactions processed fascinating:
Demographics: 156,900 processed in 491 minutes (8.18 hours)
Appointments; 313,280 processed in 1570 minutes (26.17 hours)

That’s a lot of data being processed. Can you imagine having to run the 26 hour data conversion twice if you messed it up the first time? Yep, data conversion is a tricky thing and can be very time consuming if you’re not really thorough in the process.

Imagine how much data will be collected 5 years from now with all these EHR implementations happening. Plus, the above data was only appointments and demographics. It doesn’t even include the physicians charting and other clinical data.