EHR transition causes its own headaches

Technology contracts often favor the vendor. Medical practices should negotiate the most agreeable terms possible, especially regarding termination, to make for a clean break.

By — Posted Aug. 5, 2013

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A large number of practices in the market for an electronic health record system are not first-time buyers; they are shopping for replacement systems. As they look to correct what they believe was a wrong purchasing decision, they may be more educated in the selection process but may be surprised at the complexities involved in changing systems.

Black Book Market Research published a February report estimating that 30% of health care organizations searching for an EHR are looking to replace their current systems with new ones. A separate report by market research firm KLAS in July 2012 estimated that 50% of shoppers aren’t first-time buyers. But as a lawsuit in Milwaukee is showing, practices need to be aware that switching systems can cause even more headaches.

Black Book published a follow-up to the February report on July 18 that found 91% of specialists say the cost and operational disruption of changing EHRs is too high, but 28% of primary care practices with EHRs still say they’re shopping for a replacement system. Seventy-two percent of practices planning to switch say usability issues are the primary complaint with their systems. The report was based on a survey of 2,880 of the original 16,000 health care organizations that participated in the February report.

Usability was the issue that had Milwaukee Health Services, a community health center, saying that after five years and $3.1 million, its system still was not functioning the way its vendor initially promised it would. The clinic decided to part ways with its vendor earlier in 2013. But instead of a smooth transition to a new system, it is now involved in a legal battle to get the vendor to release the records of its 30,000 patients.

“You don’t go in thinking it will end badly, but you must be prepared,” said Dianne Bourque, a health care attorney at the Boston office of Mintz Levin. Technology contracts can be very one-sided in favor of the vendor, she said. The goal is to negotiate the most agreeable terms possible, especially regarding contract termination.

A long transition

The most critical point to consider when a contract is terminated is how the practice can access patient data after its relationship with the EHR vendor has ended, said Jerrilyn Cowper, application management solutions manager at CTG Health Solutions, a health IT consulting firm in Buffalo, N.Y.

But simply asking if the data can be converted is not enough, she said. The practice needs to know how much the data conversion will cost, in both time and money. Sometimes it’s too cost-prohibitive, or the data must be converted to a format that cannot be read by the new system and must be entered manually, a process that can take several months.

Cowper said many practices are unable to go live with one system and shut off the old system at the same time. There is usually a transition period as the practice sunsets the old system. This is what Milwaukee Health Services planned to do, so that during the transition, the center would have access to the old records in a read-only format for historical purposes.

Cowper said details of any transition should be in place from the very beginning. Practices should count on taking up to six months or longer to transfer the data, then validate that the transfer occurred correctly.

The reality is that both old and new vendors must communicate with each other to make for a smooth transition, said Jim D’Itri, a partner at the technology firm CSC in Falls Church, Va. Cowper said the vendor should provide an analysis of what that data transfer will look like. D’Itri said the contract could include a requirement to cooperate with any new vendor.

When legal issues arise

The transition can result in legal headaches, depending on how deals are drawn up and interpreted. Tito Izard, MD, the CEO of Milwaukee Health Services, who was not involved in drafting the disputed contract, said the EHR company was just getting started when the health center implemented the system, and that no termination agreements were made.

The primary reason practices choose EHR systems is to meet meaningful use criteria.

Business Computer Applications of Atlanta now claims in a lawsuit filed in a Georgia state court that the health center owes more than $280,000 for delinquent service charges — an amount the center disputes — and will not grant it access to the records until the charges are paid. The EHR company, which said it offered to extend its term with Milwaukee Health Services or convert data into an accessible format, disabled the clinic’s on-site backup servers that contained patient data.

After the vendor’s June lawsuit, the Milwaukee clinic filed a federal lawsuit on July 15 — two weeks after the contract ended — claiming that Business Computer Applications’ actions regarding patient data violated federal and state laws and that the EHR was never fully functional as promised. The company denies the allegations.

Is a change necessary?

Many of the issues with EHRs that lead to a switch are caused by over-promising and under-delivering on the vendor’s part, D’Itri said. But just as many are self-inflicted problems on the practice’s part, he said. These problems will not be made better with a switch, he added.

Cowper said many practices haven’t gone through the “optimization phase” of implementation. She said many EHR systems are highly customizable, but practices don’t take the time to learn how to use their system in a way that makes sense to the practice.

D’Itri said this is an unintended consequence of systems considered to be “plug and go.” Practices are so focused on getting a system they can implement and use right away that they don’t spend enough time learning how the system will affect practice flow and patient care. The subsequent changes are too much for the practice to handle.

According to the Black Book survey of practices planning to switch systems, 84% chose their systems with the primary criteria of achieving meaningful use criteria. Doug Brown, managing partner of Black Book, said buyers are considering only replacement systems that will qualify them for stage 2 of meaningful use. “The major trials in complying with these standards through a system swap are managing change among staff and re-training,” he said.

Before a practice jumps ship, Cowper said, it should seek out other options with its current vendor. She recommends calling in outside help.

An outside expert probably will have knowledge practice members don’t. Switching to a new system means that more money will be spent on the technology and that productivity also will be affected. Exploring other options may save the practice time and money.

Dr. Izard said Milwaukee Health Services’ experience is helping to guide things the second time around. Not only did the practice seek several references from others using the new system, it also included contract provisions to protect them in the event it parts ways with the new vendor.

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