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EHR vendor selection doesn't always go well: Many rip and replace

Nearly one-third of healthcare facilities are choosing a new EHR vendor only four years into the HITECH Act.

Four years into the HITECH Act, 31% of surveyed EHR buyers are ripping and replacing their EHR software, according to Software Advice research. Of those buyers, dissatisfaction with existing solutions has increased by approximately 11%.

The survey results seem to validate some predictions made when the HITECH Act went into law in 2009. Some forecasted healthcare organizations might rush the EHR vendor selection process to receive incentives and then would later have to deal with the repercussions of their hasty decisions.

There were a lot of people saying the product didn't have the features they needed it to. Or it was too complicated. Or too simple.

David Fried,
contributor, Software Advice

According to the study, one out of eight buyers said costs, specifically unexpected costs, are one of the main reasons they're replacing their EHR. Of the 385 respondents, half cited forced upgrades and associated costs as a major problem, while others mentioned nickel-and-dime antics and ambiguity over what to expect from final invoices contributing to dissatisfaction with their overall EHR situation.

Beyond vendor concerns, buyers have issues with the EHR products themselves. Complaints about EHRs grew from 58.8% in 2010 to 74.2% in 2013, as respondents described their systems as "too cumbersome," "too generic" and "lacking key features." Meanwhile, some buyers indicated they weren't necessarily unhappy with their systems, they just weren't particularly happy, either. Four years saw a 232% increase in people simply "looking to see what else is out there."

David Fried, contributor for Austin, Texas-based Software Advice, and who summarized their survey's findings for the final report, said buyers were already replacing their systems back in 2010, just for different reasons.

"In 2010, the main reason they were changing EHRs was they had an existing product that was discontinued, very old or unsupported," he said. "By 2013, it was much more a function of, 'We're dissatisfied with our EHR or EHR vendor.' There were a lot of people saying the product didn't have the features they needed it to. Or it was too complicated. Or too simple."

So, what changed in the world of EHRs to spur the swap? In an email to SearchHealthIT, Software Advice CEO Don Fornes said since 2010 many vendors have released more mobile and tablet capabilities, in addition to enhanced functionality for meaningful use reporting, accountable care reporting and other "compliance-related" capabilities. Others agree that improved systems help realize EHR benefits.

The data also indicated that in 2013, more organizations were changing EHRs than starting with paper records and implementing electronic records from there, as was the case in 2010. Notably, qualifying for meaningful use incentive payments didn't seem to be a major driver for those buyers in 2010; it ranked only sixth in a list of reasons for the switch. Even after reimbursements began to surface in 2011, the number of organizations driven by stimulus funds dropped even lower -- from 8.2% to 5.4% in 2013.

Fried said that although incentive payments may not have necessarily motivated early adopters in 2010, Medicare penalties starting in 2015 will likely inspire laggards to join the EHR bandwagon in coming years. That will lead to a spike in the number of organizations going from paper to electronic records once again. Fried said there will "almost certainly" be a follow-up study to track future EHR adoption.

"I would say that at this point, buyers who are just looking at EHRs now, coming from paper records, feel like they're being dragged along. I have the sense that they're more likely to have challenges because they're the ones fighting it," he said. "And of course, what this survey doesn't include is the thousands of buyers who bought an EHR years ago and aren't looking again."

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