System functionality and cost are the two largest deciding factors in healthcare providers’ decision to switch electronic health record (EHR) vendors, despite the significant cost associated with a new EHR purchase and implementation, according to a study published in the journal Perspectives in Health Information Management.
Researchers, led by Alberto Coustasse, DrPH, M.D., a professor in the Healthcare Administration Program at Marshall University in South Charleston, West Virginia, sought to examine reasons why healthcare providers are switching EHRs vendors, assess user satisfaction with replacement systems, and evaluate the cost and implications of transitioning to a new system. For the study, the researchers conducted a systematic literature review of studies related to physicians and health systems that switched EHR vendors, including their reasons for replacing their current system and the barriers to doing so. The researchers evaluated a total of 26 research articles in their literature review.
The researchers note that providers are choosing to switch EHRs for many reasons, including inefficient workflows, lack of reporting capabilities, mergers and acquisitions with larger health systems requiring more complex systems with greater interoperability, and the need to interface with other systems. Shifting regulatory standards require new functionality to fulfill quality reporting measures, including MU (Meaningful Use) requirements and the Physician Quality Reporting System. And, despite the costs associated with switching EHR vendors, many physicians and health systems have decided to switch to receive additional functionality, improve reporting capabilities, and increase platform benefits, the study authors state.
The study authors note that most providers began using EHRs to fulfill government mandates and receive the financial incentives offered for utilizing the software. By 2013, the EHR adoption rate was 78 percent in ambulatory settings and 59 percent in acute care settings in the United States. A 2010 survey by the Medical Group Management Association (MGMA) found that only 41 percent of EHR vendors reported that their systems had the functionality requirements to allow providers to fulfill Meaningful Use (MU) criteria. Many vendors have remedied these gaps by providing add-ons and new modules to enhance their systems, however, these add-ons and new modules has led to problems in interfacing with other health information systems, according to the study.
Additionally, mergers and acquisitions have resulted in software vendors phasing out older products and replacing them with more complex systems, and this has led to health systems replacing the systems originally purchased with more advanced software. According to the Healthcare Information and Management Systems Society (HIMSS) Analytics Database, 305 hospitals switched EHR vendors and 62 hospitals changed their EHR systems in 2013.
The study authors conclude that switching can result in positive and negative outcomes, with cost being the most obvious negative outcome and a significant barrier to adoption related to switching. “The cost of switching systems can seem excessive, often in the millions, when the cost of the new system is coupled with the cost of its implementation; however, health systems must remember that the benefit to the patient is the main priority. Some practices have found that the functionality of the new system increases the level of care the patients receive by speeding up communication. Others have seen benefits for the hospital in terms of a reduction, often by half, in rejected claims,” the study authors wrote.
The study authors also contend that the cost involved with health systems switching from legacy systems to new EHR systems has significant implications for the U.S. healthcare system. “Switching costs include not only software and hardware upgrades, but also repeat training for staff and initial loss of productivity due to unfamiliarity with the system. The incentive monies are not high enough to cover the expense, and as a result the cost of care may rise. In order to meet the data-sharing requirements and other requirements still being defined by CMS (The Centers for Medicare & Medicaid Services), provisions of $44,000 per eligible health provider, paid out in stages, were established and may be paid out upon successfully meeting the requirements of the legislation. These costs could lead to higher copayments and higher premiums for patients and may make it more difficult to receive care,” the study authors wrote.
Despite the costs involved with switching EHR vendors, the study authors contend that there is one practical, beneficial implication of healthcare provider organizations switching from legacy systems to new EHR systems—the better likelihood of interoperability. “With more health systems switching to some of the more widely utilized EHRs, the interoperability issues of the past may be easier to overcome with more interfaces being built and potentially with the new FHIR (Fast Healthcare Interoperability Resources) standards being implemented by the vendors,” the study authors wrote.
“Switching has proven to be a costly endeavor, but in view of the lack of value provided by their former EHR systems, many healthcare systems have chosen to move forward with switching vendors despite the possibility of not receiving an immediate return on the investment,” the study authors concluded.
