EHR Optimization: Necessary Because EHRS Are Never “Done”

Why, if over 95 percent of hospitals have implemented EHRs, are so many planning to invest in improvements or replacements this year? A new Healthcare IT News survey of hospital executives showed that 24 percent are conducting a major EHR system upgrade, and 21 percent are replacing their EHR at one or more sites. KPMG’s survey of CHIME members last month found that at least 38 percent of CIOs are investing in EHR optimization projects this year; in fact, they plan to spend more on EHR optimization than any other area of HIT. These numbers are huge when you consider that most hospital EHRs are newer versions implemented to meet MU attestation requirements. A central reason for the continued need to upgrade or optimize, cited by both groups, was straightforward. Doctors and nurses still don’t like their EHRs. The problem seems straightforward, but it’s not.

Strange but true: the same EHR products get widely varying reviews. When you talk to doctors in some hospitals, you’ll find strong appreciation for their systems, describing them as well designed tools that prompt users only when needed, save time, and support logical workflows. In other hospitals, physicians using the same commercial products as their satisfied counterparts are very unhappy. Complaints are that EHRs add work, decrease face time with patients, reduce the quality of relationships with patients, create usability slowdowns, and cause new errors. These physicians complain that the EHRs are not designed for the way they think and work.  A shorter interpretation: The EHRs are not user-friendly. Why the disparate responses to the same EHR products?

Poorly executed implementations are probably the single greatest reason physicians and other users dislike their EHRs. Every EHR approaches clinical problems differently, but federal requirements ensure a common set of necessary functionalities. Beyond these standards, each system does some things particularly well and other things not so well, depending on a hospital’s needs and priorities. Given the disparities between individual implementations, does one EHR have innate superiority over others?  The context of the question is everything. What were the specific needs of your hospital? What upcoming challenges would need to be addressed? If these and other questions were not included in your hospital’s implementation planning, it is not surprising that complaints about serious problems abound...