Selecting and implementing an EHR is a serious commitment. Hospitals and health systems invest multiple years and millions of dollars in these systems that serve as the lynch pin of how health data is stored and shared. But, not all commitments stand the test of time. What happens when an organization decides to look elsewhere for an EHR vendor?
What causes a break up?
Considering the time and capital poured into rolling out and maintaining an EHR, dropping one system for another is not a decision made lightly. One of the most common reasons hospitals and health systems pursue another EHR vendor boils down to the original decision-making process: It simply wasn't done right.
A critical element of choosing an EHR, the right EHR, is having buy-in from not only executive leaders but the system's end users. "The physicians need to be an active participant in the selection process," says Matt Adams, a healthcare IT analyst with MD Buyline, the Texas-based strategic sourcing and contract management company, focused on healthcare. If they aren't, justifiably or not, dissatisfaction with the EHR will likely be high and serve as a major impetus behind the choice to move to a new system.
Though consensus among leadership, physicians and all EHR users is an important element of selecting an EHR, it does not guarantee success. Despite common ground prior to implementation, an EHR can prove to be better in theory than in practice, or a hospital's needs can just evolve beyond what a system can offer. Such was the case at one 238-bed community hospital: "We replaced our vendor because they did not have all of the functionality we required at our facility," says Cindy Peterson, vice president and CIO of Henry Mayo Newhall Hospital in Valencia, Calif.
Henry Mayo Newhall Hospital switched from Keane-First Data to MEDITECH in 2007. The hospital is still using MEDITECH today. “It takes a lot to switch to a new vendor but organizations need to do so if their current vendor is not offering what they need to meet their strategic goals. Fortunately, for the past eight years, MEDITECH has been introducing new functionality that meets our continually evolving needs. In fact, we are moving to MEDITECH 6.16 because we have confidence in our vendor. As a result, we can focus on our goals to improve patient care, patient safety, reduce costs and better serve our community," Ms. Peterson says.
In other cases, the type of vendor may be the motive behind an EHR change. The best-of-breed EHR is generally being left behind in favor of an enterprise EHR. Hospitals and health systems using a best-of-breed approach, one in which they select each solution for its respective qualities, may feel the pressures of the regulatory environment dictate a transition to a single vendor strategy. "The cost and resources to maintain a best-of-breed system may be higher than desired," says Ms. Peterson.
In the case of larger health systems, different hospitals may use different EHRs. Consolidation can motivate major desire to switch. Just this year, Mayo Clinic, based in Rochester, Minn., selected Epic's EHR and revenue cycle management system. This move means Mayo will consolidate all of its locations onto a single EHR, dropping contracts with Cerner and GE in the process. Consolidation gives leaders a chance to once again evaluate vendors and select the one they believe will be best serve a health system's needs as a whole.
As hospitals and health systems grow through mergers and acquisitions, the EHR question is bound to arise. For example, Banner Health and two Tucson hospitals previously part of University of Arizona Health Network — Banner-University Medical Center Tucson and Banner-University Medical Center South — will transition from a $115 million investment in Epic's EHR to Cerner's EHR.
"A key element of the Banner strategic plan is to employ a single, integrated EHR system across all care settings," says Geoffrey Duke, vice president of clinical applications at Phoenix-based Banner Health. "It was a difficult decision to retire the Epic system; however, Banner has a significant investment in and experience with Cerner Millennium, which is being utilized across all other Banner hospitals in seven states, plus a growing number of our ambulatory settings."
Navigating the switch
Hospitals and health systems transitioning to a new vendor have the benefit of hindsight; this isn't the first EHR implementation. But, the process still requires significant time and resources. "The time frame for switching will be 18 to 24 months in average-sized facilities," says Mr. Adams with MD Buyline.
During those months, education is one of the most important steps to take. Leaders will be tasked with ensuring all EHR users are properly trained and prepared for the switch, and training goes beyond the go-live date. "All staff and physicians must be trained and supported for approximately 90 days post go-live," says Ms. Peterson.
Adequate support pre- and post-implementation goes a long way in supporting a successful switch. "Your staff will be learning the new EHR's functionality and workflow, while actively working in the legacy system," says Mr. Adams. "Developing structured training sessions can help you identify, adjust and correct potential obstacles in areas such as workflow, reporting, or communication over the long run. Your EHR vendor should be able to provide an idea of the estimated amount of training time or an end-use to get the hang of the new system from comparable migrations. It should go without saying, the more hours employees train on the new system, should translate to a smoother go-live.”
Banner Health is still in the midst of migrating from Epic to Cerner; go-live is expected in 2017 or early 2018. But, already its leadership is tackling the user experience. "As we get further into our transition, our clinical users will be introduced to a whole new set of tools to be used in their daily work," says Mr. Duke. "A significant focus in our transition planning accounts for how we will train and support staff and physicians through that change process."
Learning by example
Changing EHR vendors can be a natural stepping stone or the result of a painful mistake, but in either case it is best to learn as much as you can from experienced peers. Here are three pieces of advice from Mr. Duke, Ms. Peterson and Mr. Adams, all of whom have been through the process:
Look ahead when considering a switch and make sure the choice will support the organization's long-term strategies and success. "Migration decisions should be guided by a long-term enterprise strategy, taking into account the local and regional needs of the organization," says Mr. Duke.
• Use your new vendor's resources, but do not rely on them to execute the entire transition. "Don't just count on the vendor for the switch; have your own project management structure, governance structure and implementation standards in place," says Ms. Peterson.
Don't waste time assigning blame for the last EHR choice. Take action. "I have seen blame from the CEO and CFO level down to middle management, negativity breeds negativity" says Mr. Adams. "Either fix the EHR or prepare to switch to something else."