Optimize or Replace your EHR? – Questions to Ask

This article first appeared in Administrative Eyecare (January/February 2019) and is reprinted here with permission from the American Society of Ophthalmic Administrators (ASOA). Originally published by Jeanne S. Holden.

Many doctors and administrators have a love-hate relationship with their EHR systems. They embrace the potential for making secure data access quick and easy, but denounce data entry that often means more time with a keyboard and less with patients. Top complaints according to experts and surveys: Data entry takes too many clicks and workflows are too cumbersome, reducing productivity.

About 30% of practices with 12 or more clinicians expect to replace their EHR systems by 2021, according to a recent Black Book Market Research survey1. These practices want customizable EHRs integrated with revenue cycle and practice management systems and cloud-based mobile tools with access to on-demand data for financial performance, compliance, etc. Other desired capabilities are telehealth/virtual care support and speech recognition solutions for hands-free data entry.

The survey also found that most small to mid-sized practices underutilize advanced EHR tools such as patient engagement, secure messaging, clinical decision support, and electronic data sharing. Such practices would likely benefit from EHR optimization – the process of refining an installation of EHR software to serve the organization’s own needs. For some other practices, however, additional investments in a legacy EHR may be futile. How can a practice decide whether optimization of replacement is better for its particular circumstances? Here, experts offer some advice.

Is Your Practice Limited by Its EHR?

All EHRs have strengths and weaknesses, stressed Candace Simerson, FASOA, COE, CMPE, consultant with iCandy Consulting LLC (Tucson, Ariz.) and former president and COO of Minnesota Eye Consultants (Bloomington). Practices need to understand why they are dissatisfied before choosing a course of action.

“What are the performance gaps or problems with your practice’s EHR?” Simerson asked. “Identify and document then,” she said. “Then investigate whether there are cost-effective solutions – perhaps investing in upgrades or new hardware or just improving communications with the current vendor.”

If productivity has gone down since implementing your system, try Tera Roy’s approach of having each department first list its problems. Roy, vice president of government initiatives at Nextech Systems, LLC, and a formally educated specialist in eyecare, suggest that “if the system permits – run productivity reports to find bottlenecks and determine whether the issues are with the system or the employees.”

Chris Dean, strategic business consultant/healthcare at Netgain Technology, LLC, (St. Cloud, Minn.), recommended asking:

  • What will upgrading/optimizing my EHR now cost compared to changing systems, including physician/staff training, equipment, hardware, interfaces, etc.? Also consider data migration and any early termination penalties.
  • How will doctors, staff, and patients respond to the change? Additionally, Dean cautioned, “When looking at newer systems, research current users’ complaints. Do any of those issues match your current frustrations?”

Why Consider Optimization?

Through optimization, practices often can improve and EHR’s effectiveness and, thus, practice efficiency. A practice might have purchased its EHR without investing sufficient time and resources to fully understand its functionality, said Simerson; alternately, and EHR’s software might have been upgraded, but the practice might not have had anyone on staff or onsite to conduct training or adapt the practice to new capabilities. Simerson noted that “practices often do things manually that an EHR could do electronically if the feature was turned ‘on.’”

Dean emphasized that optimization means “continuous improvement, not viewing EHR adoption as a one-time thing.” It involves making technology work as effectively as possible for doctors and staff given their workflows and needs, and training them to understand technology’s potential. “Minimally customizing prescriptive ‘out-of-the-box’ templates can provide desired workflows and minimize clicks,” she said.

Simerson suggests practices explore optimizing an EHR’s functionality every 2 to 3 years because new features might be available. For example, she said, “Utilize the system to import electronic remittance advice and auto-post. Instead of posting each payment, staff will manage claims on an exception basis. Also, use the system to attach electronic explanations of benefits to claims so information is all in one place.” Simerson estimated that “a two-doctor practice could save two FTEs just through these practices.”

Why Consider Replacement?

Certain EHR issues can’t be resolved by optimization, however. Roy described some common ones:

  • An older server-based, in-house system can be very expensive to maintain compared to a cloud-based system.
  • Software updates can be riddles with issues, rather than adding value and efficiencies.
  • Primary care applications can have ophthalmology-specific “shoehorned” into them, making them uncomfortable to use or even ineffective.

Moreover, Roy stressed, “If productivity declined after EHR implementation 2 or more years ago and didn’t recover after optimization, then it is time to evaluate other systems.”

This happened to Eye Centers of Tennessee (ECOTN, Eastern Tennessee). Sheena Lee, COA, OSC, explained: “Our EHR was very outdated, and the company was unwilling to make necessary changes. It required lots of clicks and going in and out of lots of screens; errors were always popping up, and we spent lots of time reentering lost information. We reached out multiple times with suggestions about improving the system. The company mentioned a newer version, but they kept putting it off. So we decided to look for a replacement.”

According to Lee, the new EHR needed to be easy to use and modern, with efficient charting features. Additionally, the practice wanted to find a company with good customer service and fast response times. ECOTN selected an ophthalmology-specific solution. The new EHR system has “exceeded our expectations,” said Lee. “The flow makes sense with how we do an eye exam. Inputting information is simple, as is making changes. We can recall patient information, even a specific test, with ease.” Interestingly, Black Book has found that specialist-centric systems top EHR satisfaction for small practices.2 Lee offered this advice for practices about finding a good EHR replacement: “Visiting practices and seeing the system in use made all the difference. Ask questions of doctors and technicians who use the system daily.”


1Black Book Market Research. (2018, Apr 16). New spike in EHR replacement activity jars larger physician practice market. Retrieved from https://blackbookmarketresearch.newswire.com/news/new-spike-in-ehr-replacement-activity-jars-larger-physician-practice-20434494

2Black Book Market Research. (2018, Apr 11). Specialist-centric systems lead small physician practice EHR satisfaction. Retrieved from https://blackbookmarketresearch.newswire.com/news/specialist-centric-systems-lead-small-physician-practice-ehr-20425095

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