6 Common EHR Implementation Challenges and How to Avoid Them

The adoption of EHRs in physician practices is definitely on the rise thanks to Meaningful Use incentives. According to the data from the Office of the National Coordinator (ONC), office-based provider adoption of basic EHRs has increased from 17% in 2008 to 40% in 2012.

And although the number continues to grow, actual implementation of EHR technology continues to challenge many practices.
Only 12% of the 1,442  respondents who completed the Physicians Practice 2014 Annual Technology Survey sponsored by Kareo reported that EHR implementation was ‘smooth sailing.’ Slightly more than 10% characterized the transition as ‘traumatizing.’

Mary P. Griskewicz, MS, FHIMSS, senior director, healthcare information systems at the Healthcare Information and Management Systems Society (HIMSS), says practices can encounter a variety of setbacks during—and even after—implementation, and they need to know how to address those challenges efficiently and effectively in order to achieve success. She provides insight into these challenges as well as advice for how to overcome them.

1. The EHR implementation is breaking your budget. According to HealthIT.gov, various studies indicate that the cost of purchasing and installing an EHR ranges from $15,000 to $70,000 per provider, depending on whether the practice uses an on-site or Web-based EHR. These costs include hardware, software, implementation assistance, training, and ongoing network fees. The cost of an EHR is the number one reason why practices haven’t purchased one yet, according to the Technology Survey. Griskewicz says practices—particularly solo practitioners and smaller groups for whom these costs are especially high—should contact their Regional Extension Center (REC) to identify ways in which they can work with vendors in an economical way. Practices may find that it’s more economical to partner with the same vendor that provides their practice management software because it’s more seamless from an interoperability standpoint. There are also several free and open source EHR products available on the market that physicians can explore to determine whether they meet the needs of the practice. Essentially, there are options for everyone, and physicians shouldn’t let cost be a deterrent.
2. The EHR just doesn’t fit into the workflow. Some practices may find that even after a careful implementation, the EHR just doesn’t provide the flexibility or customization that the practice needs. This is the worst scenario in which physicians find themselves because they’ve already invested in the technology and are unable to use it effectively. The 2014 HIMSS Physician Community EHR Usability Pain Point Survey identifies several deficiencies related to clinical data review, documentation, clinical decision support, and more. The best way to avoid this problem is to ensure that each potential vendor provides an in-depth demonstration regarding features and functions. All staff members should be able to ‘test drive’ the software and provide input.
3. EHR training is difficult and time consuming. Although vendors should be able to provide thorough training for all employees, practices that succeed with EHR implementation are those that identify super-users who really take the time to get to know the EHR and who can serve as a resource for physicians and others, says Griskewicz. Also be sure that your EHR vendor specifies the type and duration of training that employees will receive. This includes training on any software updates or patches. The vendor should also provide an active support line that users can call when they have questions. Again, the vendor should outline all of these details, she adds.
4. Physicians resist using the EHR. Some physicians simply won’t want to use the technology either because they don’t believe in its efficacy, they feel that it will decrease productivity, or perhaps they are even intimidated by it. Practices must identify a physician champion who can encourage others to adopt the technology and feel more comfortable using it, says Griskewicz, adding that a peer-to-peer approach works best.
5. Your chosen vendor hasn’t—or doesn’t intend—to meet Meaningful Use Stage 2 requirements. Griskewicz says some practices are frustrated because the certified vendor they chose to meet Stage 1 requirements either isn’t going to meet the more detailed Stage 2 requirements or will be delayed in doing so. Only 40% of respondents stated their vendor was ready for Stage 2, according to the Annual Technology Survey. If practices intend to continue the attestation process, they may need to find a new vendor entirely. For those that choose to ‘wait it out’ with their vendor, keep in mind that time is money, and the longer that practices must wait on their vendor to update software to meet the new requirements, the fewer incentives they’ll receive. Griskewicz says one way to avoid this is to vet your vendor thoroughly to ensure that it intends to invest the time and money to accommodate ever-changing requirements. RECs may be able to help physicians switch vendors in a cost efficient way and help them choose a vendor that meets the needs of the practice.
6. The practice falls behind in meeting Meaningful Use requirements. There’s no doubt that it’s challenging to keep up with the requirements to comply with Meaningful Use. Even practices whose vendors are ready for Meaningful Use requirements sometimes fall behind because they don’t have the internal processes in place to ensure success. Practices that miss deadlines will unfortunately be subject to penalties. The best way to avoid this is to appoint someone within the practice whose responsibility it is to oversee requirements, deadlines, and ongoing communication with your vendor.

Networking is often the best way to resolve EHR challenges and identify best practices. Many EHR vendors provide user groups, and practices should take advantage of the opportunity to network with other providers and ask questions. Oftentimes, practices face the same challenges and can benefit from best practices and lessons learned, says Griskewicz.

For more strategies to help you successfully implement your EHR, download this guide.