Executive Session: Should your EHR system stay or should it go? Podcast Electronic Health Records Sign in to save David N. Gans MSHA, FACMPE, SENIOR FELLOW Key takeaway: Without a holistic assessment of your organization's information technology needs and thorough vetting of vendor offerings, the decision to add bolt-on services to an existing EHR system or selection of a new EHR altogether may result in increased expenses that don't move the needle on functionality or quality metric reporting. As noted in my recent Data Mine feature, healthcare leaders understand that investments in information technology (IT) are critical to their organization’s success. Unfortunately, most healthcare organizations are very dissatisfied or describe experiencing a sizable amount of pain over their IT systems. It may have a lot to do with the trend of IT costs. Looking at data reported by multispecialty groups in the 2017 MGMA DataDive Cost and Revenue, physician-owned groups with primary and specialty care are spending about 90% more on IT equipment, maintenance and software costs than they did 10 years ago. This increase in a practice’s overhead heightens the importance that practice executives take a holistic approach to EHR systems and the organization’s IT strategy when it comes time to make a change, whether that’s bolting on ancillary applications or selecting a new EHR vendor altogether. Dr. Marion Jenkins, founding partner at HealthSpaces, is an ideal person to describe how executives should approach this topic. He has an excellent perspective on the issues based on his work in helping healthcare organizations of all sizes and sophistication define and successfully execute viable IT strategies. “For most organizations, their EHR is the primary IT application, but there’s a whole host of add-on applications that enter the mix,” Jenkins says. “There’s lots of integrations in addition to the EHR … while more and more is being asked of the EHR, so what started out as a relatively straightforward set of requirements has grown dramatically.” Many EHRs were sold on the concept of being a paperless solution; however, first-generation EHRs essentially automated a paper medical record. The reality today is not much different, in that EHRs have become increasingly complex and have undone the promise of administrative simplification. “We see practices using more paper now than they were back in the day, even with electronic systems,” Jenkins says. “A lot of that has to do with the fact that the practice didn’t kill off their old processes.” The sprawl of bolt-on applications that perform just one or two functions, such as patient check-in, is a contributor to this issue. The struggle to keep up with regulatory mandates also stymied many EHR products in comparison to what happened in consumer-focused apps and devices. Quality reporting is a major focus for governmental and commercial value-based payment programs, which have necessitated further EHR complexity. “For the last several years, EHRs have been the primary repository for quality metrics and are the engine that drives Meaningful Use and now MACRA and MIPS compliance. So much of the so-called new functionality has really done little to improve the clinician and patient experience,” Jenkins says. EHRs have not kept "up to date with the kinds of technologies that users are accustomed to with their smartphone apps, with touch-and-click [functions] that are much more user friendly.” Jenkins recommends that practice leaders take a lead role in defining what it is their organization wants from their EHR system and that they need to determine their organizations' broader IT strategy and long-range planning. “People get to a certain point and get frustrated and then say, ‘We want something new.’ They don’t really spend the time just deciding what is it that they need that’s new and what are their most important criteria,” Jenkins says. This may lead to inviting a few vendors for presentations and letting the vendors drive the conversation, giving product demos that are tailored to the software’s strengths as opposed to the real-world needs in the organization. “The practice needs to have their agenda as to what important, and not accept the vendor’s agenda,” Jenkins says. “The vendors are not evil; however, they don’t have the practice’s best interest. The practice is the only thing that has the practice’s best interest. “The C-suite needs to work with their physicians and the other stakeholders in finding out what are the critical items and prioritize and rank those” in a framework assessment involving risk, cost and performance, Jenkins says. This should include your existing system scored on the same criteria and then “put them through the same evaluation process.” Narrowing the field of vendors also requires assessing the organizational needs to be improved or eliminated. In some cases, your practice may not be maximizing the functionality of its current system, which can lead to acquiring an ancillary application or service that creates redundancy and waste. “You need to look very closely from a financial standpoint [for] the true cost of these integrations, ongoing support, ongoing maintenance and training,” Jenkins says. On the other side of that coin, the amount of user-friendliness of the system needs to have a value affixed to properly estimate your return on investment. While Jenkins cautions there is no killer app right now, building your EHR assessment into the broader scope of your IT strategy for phone systems, PAC systems, labs systems, e-prescribing and the like is essential. “There is no single company or solution that is going to put all this together … You’re always going to have points of interface and points of integration. You want to try to maximize the functionality of your major systems and then make sure that the add-on systems are going to tie in and work with those the best you can,” Jenkins says. That means creating a strategic initiative: “Ranking and scoring, get all of the functions that everybody needs — from the billing office to the call center, to the lab, X-ray, to providers, front office, back office. … Synthesize all the factors and then … develop a strategy around that,” Jenkins recommends. Be sure to listen to the full conversation via the Soundcloud player at the top of this page for more insights into my conversation with Marion Jenkins. Executive Session will return on Aug. 16 with my conversation with David Baker of Health Facility Advisers of Denver on key issues facing healthcare executives regarding the optimization of the care environment. Learn more Sign up for MGMA18 | The Annual Conference, Sept. 30-Oct. 3 in Boston, to attend David Gans' session on this topic, as well as numerous other educational sessions led by industry-leading experts. Read about how the Mayo Clinic moved to a single, enterprise-wide EHR in the July Executive View case study. Find more health information technology content in the July issue of MGMA Connection magazine.