D'Arcy Gue

Changing EMRS? This Time Make Your Users Happy.

July 23, 2015

Healthcare IT, IT Project Management 6 Minute Read

A notable, negative outcome of Meaningful Use / MIPS has been discontent.

One-third of physician EMR users were “very dissatisfied” with the ability of their EMR to decrease their workload,  according to a 2013 survey by the American College of Physicians. A RAND Corporation study points to EMR usability issues, interference with face-to-face patient care, and a degradation of clinical documentation. Surprisingly, the more functionality an EMR possesses, the more likely the physician is to find it unsatisfactory.

The in-the-weeds reasons are many: The system is too complex, it isn’t in tune with the particular environment, time is wasted on electronics that should be spent on patients, IT staff can’t keep up with support needs,  the vendor is unresponsive to concerns…even… too many clicks are required.

The rush to meet Meaningful Use / MIPS deadlines and the general inexperience of hospitals with compliant EMRs has, in many cases, produced internal operational issues never expected or planned for. These are interfering with physicians’ daily processes and overall quality of patient care. How can you  change this situation?

With the kind of feedback above — not to mention the daily complaints physicians are voicing to executive leadership — it’s no wonder that many hospitals are thinking about pitching their EMR for a better replacement.   Indeed, there are times when it makes absolute sense. We have worked with several hospital groups discussing the purchase of a new EMR solution, for the following good reasons:

  • Excessive Complexity/Cost: One hospital client is finding it difficult to maintain its EMR with its current level of expertise..and at its size the hospital can’t afford to expand resources.  The IT staff is swamped by physician requests to install new capabilities — which only make things worse.  The hospital has also discovered that the costs of both maintaining and performing critical upgrades, such as those required for Meaningful Use / MIPS and ICD-10, far exceed their expectations.
  • Difficult Integration: Another client is unhappy with the level of integration it has been able to achieve in the operating environment. This has led to duplicate work by physicians and nurses, greater potential for error, and significant dissatisfaction. Their EMR vendor is proprietary about allowing interfaced connections, with almost every interface connection costing $25,000 – $50,000 from the EMR side — and those interfaces are inflexible in their implementations.
  • Unsupported Technology: Two more customers are facing systems at their end of life.   One hospital’s EMR is scheduled for sunset in 3 years, and the other has a product that will be supported a while, but will not be not updated/certified for MU Stage 3. Both McKesson Horizon Clinical and Siemens/Cerner MS4 customers are currently facing issues of this type.

What These Issues Have In Common:

All of these examples are about business/IT strategy. When the current EMR product doesn’t, can’t, or won’t meet the long term needs of the organization, system replacement makes good business sense.  In other articles, we have discussed a potential alternative to replacement — optimizing the current EMR. This can be a better choice if the issues surrounding the installation are process/organizational problems.

In any case, recognize that the end result of physicians’ dissatisfaction with current EMR implementation is much broader: it morphs into a lack of trust in the system, the IT staff, the organization’s capability of properly installing a new system,and even the judgement and agendas of the organization’s executive management. If not addressed, this culture of lack of faith will likely persist through whatever path is chosen, going forward.

How to Select a New System that Will Make Physicians Happier?

The decision to replace core information systems is one of the largest and most critical decisions a hospital or health system can make.   Selecting, installing, and maintaining core systems, requires an intimate understanding of the broad spectrum of organizational needs, including a complete understanding of the clinical work processes required, and the needs of physicians and clinicians. And, the endeavor is very expensive.

Our approach to a system selection includes the following steps:

  • Build a cross-functional system selection team driven by a leader with experience in selecting and implementing clinical systems. In many cases, this person is best found outside the organization, either as an independent, objective consultant or as a new hire with broad vendor knowledge. In addition to his or her knowledge of system selection methodology, this team addition won’t be weighted down by the baggage of having been involved in the most recent EMR install. The team must also include senior leadership and a broad range of active, concerned physician, nursing, and other operational partners.
  • Current State  and Needs Assessment – Before your organization makes any decision to change EHRS it should conduct an in-depth review of the current state of  existing systems and workflow processes to develop a detailed understanding of the specific functional requirements that must be met by a replacement system. Also determine who the most important users  of their system are — such as physicians, clinicians, caregivers, administrators, finance staff, HIM, ancillary departments and allied health — and develop a needs assessment tied to those individual groups. Short changing this step will definitely cause issues during and after install. which will affect many workflow and patient care facets.
  • RFP Development – Base the RFP on the functional requirements that have been identified.
  • RFP Publication – RFPs should be released to selected vendors only. This will minimize confusion and extraneous influences causing challenges during the procurement.
  • Response Evaluation – The vendor responses should be evaluated against scoring criteria developed alongside the RFP.   We note that classical “scoring” has limitations that can be overcome by other evaluation methods which we often recommend in our selections.
  • On-Site Demonstrations – The top two candidates should be invited to your site to demonstrate their solutions to stakeholders, following a pre-determined set of objectives.
  • Site Visits – Key members of the project team will visit customer sites where the products under consideration are deployed, again with a predetermined set of objectives, which will be scored.
  • Summary of Findings – The project team must tabulate the results of the RFP, demonstrations, examine the total cost of ownership, determine risks to the organization of the solutions presented, and then prepare a final recommendation of the vendor of choice. Finally, open communication on these results to all major stakeholders, including physician leadership is essential. The term “buy-in” is critical here…go for it!

Hospitals rarely have extensive experience in large system selection, and if you are replacing an EMR gone wrong, your past experience may not have been helpful. Phoenix consultants have decades of experience selecting and implementing systems that meet hospital organizational needs. The highest quality procurement consultants emphasize physician involvement and buy-in in the process, to achieve their satisfaction with the end results — in addition to the many other business, financial and other realities that must be taken into consideration.

If you’d like to learn more, including our methodologies and standards for successful EMR selection, please contact us!



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