Understanding C-Level motivations for an EHR

Practices change EHR systems or further invest in existing technology for many reasons. One of the overriding reasons practices change or invest further in their EHR involves dissatisfaction with an existing system’s functionality or usability. According to Medical Economics’ 2017 EHR Report, nearly half of the 62% respondents who noted they had switched EHRs state that deficits in the previous system led them to look for a replacement or prompted further investment.

With the significant segment of those in healthcare who display some level of dissatisfaction with their EHR, survey data indicates that there exists some enthusiasm for further investment.  For example, in a recent survey conducted by KPMG, the chief information officers surveyed plan to invest heavily over the next three years to improve how electronic medical record systems are used, by spending heavily in optimizing existing EHRs at their organizations.

The survey results show CIOs are concerned about the efficacy of “factory boilerplate-style system installations." The poll found that 38% of the 112 survey respondents ranked EHR or EMR optimization as their top choice for where they plan the majority of capital investment over the next three years.

Investment in optimization appears to be where future EHR investment will take place.  The report suggests that senior management investing in EHR optimization focus on the following areas:

• Enhancing user experience
• Training 
• Coding services more effectively 
• Mobile access to their EHR
• Aligning EHR technology within the larger organizational infrastructure
• Automating functions

Besides EHR optimization, the CIOs surveyed listed and rated the following areas of functionality as high investment priorities:  

• Accountable care/population health technology (21%)
• Consumer/clinical and operational analytics (16%)
• Virtual/telehealth technology enhancements (13%)
• Revenue cycle systems/replacement (7%)
• Enterprise resource planning systems/replacement (6%)

The main takeaway from the KPMG survey indicates that CIOs are not seeking to invest in basic functionality for compliance purposes. Instead, CIOs are looking to direct investment into making their EHR a more powerful tool that can enhance how these organizations deliver care and can do so more efficiently.

Problems with EHR investments

Although received wisdom indicates that investments in EHR technology are considered a cost of doing business, organizations investing in this technology still expect some return on investment. Herein lies the problem, the return on investment that comes from EHR technology can be challenging to quantify, and its benefits are often incremental. Thus, if the expectations regarding return on investment are immediate and clearly understood benefits investors might be disappointed.

One should assume that problems related to returns on EHR investment are a product of not understanding the nature of the investment. Rather there are some concrete and justifiable concerns regarding whether increased investment beyond what is needed for regulatory compliance is worthwhile.

Other evidence does indicate that primary care practices have experienced positive results when investing in EHR technology. A study conducted in 2014 and published in the journal JMIR Medical Informatics indicates that among the surveyed primary care clinics that EHR investments were recovered “within an average period of 10 months (95% CI 6.2-17.4 months).” These practices were able to see more patients with an average increase of 27% after an EHR implementation. The study also indicated that the increase in patient volume resulted in a breakeven point of 10 months.

Other evidence confirms these findings, a study published in Health Affairs looking at return on investment (ROI) for implementation of an EHR system in smaller medical practices showed these practices were able to make up for the cost of EHR implementation in 2.5 years due to increased revenue resulting from improved accuracy in coding and increased provider productivity.

For larger organizations, investment performance data shows that investment must be carried out thoughtfully. According to a study by the National Board of Economic Research (NBER), hospitals that invested in advanced EMRs and did not have the expertise to innovate to improve operations wound up increasing their overall costs by 6%, even after several years. However, this should not be taken to mean that large organizations do not realize significant gains on EHR investments, rather investments need to be made strategically in areas that will result in positive benefits for the practice. For example, evidence from the study by the NBER shows some leading hospitals are realizing substantial and sustained improvements in clinical and financial metrics as a result of  EHR investments.