More than 90 percent of the country's hospitals have received an incentive payment for their adoption or use of an electronic health record system, and the EHR implementations are expected to continue: About half of hospitals with 200 or more beds plan on purchasing a new EHR system by 2016, according to a survey from KLAS.
However, on the path to incentive payments and improved patient care lie a variety of potential pitfalls to EHR adoption.
1. Unexpected costs. Hospitals and health systems are often unaware just how much an EHR implementation will cost, according to a study in the Journal of the American Medical Informatics Association. After interviews with leaders of hospitals and health systems undergoing EHR implementations, the researchers concluded the costs for all aspects of the implementation, from training to facilities to infrastructure costs, were often underestimated.
2. Missed deadlines. Meaningful use has put a time crunch on EHR implementations across the country. With deadlines looming and vendors scrambling to get certified products to their customers, unexpected delays or competing priorities can lead to organizations missing deadlines and incurring meaningful use penalties.
Intermountain Healthcare, based in Salt Lake City, has already announced it will not be attesting to meaningful use stage 2 this year. The health system, which is in the middle of an organizationwide Cerner implementation, said focusing on the implementation and ensuring patient safety during the transition takes precedence over attestation.
3. Physician dissatisfaction. Implementing a new system is bound to lead to initial stumbling and glitches in day-to-day operations, frustrating physicians, said Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative. He said because a little trouble is inevitable, it is important to educate physicians on the technology, along with how it can help them improve patient care. "Even the best of implementations have bad spots, and without that context, people abandon technology," he said.
4. Workflow interruptions. According to a survey from the Healthcare Financial Management Association, 46 percent of organizations took between one and two years to resume normal workflow after an EHR install, and 11 percent took between two and three years.
"Workflow changes a lot when you switch to electronics," said Brittany Peters, a project manager at Providence Medical Center in Wayne, Neb. To minimize these disruptions, the hospital began weekly meetings to share best practices and keep tabs on issues as they arise. "[The meetings] helped us be in constant contact with our staff, which is necessary when so many changes are impacting every aspect of workflow," said Wendi Dwinell, a project manager at Providence.
5. Credit challenges. Recently, several hospitals, including HealthEast Care System in St. Paul, Minn., and Saint Luke's Health System in Kansas City, Mo., have experienced credit challenges related to a recent EHR implementation. Often, these credit challenges result from the large capital outlays needed to install an EHR and a loss in productivity without having an adequate financial cushion.
6. Vendor shortcomings. In December, Mountainview Medical Center in White Sulphur Springs, Mont., filed a lawsuit against NextGen Healthcare for allegedly failing to install a meaningful use-compliant system on time.
While this type of lawsuit is relatively rare, vendor shortcomings have and will continue to prompt a non-negligible number of providers to switch to a new system. About one in six providers will replace their EHR system in the next year, according to Black Book Rankings, most of which did not adequately access their EHR vendor prior to purchase.
7. Achieving meaningful use, but little else. According to a survey conducted by Stoltenberg Consulting at HIMSS' annual conference in Orlando, Fla., in February, more than 70 percent of the 211 IT professionals surveyed said their hospital, health system or physician practice has successfully attested to meaningful use stage 1 but has not yet maximized the full potential of its EHR to improve care and workflow efficiencies.
Getting the maximum value out of EHRs requires using the data intelligently to improve clinicians' workflow by providing additional, actionable intelligence, said Shane Pilcher, vice president of Stoltenberg Consulting. "Just getting a physician in front of a computer isn't enough…You have to get all the functionality out of the application and drive [the physicians] with information to help them better understand what's going on with their patients," he said.
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