When Does EHR Optimization Beat Replacement?

By Megan Williams, contributing writer

Poor results after an EHR (electronic health records) implementation may leave a hospital or facility wanting to scrap a project altogether and start from scratch. Depending on the situation though, this may not be the best option.

An attentive solutions provider will be able to step into a situation and determine whether a brand new (and expensive) EHR solution is the best option to address a facility’s clinical information issue, or whether a well-thought-out optimization is actually a better option.

A good example of this decision making process is found in the case of the 28-provider, United Regional Physician Group (URPG), that was faced with a failing and frustrating EHR, and contemplating getting rid of the system and starting with a new implementation.

The Problem

The URPG staff and clinicians were highly dissatisfied with their EHR. Trouble tickets were going nowhere, staff wasn’t properly trained, the system was not working well, and their consultants, ECG Management Consultants, had informed their leadership that a replacement would be lengthy and difficult.

The Cause

After some digging, ECG found that there had been high turnover in the IT department when the current system was implemented four years ago. Beyond that, the system was in no way being used to its full capacity.

Michelle Holmes, a principal at ECG put it this way, “When we lifted the hood and looked underneath, it was clear that implementation was barebones and training was optional. Key processes such as new user training were not even in place.” The system had no workflow request or other change management process in place and was additionally three versions behind on updates. Many functions had not been turned on and the support staff assigned was inadequate.

The Solution

ECG explained to URPG leadership that the process of implementing a new system would be long, and expensive, and instead suggested they consider an EHR optimization, especially since Stage 3 Meaningful Use had not been defined.

They began by asking a series of questions,

• Had URPG efficiently leveraged the existing systems?
• Were the users adequately trained?
• Were their needs at the time different than when the system was installed?
• Was physician dissatisfaction the primary reason they were considering replacement?

ECG decided that if the answers to all the questions other than the last one were “no,” then they would not switch systems, and instead would begin on a plan that included evaluations of data optimization and governance, strategic initiatives, operating metrics, project status, and infrastructure. ECG also conducted a survey to establish a baseline of current capabilities and to help them establish what issues they wanted to target.

ECG then conducted role-based use proficiency assessment of about 100 users, finding low levels and that most service requests fell off into limbo. New policies and procedures were created for the enhancement process, change control, and service desk. Scheduling was optimized, payment issues were addressed, and tasking and work log functions were implemented.

The Results

URPG, which at the time, had not yet qualified for Stage 1 Meaningful Use, recently became a Meaningful Use organization and currently submits measures to the PQRS system. The care system now also has an established infrastructure for upgrades and maintenance, as well as being live on a patient portal and HIE (something only 34 percent of hospitals had achieved as of September of this year.)

Going Deeper
To read more detail about the full results of the optimization, you can access the original article at HealthData Management here.

To read more about data governance and the important role it can play in situations like this one, read "Data Governance: A Subject New To Your Healthcare IT Clients," which takes an overview of the subject and provides tools on helping your clients get started with the concept.