Many hospitals and health systems are evaluating new partnerships to ensure long-term financial viability; in fact, hospital mergers doubled between 2009 and 2012. This trend likely will continue as it is expected that one out of five hospitals will merge in the next five to seven years, according to a New York Times article published in August 2013. Mergers bring many changes, one of which is the need to connect data from disparate electronic health records and other ancillary databases, and to make the systems interoperable.
To achieve smooth data sharing and use, merging organizations most likely will need to convert to a single EHR. However, this does not necessarily have to happen right away. Health care organizations must decide whether to convert to one system soon after the merger or to delay the change. It is a complex decision that requires careful consideration of several factors, not the least of which is each organization's existing meaningful use objectives. To reach the most appropriate decision, organizations must explore carefully the benefits of delaying versus moving ahead.
Advantages of Delaying Conversion
There are many reasons that delaying an EHR conversion may be in an organization's best interest. Continued use of the existing EHRs may help current meaningful use efforts and ensure seamless receipt of incentive dollars. Similarly, organizations already may have significant financial and human capital tied up in the quest to become ICD-10-compliant by October 2014, and maintaining disparate systems for the time being may be more cost-efficient.
In addition, some organizations may not have readily available capital to fund a multifaceted conversion, or they may lack the staff resources for a change of this magnitude. It is also important to consider current EHR vendor contract terms and any financial penalties for early cancellation.
Another reason to delay is physician dissatisfaction that could result if an organization moves too quickly to a new system. Especially if the existing EHR implementation occurred recently, physicians may be resistant to switch to a new system; it takes time to learn the new EHR and get retrained. Likewise, switching solutions too quickly can damage patient satisfaction as patients may just now be getting comfortable with the current EHR.
Benefits of a Quick Conversion
Although moving to a single EHR requires one merging entity to start over on its technology journey, conversion can be a big win if the newly merged organization is equipped to handle the enormity of the project. In fact, changing to one system often enables more effective progress toward meaningful use requirements and attestation. A single EHR improves the ability to report meaningful use and quality measures, eliminating the need to gather data from other systems for consolidated reporting; ICD-10 conversion also may be more straightforward with one system.
Implementing a single EHR early in the post-merger process helps to better prepare the organization for more mandates on system integration, interoperability and transparency.
Moreover, an immediate conversion helps to enhance communication between providers, which builds support of the newly merged entity and improves physician engagement. At the same time, patient satisfaction may improve when there's a single point of access to data from providers and facilities.
Questions to Ask
Every merger is different; the participating organizations must review implications and issues particular to the parties involved and the situation at hand. EHR conversion should be part of the due diligence process. Institutions can do this most effectively by creating an information technology strategic plan and IT business plan to evaluate the pros and cons of the current EHR systems. These plans not only point to whether conversion should occur now or be delayed, but also can indicate which system is the optimal choice for the merged entity.
Consider the following key questions to ask as part of this strategic planning process:
How are the systems performing with regard to patient safety? Due diligence and post-merger planning must prioritize existing systems in need of replacement, and outline when conversion will take place.
Is the EHR certified for meaningful use Stage 1 and Stage 2? If the EHR is not certified for Stage 2, there is no need to pursue that system long term.
How will the new EHR affect registration, scheduling and billing systems? EHR conversion becomes even more complex when there is a need to convert business systems to foster integration. Getting a firm handle on the scope of a conversion is key to knowing when and whether to embark on the journey.
Are physician and staff users actively engaged in work groups? Strong user involvement can have a positive impact on physician use and support and patient satisfaction. It also can make the conversion process easier and more streamlined.
Does the merged organization have the right resources — the financial and human capital — to make the switch? Even if an organization decides to pursue conversion, it may be necessary to delay the effort for three to five years until the organization has the appropriate resources and a clear path to successfully complete an initiative of this size.
The decision to immediately adopt one EHR or continue with separate systems until the time is right is one of many merger-related challenges. While organizations will most likely need to embrace a single EHR eventually, changing technology systems is not as simple as flipping a switch. Although this is a complex, arduous and costly decision, it is worth investing in the due diligence because it paves the way for future organizational success.
Johanna Epstein is the vice president of strategic services at Culbert Healthcare Solutions in Woburn, Mass.