We frequently receive comments on the column and podcasts that question our optimism about the benefits of electronic health records. The truth is that we continue to believe that electronic records will lead to better access to information, improved communication, and higher-quality patient care. We also agree with many of the e-mails that we have received from readers. There are many problems with current EHRs and the physicians who use them encounter many challenges. Some experiences with EHRs can be incredibly frustrating and create truly unforeseen challenges. Chris had one such experience recently that offered a heavy dose of reality and frustration. This occurred during the transition from one EHR to another, and we felt it would be worthwhile to share the story here.
The best of times...
In January 2012, Chris’s practice was acquired by a regional health system in southeastern Pennsylvania. This certainly presented an amazing opportunity for growth, as the hospital’s excellent reputation and expanding network would allow for better access and opportunities for both the practice’s patients and providers. One such opportunity was the chance to adopt the system’s enterprise-wide EHR. This was truly exciting to everyone in the practice, as the EHR software was the foundation of a successful health information exchange. Also, Neil, having been employed by the same system for years, was already using the EHR and felt that it was a system of quality and value. At first, Chris was really looking forward to the switch.
Dr. Neil Skolnik and Dr. Chris Notte
But there was a very large elephant in the room: the practice’s existing EHR. For several years prior to the acquisition, the practice had been very successfully using an excellent but different EHR. Also a high-quality and highly regarded product, this software had met the practice’s needs and everyone in the practice become comfortable – and "meaningful" – users of the system. No one really understood what it would be like to learn a completely new EHR. The practice as a whole was probably a bit overconfident in its ability to make an easy transition. The physicians, including Chris, thought that since they were already using an electronic record, it was unlikely that their workflow would need to change at all. Wasn’t this just like buying a new car? Sure, some of the knobs and buttons would look different, but we all know how to drive. This should be a snap, right?
Unfortunately, everyone in the practice quickly learned that EHRs and automobiles have very little in common.
The worst of times...
We have specifically chosen not to mention either EHR company by name because we feel both offer excellent products and meet the needs of their customers; to continue the automotive analogy, we would be happy to own either as our "set of wheels." But no two EHRs are ever alike, and physicians who make the switch are often shocked by some of the differences. For example, each EHR uses different terms to describe similar tasks. While the concepts might be easy to grasp, without a firm grip on this euphemistic language, it can be difficult to navigate the system. What one system might call a "task," another might call an "action." You could be searching for a "planned package" but should be searching for an "order set." And typically, none of the buttons or symbols look the same.
For physicians and staff in Chris’s practice, the change in "language" represented a steep learning curve, and learning curves translate to loss of productivity. The "muscle memory" that staff had developed over years of using the complex software was not easily reprogrammed. A friend likened it to switching to a Mac after years of using a Windows PC. Both devices essentially perform the same tasks – and do those tasks well – but all the icons and buttons seem to be in exactly opposite places.
In addition, there was the issue of data migration. How could we take years of structured demographic data, progress notes, scanned documents, medications, allergies, lab results, and other information and move them into the new system? While technically possible, this is a costly and time-consuming undertaking, and requires the full cooperation of both EHR providers to successfully accomplish it. We were lucky to have the financial backing and influence of a large health system to see this through to completion, but independent practices making the switch might not be as fortunate. Overall, the process went as planned, but it remains difficult to locate certain information when it’s needed because each EHR has its own areas in which data elements are held.
