Key factors in making a decision on an EHR
How does a healthcare delivery system know when—or if—it’s time to make a change from a current electronic health records system? Organizations may get tired of spending millions of dollars on upgrades, or existing systems may struggle to keep up with burgeoning records capacity.

Or senior executives may want to consider EHR options that other area health systems may be using. System maintenance concerns may arise, because some products age poorly. Maintenance may be becoming difficult. Vendors may struggle to keep up with security and basic functionality issues, let alone new features. So, when is it time to consider another vendor?

The following areas for assessing a decision are offered by Dick Taylor, MD, executive vice president and chief medical officer for MedSys Group, a healthcare IT services firm that works with a wide range of provider organizations.
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What is the organization's capacity for change?
A healthcare system needs to assess its ability to make a shift, because changing an EHR is brutal. So ask: Are we up to it? What is our capacity for change? How have previous changes like this (or totally unlike this) gone?
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Can the organization afford the cost?
Healthcare information technology is expensive, and rip-and-replace implementation is even more so. A full EHR replacement is one of the most expensive capital projects a healthcare system can undertake. On the other hand, staying with an obsolescent system and preserving inefficiencies can be equally, or more, costly. So very simply: Do we have the money?
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Will executives take the lead?
System transition can be very difficult on an organization, and top executives must be completely committed to the change and willing to make the investment in time and trouble. Questions to ask include: Can we adapt operationally to change? Installing the perfect system means nothing unless clinicians and providers can adapt to it. Leadership and staffing challenges, external mandates and competing organizational initiatives can interfere dramatically. Are we and our leaders ready?
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What is the organization's readiness to handle change?
Organizational culture can sink any strategic decision; it can also create amazing strength in the face of adversity. A decision to stay or to go has to use culture actively to support that decision. So, consider: What is our culture? Have we exhibited the ability to assimilate change, particularly in adopting technology?
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Have vendors been thoroughly assessed?
The vendor that’s eventually selected matters. Some vendors seem to see their customers as trophies, or references, or just as a recurring revenue stream. A true partnership is essential. So, ask: How satisfied are we with our vendor? How are they coping in the market? Are they going to survive?
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Are the products reliable?
In considering vendor offerings, it’s important to assess facts regarding whether systems are available, reliable, easy to maintain and robust. So be honest now: Are these systems reliable? How is our downtime? Do our users rely on our systems, or do they know better? What has our vendor done to help?
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What are vendors' track records for improvements?
A vendor’s product should have features and functions that continually improve. So, consider: What is our track record? Are we using the latest release to its full capacity? Why or why not?  Is our vendor getting critical features out the door? Are we getting what we need from engineering, support and development? Brutal honesty is essential, because organizations should pay vendors for being good vendors, not just to cash checks.
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What are the implications of staying with the current vendor?
Assessing a decision to keep the product of the current vendor in place requires assessment of the following factors. What does “stay” mean? Do we need to upgrade, and if so at what cost and when? Have we calculated the cost (including operational cost) of becoming fully current? Are we “out on an island” with obsolescent software and deferred maintenance?

Is our vendor offering a brand-new system with the same brand name? If it's brand new, then it may be no cheaper or easier than making the switch to a new vendor, because it’s “go” masquerading as “stay.” Calculating the cost, schedule, and operational implications of maintaining existing vendors is crucial. They’re familiar and well known, but are they performing? The decision to stay should be an active decision, with a positive recommitment to a vendor who will sustain the organization into the future.
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What are the implications of deciding to make a change?
If the assessment points to a change in systems, there are a number of issues to consider. How could we “go”? With our existing vendor, we know what we have and what we’ve learned to live with—with a new one, we must re-examine those choices and consider technology, areas of automation and new compromises. We should narrow the field progressively and dig in to evaluate in detail. By the time we commit to a multi-decade relationship with a vendor, we should know them at least as well as we know our old one.

When an organization makes that choice, it should be ready to take the plunge the whole way. It can be tempting to “try a module” or “try one clinic.”  But the “halfway” state is dangerous. Economies of scale are impossible to achieve on fragmented platforms. Updates, maintenance, clinical progress and defect correction all become far more complex with a bloated IT portfolio. In a well-planned implementation, this is the most expensive and dangerous time. In a stalled implementation or a “perpetual pilot,” it’s just a mess.