Many health care organizations are now several years into implementing and using their electronic health record systems and are coming up for air to ask “should we switch EHRs?” The Massachusetts eHealth Collaborative has helped many providers determine when it’s time to switch and where to go to next. Here are some of the things our customers have found to be crucial in making their EHR switching decisions:
Strategy first: It is really difficult to objectively assess the current situation and vendor in the absence of a clear strategy, or at the very least, some well accepted organizational priorities. Requirements for a new vendor selection also flow directly from the strategy. Take the time to understand your changing healthcare environment and articulate your priorities on both the clinical and business sides. The technology decision actually creates a good impetus for focusing leadership and staff on what is most important to the organization. It is well worth it to create a process where staff may voice their desires and concerns and then you can do the careful work to bring the organization to consensus. Organizations that try to make technology decisions without consensus on strategic priorities find that vendor switching and vendor selection choices become completely muddied by unresolved, unvoiced, and competing views of what is most important to the organization.
Separate the technology from change management and training issues: When you continuously hear “this EHR system is awful” (or worse) there is some work to do to tease out technology issues, change management pain points, and product knowledge/training shortcomings. This can be done efficiently through interviews with leading, lagging, and somewhere in the middle EHR users. Before your organization jumps to the question “what new EHR should we choose?” you will be well served to share the nuance of the problem you are trying to solve with everyone involved. Remember that unresolved change management and knowledge issues will accompany the organization to a newly selected EHR so deal with these challenges up front.
Dispel the myth of the silver bullet: Users have understandably high expectations for their EHR system. These expectations often come from the other parts of the user’s life where he or she uses mature technical services for everything from booking a vacation, to managing money, to filing taxes. Unfortunately, expectations of EHR users need to be carefully reset when it comes to health care. Care activities are more complex than most other parts of the economy and delivery of care is highly variable among different health care organizations. This has resulted in technology that is less mature than other parts of the internet economy and users should be prepared for the fact that the technology will not solve all of their needs.
Separate EHR issues (globally) from specific vendor/product issues: Though all EHRs are not created equal, there are some challenges that all EHRs share. Clinical workflows and taxonomies are highly varied among and within health care organizations. It is inevitable that an EHR workflow or a nomenclature decision will not align with at least some clinicians. Users may need to be briefed on these factors so they can set expectations for their current EHR and any other EHR vendors they are looking at.
Talk to peer organizations: One of the best ways to figure out if and how to switch vendors is to go out and visit peer organizations. Pick a range of peers that are on the same EHR as you and on other EHRs in which you are interested. Pick peers that are both happy and dissatisfied with their EHRs to gain a nuanced view of each vendor. Vendors can offer references but you can eliminate some bias by finding your own peers.
Ground RFP writing and vendor selection in consensus requirements: When you get beyond the switching decision, consensus requirements are the north star of a successful vendor selection process. Consensus requirements flow from the strategic priorities upon which everyone agrees. These requirements focus the vendors on what is most important and they will use this information when proposing and demonstrating their products. The requirements give the selection committee an objective frame for choosing among the top 2-3 vendors that rise to the top. At the end of the process, the organization will be able to unite behind the decision to select the vendor that best meets the requirements agreed to up front.
Understand switching costs clearly: There are inevitable productivity gains and losses that come with an EHR switch. Take the time to understand these and be realistic with what the transition will costs in terms of money, time, and management oversight. Many organizations reduce their patient loads (and revenue forecasts) to clear the way for staff learning during transition. Final decisions often (un)hinge on the costs so take the time to tease out the nuances of the options with both the transition costs and longer term (5 year) horizon clearly articulated for your organization’s financial leadership.
If you are interested in this topic, watch for a more detailed white paper on vendor selection on the Advisory Services page of our website.