Cerner Ambulatory : Why Practices Are Changing EHR, and How to Know if You Should Too
Buyer s remorse happens: that red paint for your living room walls, that luxury SUV with no down payment, that puppy at the pet store. For as many as a quarter of all physicians, it is the electronic health system they use in their practice. The Black Book Rankings marketing research firm polled roughly 17,000 users for its February 2013 survey. The numbers speak for themselves. Of those polled, anywhere between 17% and 31% of physicians planned to switch their systems; an additional 8% wanted to, but couldn t afford it. The reason for the switch: 80% of providers say the product they purchased did not meet the needs of the practice. However, more than three-fourths of those physicians accept some of the blame, saying they failed to properly assess their needs and the software s capability prior to purchase. 17,000 Physicians Surveyed 25% want to switch EHRs 80% say product did not meet needs 79% of those admit some fault themselves The expected upheaval has begun, and continues. Analysts predict the EHR replacement market will top $4,000,000,000 that s four billion dollars. Palmetto Health, a health system based in Columbia, South Carolina, chose to replace its paper and disparate electronic health records and instead have one cohesive system. It chose Cerner solutions. We recognized all the changes going on in healthcare, explained Assistant Vice President and Medical Informatics Officer Dr. Tripp Jennings. With the fundamental shift towards population health, we recognized we needed to do as much as possible to get our systems simple and aligned so we could have a flow of information to meet our needs. From the interactions we had with Cerner, he said, as well as the kind of company stability and with the technologies they had invested in, we realized that was certainly the way for us to go. Palmetto Health has more than 60 physician practice sites, several hospitals, and employs more than 250 physicians and mid-level providers with an additional 200 medical residents.
The expanding health system was on several different EHR systems at its dozens of sites. We re growing our ambulatory network we were starting some new practices, and acquiring new practices, like most health practices across the nation. Many of those were on paper, or they were on a different system. One advantage: its hospitals were already on Cerner. We weighed the complexities of switching the acute side to a different vendor and aligning with that, or having a natural, logical approach. The fundamental point that we kept coming back to was, does it make sense to switch all of our acute care side from a system we were happy with and having success with to something else? Caleb Anderson, Cerner Ambulatory Sales Director, notes that is a common reason for EHR replacement, and an advantage Cerner has in the marketplace. The smaller practice will come to a hospital that s already on Cerner technology, and join that existing infrastructure. From our perspective, it s good to be a vendor on both the acute and ambulatory sides. In another part of the country, one internal medicine physician also weighed hefty questions about his EHR vendor. Dr. Juan Salazar of Southern Texas chose Cerner for his 20 physician practice. We traveled all over the country, said Dr. Salazar. We had five contenders: Epic, Cerner, MediTech, et cetera. We looked at all of them and we went to all the different sites. We also went to physician offices and saw them in action. The McAllen practice then narrowed it down to two vendors. We picked Cerner because it met our goals, he said. We had several options and we picked it because everything that we wanted was right there. Note that 79% of those who want to switch EHR vendors felt they did not properly research their purchase. If they were coming off of paper, they didn t know what they didn t know, said Cerner Ambulatory Sales Director Caleb Anderson. Dr. Tripp Jennings called his health system s switch a crash course in change management. Several of the South Carolina sites were on paper. You can t just take a paper system and plug it into an EHR, he said, no matter what the vendor. It was very difficult, but much more difficult from a human standpoint than technological. Dr. Jennings explained, The technical challenges can be and have been resolved. It s really the process of changing everyone s workflows. When taking a practice from a paper system to an electronic system, you really have to stop and evaluate all of the clinical and workflow processes.
In some cases, they went out and looked for the lowest price point possible with a solution that would meet Meaningful Use and didn t do due diligence on what was going to be best suited for their practice workflows, Anderson continued. I submit that even those that did a full due diligence process probably still didn t always understand the dramatic impact that it would have on the way they were going to practice. Why Practices Switch EHRs, according to Black Book 80% 79% 77% 44% 20% Solu)on does not meet the specific need or workflow of Prac)ce Prac)ce did not adequately assess needs before selec)ng the original EHR Solu)on design is not suited for Specialty Vendor not responsive to requests and needs Current EHR does not adequately communicate with other EHRs Dr. Joseph Scalia of Raritan, New Jersey understood that. Since implementing Cerner Ambulatory s PowerChart EHR solution in his family practice, he has continued to have the health care IT company educate his staff. We brought the trainers back, because there s only so much that you can actually absorb in the initial process he said. Physicians are able to get through the basic aspects of entering data, but there are so many nuances in a very complex system, Dr. Scalia explained. You want to be able to utilize it to the best of your ability. We felt it was important to bring our trainers back to give a secondary and tertiary level of training. Anderson echoes Dr. Scalia s sentiments. As these physicians implemented EHRs in their offices, they became more sophisticated in terms of their demands of an EHR. In the February 2013 Black Book Rankings survey, physicians cited several reasons for the need to switch EHR vendors (see below chart). But there is another reason many switch: Meaningful Use. Caleb Anderson began working for Cerner fewer than 10 years ago. When I started, there were about 1,100 companies that had an EHR. Then it dropped to around 400. Then, Meaningful Use came out. Anderson says that rekindled the market, and hundreds of vendors immediately resurfaced. Meaningful Use drove a lot of new entrants into the market, he continued. I think the bar for Meaningful Use Stage 1 was, rightly or wrongly, attainable for a lot of those. But Stage 2 and Stage 3 may not be. I see additional consolidation and migration from the small end suppliers who won t be ready for Stage 2 or Stage 3. The physicians on these systems are looking long-term, aligning to capture those Stage 2 and Stage 3 dollars, and considering population health implications.
Timing is also crucial when a practice decides to switch electronic health record vendors. When Via Christi Health in Kansas chose to switch, it Meaningful Use Stage 1: Data Capture & Sharing Electronically Capture Health information in a standardized format Use that information to track key conditions Communicate that information for care coordination Initiate the reporting of quality measures and public health information Use information to engage patients in care realized it would have to act fast. Meaningful Use and the ICD-10 conversion loomed on the horizon. Our overall goal is to provide a fully integrated, patientcentered health Meaningful Use Stage 2: Advance Clinical Process Connect to health information exchanges (HIEs) Increase e- prescribing, sending, and receiving orders and results Electronically send patient care summaries Engage with the patient to effectively manage care record across the continuum of care. The original plan to switch was likely going to take 3 years, explained Ambulatory Chief Medical Information Officer, Dr. Brendan Rice. But because of ICD-10 and Meaningful Use, either we go live before all those deadlines or we d have to upgrade all of our current systems, which would have a large operational and financial impact. Dr. Rice added that Via Christi s former ambulatory vendor was planning a large upgrade. This was drastically different from our current version, which would mean retraining everyone on a system that would only be used for a year. Within six months of looking for a vendor to provide an integrated platform, Dr. Rice and the Via Christi leadership chose to sign a contract with Cerner. That decision was made in the winter of 2012. We said we wanted to have Cerner everywhere within 18 months said Dr. Rice. It was a very ambitious plan, but it was a clinician decision -- not an IT-driven one. Via Christi began the move to Cerner solutions in Spring of 2014, ahead of the original ICD-10 deadline of October 1, 2014. Meaningful Use St Improved Outco Improve quality, safety, a efficiency Identify and manage hig priority conditions Grant patient access to s management tools Gain access to comprehe patient data through HIE Once a practice or health system decides to make the jump between electronic health record vendors, data migration becomes the biggest challenge. As Dr. Jennings at Palmetto Health discovered, The real challenges are doing that while still keeping a practice performing at an acceptable level. There are two Switching questions practices EHR face.
I have a number of clients who have done migrations, he continued, who say, We thought we needed to move everything, so we moved everything and all we did was clutter the new system with junk from the old system. What Data Should Move? How Should That Data Move? Practices have the ability to select which data components they want to move and the scope of the files The hardest part of the discussion, Anderson added, is the timeline to move the data. Do we phase it in? he asked. Then the patient has a record in primary care, in endocrinology, and in cardiology and those could all be in three different go-live phases. So do we migrate it all at once, or do we migrate three times? And what s the impact of moving the patient three times on chart management? Since each client situation is slightly different, it is best that the practice discuss data migration with their vendor. Dr. Scalia of New Jersey has a word of warning for practices as they move to their new EHR: practice makes perfect. The internal medicine physician noted the effectiveness of the software hinges upon the doctor using it. Use it consistently, he advised, entering the patient data the same way every time. Mergers and Acquis)ons within the company Senior Management in Disarray Vendor Red Flags Dissipa)ng Market Share Disloyal Customer Base Once the patient data is in the electronic health charts, the possibilities are almost boundless. Dr. Jennings of South Carolina said his staff can now focus on population health. Now we have systems that actually talk. But we need to optimize those so they talk effectively.
Money, Palmetto Health s Title Meaningful Medical Informatics Franklin Use, Officer Gothic and listed ICD-10 off three things his health system can now do. One, we went from having no information to having so much Demi information 18pt we have to organize it effectively for the providers. Two, now we have to design care pathways that support population health. Three, we need to take our organized system and reach out to other organized systems in our region. Of course, vendors are doing what they can to keep their clients from being the one out of four who want to switch EHRs. The same guidelines that promote ease of data migration also allow for ease of client migration. Standards are good, in our opinion, said Anderson of Cerner Ambulatory. But it does keep us on our toes. Anderson continued, I think the days of providing minimum support because it was too hard or too expensive to switch from one vendor to another are over. We ve got to differentiate ourselves around the quality of the product and the support we provide. In July of 2013, Black Book Rankings ranked Ambulatory EHR vendors. From 600 qualified vendors, Cerner ranked in the top 1%. In November of 2013, the publication Medical Economics put Cerner Ambulatory s PowerChart at number one on its Top 100 EHR list. 84% Vendor Viability Black Book s Top Five EHR Must Haves 83% Data Integra)on and Network Data Sharing 78% Proven Return on Investment, Clinical Improvement 75% Adop)on of Mobile Devices 66% HIE Support, Conec)vity, Interoperability For more information about Cerner s Ambulatory Solutions and Services: CernerAmbulatory@cerner.com 800.927.1024 www.cernerambulatory.com/why