How to assess the decision to switch EHR systems

In a market increasingly dominated by a few major vendors, providers may feel pressure to make a change, but first need to gauge the real reasons for doing so.

With almost any industry, there are a few companies that have the majority of market share. We’re all familiar with the dominant players in the EHR market, those top 10 systems who hold the 80 percent to 90 percent of market share year to year. According to market research, Epic, Cerner and Allscripts currently top that list.

I can’t tell you how many times I get asked, “Should I just switch to Cerner or Epic or Allscripts?” by health IT executives whose health system uses an EHR other than one of these major systems. Health system leaders should take a close look at their current situation alongside their short- and long-term objectives to determine the right answer for their organization—with only a little consideration for what’s popular in the market.

Health systems tend to switch EHRs for a number of reasons, but I like to categorize them into urgent and non-urgent reasons to help weigh the pros and the cons of investing in a new system.

One urgent reason is if your existing EHR vendor has announced it will be “sunsetting” support, or no longer making enhancements to the current system. Another is if the health system has undertaken or is undertaking a merger that leaves it with multiple EHRs and potential interoperability issues. Finally, lack of certification for federally mandated programs—think Meaningful Use and PAMA—can trigger an immediate response.

In any of these situations, the health system needs to launch immediately into a fully baked process to select a new EHR. This process should include a close look at the major EHRs as well as other vendors active in your market, with considerations for your budget, your physician partners’ systems, EHR-specific talent in your market, and your overarching strategic objectives.

Often, though, it’s not any of the urgent reasons cited above that prompt the question about switching to a major EHR. Rather, it’s when health system leaders find efficiency issues that trace back to the EHR; they realize the EHR isn’t aligned to support the health system’s strategic goals; or even just because competitors in the region have moved to one of the “bigs.”

These scenarios don’t require the same immediate action as the urgent situations and allow the health system to be more thoughtful and strategic about their EHR investments. And, let’s face it, EHRs are expensive and, depending on the size of the health system, a new EHR platform can take a few years, hundreds of staff and thousands of hours to fully implement. So any decision to invest in a new EHR should be made cautiously.

If you’re facing a non-urgent issue, there might be a couple of alternatives to switching EHRs. I often encourage clients to consider how they might optimize their current system.

There are ways to optimize for efficiency, like changing a display to suit a specialty’s specific needs. And there are ways to enable your EHR to support strategic goals, like implementing an EHR-driven effort to increase Medicare annual wellness visits, an initiative that furthers population health management and primary care strategies.

It’s ultimately important to understand how your vendor’s capabilities may align—or conflict—with your organization, and some regional EHR companies are making new partnership decisions to assure clients they can meet their strategic objectives.

For example, RazorInsights is an EHR system that primarily serves rural, critical access and community hospitals; it was acquired by athenahealth in 2015. Now with the wealth of anthenahealth resources backing it, RazorInsights can continue to build on its core competencies, such as billing and collecting through the system and potentially leverage athenahealth to link the platform to physicians’ offices. It’s a great example of a regional EHR player combining forces with a market leader to bring forth the best in each.

If neither optimization nor enhancing for a mutually-beneficial partnership is available to address your EHR issues, it might be time to consider switching to one of the dominant players, and potentially reaping benefits from working with those vendors.

A major EHR vendor brings with it a large cohort of other health systems on the same platform. This means more data used to identify best practices and new innovations. Companies like Epic and Cerner are investing millions in research and development to hardwire those best practices and make them available to their entire customer base. Their market presence also contributes to their ability to develop and maintain a strong pool of talent with deep technical expertise available for hire in many markets.

Regardless of what EHR is right for your health system, I know first-hand from working with nearly every EHR on the market today that all are working toward the same goal—provide the best care and the best experience for patients. Health systems that are getting the most out of their EHRs—major or not—examine the experience through the lens of the patient, clinician, and administrator and invest in optimizing their EHR to meet the health system’s strategic goals. And happy “switchers” diligently plan for, track and pursue the clinical and financial ROI intended with the trade.

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