Does your EHR need a tweak or a trashing?

How to tell if your system is already in need of a major goose.

By Robert N. Mitchell

As ophthalmologists move steadily toward adopting the technological sea change that is EHRs — 32% of practices had fully implemented an EHR and 15% had implemented an EHR for some of their physicians or were in the process of implementation in 2013, according to the American Academy of Ophthalmology¹— it is already time to consider a question most won’t welcome: Is it time for an upgrade?

While the revolution in medical record keeping and practice management is still far from complete, it is already appropriate for those who have adopted EHR to contemplate a further investment. Are upgrades expensive? Often. Do they require still more forethought and work to implement? Yes. Conditions, however — including government regulation or simply poor planning the first time around — may leave you without much choice. Here’s how to tell.

Upgrade vs. update

First of all, it’s important not to confuse an upgrade with an update, points out Tera Roy, director of ophthalmology at NextGen Healthcare in Horsham, Pa. “In general, updates are changes to drug lists, ICD-9 codes, or minor bug fixes,” she says. “Typically, EHR updates don’t change the day-to-day operations. Upgrades, however, are bigger changes that address product features, such as user interface, product capabilities, and reporting features, to name a few.”

With federal mandates such as Meaningful Use and ICD-10 initiatives (the latter is delayed until October 2015), an upgrade may be necessary for the practice to meet these specific regulatory requirements. Other factors that can contribute to a practice’s need to upgrade include industry trends, the development of new technology and organizational growth, Ms. Roy notes.

WHEN IT’S TIME

Consider embarking on an upgrade

How does an ophthalmology practice know when it’s time to upgrade? And if it is time to upgrade, which route is better: Take every available update from the EHR vendor or upgrade the entire system?

Some ophthalmology practices may have done their initial due diligence when they went EHR shopping for that first system, but often that is not the case. “The choices they made earlier when selecting an EHR were influenced and motivated by price, what looked like a [decent] system that was easy to use,” explains Jim Messier, vice president of sales and marketing at Medflow, and EHR provider based in Charlotte, N.C.

“The practice may have chosen a company that oversold the capabilities to implement and train the staff, or it may have failed to include enough initial training to make the go-live successful, or chose a product that was not eye-care specific,” Mr. Messier says.

Heather Bush, COT, ophthalmic product manager at EHR vendor Compulink Business Systems in Westlake Village, Calif., sees practices that realize they need to switch EHRs altogether for these reasons as well. While the change is costly, “Some early adopters are beginning to realize they didn’t do the research on what would work best and are looking at other EHRs that better fit their practice’s needs,” she says.

The non-ophthalmology EHR

Having an EHR that not ophthalmology-specific is a common reason practices upgrade. Forty percent of the new customers of Management Plus are practices that have shifted from a general medical EHR ­­— that is, one not designed specifically for an ophthalmic setting ­— to an EHR that is designed specifically for ophthalmology practices, according to Christine Archibald, founder and CEO of the Salt Lake City-based company.

“Some are using an EHR that was designed for a cardiology practice,” Ms. Archibald says. “While the practices are similar, if the cardiology EHR is upgraded, there’s a chance it may no longer meet the needs of the ophthalmology practice. This may cause the practice to have to make a huge capital investment for a specialty EHR that no longer meets its needs” — a mistake no practice can afford.

So if any of these scenarios sound like your practice’s situation, yes, it is time to investigate an EHR upgrade.

On the other hand

Difficulty with an EHR system does not always mean the practice needs to get a new system or even an upgrade, however. Training (or lack thereof) is often a major concern and reason for an EHR failure, Mr. Messier says. It’s not that the technology isn’t working; sometimes it’s just that it’s not been used as effectively as it could.

“If the practice never fully invested in the EHR and its processes, then they only have themselves to blame,” Mr. Messier explains. “You can never underestimate the need to train and prepare the staff and ophthalmologists, regardless of how slick the product may appear.”

LOOK BEFORE YOU LEAP

A matter of flexibility — or lack of it

Mr. Messier calls the decision to buy an EHR the biggest decision a practice will make. “It affects every aspect of patient care and redefines the way the practice delivers services,” he says.

This leads to another significant reason practices want to replace their systems: “Most systems require the ophthalmology practice adapt to the software as opposed to having flexible workflow that adapts to the way the practice is used to working,” Mr. Messier explains. When the differences between the work flow of the practice and EHR are too drastic for physicians and staff to adapt, an upgrade is a matter of when, not if.

What to ask before taking another plunge

Once you’ve decided your practice needs to upgrade, consultant Ron Sterling of Sterling Solutions Ltd., in Silver Spring, Md., recommends you ask yourself two questions:

• How does this upgrade impact the practice?

• If it impacts the practice, then is it relevant to my practice’s specific needs?

“A practice may say that as part of its implementation plan, it needs to validate the database, such as how it needs to integrate with other software or the optical shop’s ability to integrate with the EHR,” Mr. Sterling says.

In those instances, the practice must evaluate the upgrade from both a technical and a clinical perspective. “You may have been documenting a procedure using certain tools and functionality that will no longer be there after the upgrade or will change substantially post-upgrade,” Mr. Sterling says.

He cites the example of a practice that indicates dilation times in its current EHR. “But with an upgrade, the ophthalmologist may no longer be able to tag dilation times or there may be a system change that affects how orders are placed, and now dilation data is added at the time the order is placed,” he says.

When it’s not a matter of choice

Today, regulatory changes often drive EHR upgrades. Medflow certified its EHR for Meaningful Use this year, receiving certification last August, Mr. Messier says. Now all of Medflow’s clients are required to upgrade, he explains. “Even with the recent CMS push to Meaningful Use Stage 2, since Medflow had been certified and prepared to rollout a 2014-certified product, our clients do not have the option of keeping the previous [2011] certified system,” he says.

Harry Colas, director of EMA Ophthalmology at Modernizing Medicine, says ophthalmologists may consider it a hassle to change their EHR, but for upgrades that help a practice with the ICD-10 transition, the right EHR can be a great assist. “In this instance, the EHR is able to do the heavy lifting,” he says.

DON’T FORGET THESE ISSUES

Operating on two differing platforms

Paul Gallogly, MD, the EMA Ophthalmology posterior segment team lead for Boca Raton, Fla.-based Modernizing Medicine and a practicing ophthalmologist, says ophthalmology practices present a unique challenge because they operate from two different charts: one with clinical data and the other with surgical data.

“When you look at an ophthalmology chart, it’s good to have an EHR that covers both sets of data. It removes redundancies, and manages images, which is important to the ophthalmologist,” Dr. Gallogly says.

The cloud question

When upgrading an EHR, ophthalmologists also should consider whether they want to remain in a local client-server-based environment or migrate to one that is cloud-based.

“Will a switch from client-server to the cloud be a significant improvement for the clinic overall?” Mr. Colas says. “How will the cost change from one solution to the next? A clinic should also determine whether the solution they’re considering makes attesting Meaningful Use Stage 2 as easy as possible.” OM

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