About 10 years ago, family practice physician Giuseppe Marzella was thrilled to purchase an EHR system for his 10-person, two-physician East Hanover, N.J., practice.
But what began as a quest to streamline a paper-based work flow turned into a staff-wide headache when Marzella's colleagues complained that the technology was too slow and difficult to use. A simple task such as going back to change a field, for example, required sifting through several other fields first.
So the self-described technology enthusiast scrapped the system after just one year.
"It was too complicated and cumbersome," Marzella recalls. "It just wasn't readily accessible; it just bogged down the system."
Marzella's practice made a decision two years ago to try again, giving an EHR system by Amazing Charts a three-month trial run. That was after passage of the federal stimulus bill that included money to encourage practices to purchase EHRs, but before the government had developed rules on qualifying for the money known as "meaningful use."
The new system was much more user-friendly, Marzella says. And by the time CMS announced those rules last July, he felt quite relieved because the vendor committed to making timely upgrades so his practice could comply with meaningful use requirements. Unlike some of his peers, he won’t need to test out another cumbersome EHR.
"I have quite a few friends who are physicians who have adopted an EHR who are now scrapping their systems" in order to comply with the new requirements, he says.
Like Marzella, hundreds of physicians who had already invested in EHRs prior to the release of the meaningful use requirements are now scrambling to bring their current systems into the era of EHR 2.0. Though the issue of getting staff to give up their paper habits may have diminished, these early adopters face other challenges — making sure their EHR is certified, ensuring compatibility with health information exchanges (HIE), and deciding whether investing in a whole new EHR system might be a better option for the future.
So how can you make the best decision without going broke on updates or consulting fees? When is it more cost-effective to purchase a new, spruced-up EHR?
The good news is that by focusing on your long-term EHR goals, such as qualifying for all meaningful use incentive funds and improving patient outcomes, you should save money and time — and experience fewer transitional snafus.
EHR systems: then and now
Not long ago, EHRs were little more than just digitized versions of paper records. Today they are the electronic systems by which a practice collects and transmits patient data, more easily accesses patient records, e-prescribes, and ultimately improves patient care.
"If we go back five or six years ago before any of this meaningful use stuff started to develop, the whole idea and concept was really just to have a digital record," says Susanne Madden, president of The Verden Group, a consulting group that works with practices. "I think the idea of the old EHRs is really [based on] ease of use when putting information in, but not a lot of thought [was given] to extracting information out, particularly when we look at physician systems."
For many smaller EHR vendors that entered the market pre-2010, the primary goal wasn't to create a product that could be used to transmit sensitive patient data.
"For a lot of smaller vendors, it really [was] about just about having nice clean interfaces, being able to access the record in a digital form," says Madden.
In the last 12 months, the priorities of both physician practices and the vendors have shifted. Today, vendors that want to sell to practices must offer EHR systems that are certified to meet the meaningful use requirements to collect federal incentives, because practices won't buy anything that doesn't.
"Basically, the biggest challenge physicians are facing is the whole concept of meaningful use adoption, and the other mandates that are coming down the pipeline, like the ICD-10 changes," says Rajiv Sabharwal, AVP and chief solution architect of the healthcare provider sector at software firm InfoSys. "Now orders have to be computerized, prescriptions have to be computerized."
Old vs. new
The EHR stimulus program, included in the larger economic stimulus package that Congress passed in January 2009, was designed to encourage practices and health systems to adopt and meaningfully use EHRs. Those providers who had already purchased systems prior to the passage of the stimulus would be allowed to cash in on the incentives — up to $44,000 per provider, under the Medicare program — as long as they met CMS' rules demonstrating that they are using their systems in a meaningful way.
