3 Key Tips for Ensuring a Smooth EHR Replacement Process

Healthcare organizations that are considering an EHR replacement cannot rush the process and need to find a system to meet their growing needs.

By Elizabeth Snell
View original publication by EHR Intelligence.

June 01, 2018 - Physician and nursing dissatisfaction with an EHR system could lead to long-lasting problems within a healthcare organization, such as fueling administrative burnout and patient engagement. Opting for an EHR replacement is not a decision that should be made lightly, and organizations often look toward new options when they begin to encounter certain issues, both technical and cultural.

A smooth EHR replacement process is not always guaranteed, and organizations will need to make well-informed decisions throughout the entire implementation process.

Each healthcare organization is different, and will have varying requirements when it comes to EHR selection. But considering the needs of physician and nurses, finding an EHR system to meet an organization's growing needs, and ensuring to not rush the selection process are all key considerations.


EHR user satisfaction is often a key reason why a healthcare organization will opt for an EHR replacement option. Involving all physicians and hospital staff in the EHR selection process, such as in product demonstrations, can help to improve provider satisfaction.

A higher user satisfaction rating can also help to lower the likelihood of physician burnout, or ease administrative burden for staff members.

A New England Journal of Medicine (NEJM) Catalyst spring 2018 report found that 83 percent of clinicians, clinical leaders, and healthcare executives found physician burnout as a problem at their organizations. Approximately three-quarters of registered nurses, 64 percent of advanced practice nurses, 56 percent of clinical leaders, and 42 percent of healthcare executives said the same.

"Clinicians feel the impact of burnout by reducing their hours, switching to administrative roles, or leaving health care altogether, taking them away from why they chose medicine in the first place: to treat patients," report authors wrote.

Stakeholders should target the organizational level, rather than the regulatory or individual level, to orient interventions and work toward overcoming burnout, the authors continued.

Nearly half of the respondents said off-loading administrative tasks to other staff members could alleviate physician burnout, while 46 percent of respondents recommended health IT innovators improve EHR systems and other health IT.

Specialty EHR product categories also had the highest physician satisfaction scores, according to a 2018 Black Book survey. Single-solution offerings, including ones that integrate EHRs, focus on revenue cycle management, and utilize coding and practice management tools would likely continue leading the way for specialty practices in 2018, the report explained.

Products that help users in their workflow, patient coordination, and critical digital capabilities will help in the value-based care approach as well.


Inefficient workflows and lacking EHR functionality could also push a healthcare organization towards an EHR replacement. Technology is ever-evolving, and with the continuous push toward nationwide interoperability, healthcare organizations will need to ensure that they have the necessary tools to meet those changes.

A 2018 literature review published in AHIMA's Perspectives in Health Information Management explained that healthcare organizations are also likely to switch EHR systems even if there will not be an immediate return on investment.

"The cost of switching systems can seem excessive, often in the millions, when the cost of the new system is coupled with the cost of its implementation; however, health systems must remember that the benefit to the patient is the main priority," wrote Coustasse, et al. "Some practices have found that the functionality of the new system increases the level of care the patients receive by speeding up communication."

For example, an American College of Physicians study found that 34 percent of providers were dissatisfied with the EHR's ability to decrease workload, with 32 percent saying they had not returned to their normal productivity two years after implementing an EHR system.

Having cloud-based mobile solutions for on demand data was also a top priority for healthcare organizations, a 2018 Black Book survey showed. The majority of surveyed EHR users also said that telehealth/virtual visit support and speech recognition solutions for hands-free data were key things for an EHR system to offer.

The size of a healthcare organization could also play into what type of technological needs are desired. Just under one-third of small- to medium-sized practices said they always or frequently used electronic messaging, while 31 percent said they always or frequently used clinical decision support.

Twenty-nine percent of small- to medium-sized practices added that they always or frequently use interoperability/record sharing, with 36 percent saying they do the same for patient engagement.

"When we look at apples-to-apples client satisfaction among small practices, it's about basic functionality experience," Black Book Managing Partner Doug Brown said in a statement. "While in large practices, the rating of customer satisfaction is based on that plus a much wider breadth of vendor offerings and client execution from claims management to population health bundled in."


Healthcare organizations should approach an EHR replacement at a good pace, as rushing in either the decision-making process or the implementation process could lead to negative results.

Time is often a key consideration for healthcare executives when approaching an EHR replacement, and leadership often wants to know that they won't need to go through the same process in a few years' time, Mark Hess of Stoltenberg Consulting Group told EHRIntelligence.com in a previous interview.

A slower and careful approach will also yield better group collaboration, and including executives and end-users in the process will help as well.

Jerrilyn Ivey, Director of Consulting Services at Culbert Healthcare Solutions, told EHRIntelligence.com that mapping out the process and conducting thorough testing is also essential.

"All of that requires a great deal of time," Ivey previously said. "Data migration sometimes gets the short end of the stick and people don't give it enough time in their project plan to thoroughly vet and test it out."

Maryland-based hospital Meritus Health will undergo an EHR replacement process over a five-year period that is slated to cost nearly $100 million. Meritus officials considered six different vendors before opting for an Epic EHR system. There was also an 18-month review process involving over 1,000 Meritus Health employees and officials.

"From a provider standpoint, they looked at what the workflow looked like within the actual computer system and software," said Chief Transformation Officer Carrie Adams. "They also looked at the availability of information following patient discharge, the ability to look at labs and progress notes, and the ability to follow up easily and quickly."