In recent years, overinflated promises from EHR and PM vendors have led to disenchanted practices ditching their EHR/PM software, shopping for new EHR/PM software, or remaining mired in inefficient manual workarounds. Yet this is not the only cause of EHR/PM failure. The truth is that technology alone cannot ensure profitability, compliance, and better outcomes- people and processes are just as critical to EHR/PM effectiveness. Each of these three components is essential to successful use of EHR/PM technology.
In 2007, the U.S. Office of the National Coordinator for Health IT reported that half of EHR implementations fail. That was before the buying frenzy brought on by stimulus money, when providers sought new, subsidized software to avoid penalties. According to IT analyst surveys, about 40 percent of EHR failures are due to poor planning and communication within practices, and 20 percent due to mismanagement and rejection by end users.
Many practices don’t objectively evaluate and reconfigure workflows prior to implementing a system. Instead, they import existing inefficiencies into the new technology, or don’t use the system as intended because they are unwilling to give up their old processes. The Joint Commission Journal on Quality and Patient Safety notes that “to attain EHR’s full potential, its adoption and implementation should be treated as a means of facilitating redesign of outdated, inefficient, and error prone care processes and a vehicle for organizational change- rather than just another information technology (IT) innovation.” This goes for billing and collections processes as well. Trying to force existing processes into a new software tool without thinking about best practices increases the likelihood of EHR failure to achieve a positive return on investment and user buy-in.
It’s also not uncommon for a good back office employee to be designated as the practice’s system administrator. However the risk is that among the best employees, few individuals may be able to visualize the big picture of the practice and truly understand the needs of end users performing functions different from their own. This is particularly true for larger practices that have compartmentalized front and back office staff. Process mapping and system configuration in “silos” for different pieces of the revenue cycle often result in costly system issues by failing to capture interactions and dependencies between roles. Additionally, the skills sets typically found in medical practices among nurses, billing and coding staff, and other key personnel typically do not include IT project management. A steering committee approach is often warranted in this case, but few practices devote the time and resources to this more formal process.
Kaplan and Harris-Salamone point out that “health IT systems must generate quality reports for a variety of different health plans. In addition, such systems must be flexible enough to support organizations ranging from solo practitioner offices to national integrated delivery networks.” As a general rule, the more flexible a system is, the more important planning and expertise become. Flexibility can yield great results, or it can enable users to misconfigure the system and cause it to fail to achieve business aims.
