Disputes between EHR vendors and clients negatively impact patient care and add to a growing list of disconcerting stories about EHR use and implementation. However, practices may mitigate their risks by taking a few key steps.

It’s no secret that many doctors don’t like EHR software. Despite the promise of decreased workload and improvements in patient care, the number of doctors who are dissatisfied with their EHR systems are swelling. According to William S. Underwood, senior associate at the American College of Physicians, there has been a 15 percent increase in reports since 2010 of doctors being “very dissatisfied” with their EHR systems. He is cited in a Healthcare IT News report, which also noted that “satisfaction and usability ratings are dropping – regardless of specialty type and across vendors. As they work to meet meaningful use, providers are struggling with workload and productivity.”

Poor software design, limited usability and interface problems may be the main causes of disenchantment with electronic medical records (EMR). But poor relationships between vendors and their physician practice clients and lack of due diligence when choosing vendors could also be to blame.

Unpaid Bills Hinder Patient Care

To illustrate, a small practice in Maine—Full Circle Health Care—experienced how a significantly a poor relationship with an EHR vendor can adversely affect the capability to deliver patient care. Full Circle got locked out from their own computers housing their patients’ medical records due to a billing dispute with their EHR vendor, CompuGroup, according to the Boston Globe. The practice’s nurses and doctors were denied access to medication histories, lab data, allergy reports, diabetes records and other health data. They now have to reconstruct the data manually using whatever paper trail was left behind. CompuGroup says Full Circle owes them thousands of dollars in unpaid bills.

E. Victoria Grover, the physician assistant who owns Full Circle, told the Globe that, like other organizations complaining of excessive fees, her small practice was squeezed dry by “exorbitant, unexpected maintenance fees and charges for hardware that was never delivered — disputed billings that she said CompuGroup refused to acknowledge or correct.”

CompuGroup said it was forced to deny access because Full Circle refused to cooperate on a payment plan to settle overdue bills. “If you were to stop paying your electricity bill, and a year later someone shut down your electricity, how would you feel about that?’’ Tetyana Buescher, general counsel of CompuGroup Medical USA, told the Globe.

This situation could be repeated in other practices and that does not bode well for patients’ welfare. It highlights a peculiar flaw in a healthcare system where business decisions and financial concerns take precedence over patient care. Thankfully, practices and vendors can choose not to jeopardize patient care by forging a mutually beneficial relationship.

Tips for Working with Vendors

Hospitals and practices often complain of problems with their EHR vendors. But when the relationship gets complicated, Julie Korostoff of Technology Matters recommends a few things that healthcare organizations can do:

  • Designate a vendor relationship manager who will monitor and enforce vendor performance.
  • Stick to a routine of regular meetings to communicate issues promptly, especially when issues arise.
  • Read the contract and use built-in tools for vendor management—such as service level and other performance reporting, requirements for regular management-level meetings, escalation clauses to senior management for unresolved disputes, price protection and benchmarking.

Korostoff says that “the best means of motivating better vendor performance is to have an alternative.” Knowing who the back-up plan will be before the need arises can be critical to ensure that patient care won’t be affected if the relationship turns sour.

Andy Nieto, health IT strategist for secure messaging provider DataMotion, recently told Medical Practice Insider  that practices should “view technology as a tool for care, no different than a stethoscope. Seek out the solution that matches your practice's needs.”

“’Divorce rates’ with EHRs are high, and I think that's a good thing,” Nieto added. “Now that you understand how systems work, find one that matches the way that you care for patients, the way that your practice runs. Don't be afraid to say this doesn't work for me. Physicians should push EHR vendors to make changes to enable better workflow.”

Recommendations from the AMA

For a practice that’s looking for a new EMR software vendor, the American Medical Association (AMA) Practice Management Center has a more detailed, 15-item questionnaire for practices to ask themselves before signing any EHR/EMR agreement.

Per the AMA, things to scrutinize in the contract include finding out whether all costs are included—like software licensing fees, implementation costs, data conversion costs, training fees, upgrades and maintenance costs. In the case of the Full Circle practice, fees increased after CompuGroup signed the original agreement, but terms were not restructured because the two sides did not talk.

Another key item on the AMA list is an orderly data recovery process in case of contract termination. When the Globe ran the story, Full Circle said it wanted 48 hours to transfer their data to a new system, but has not been allowed to do so. It’s unclear what resolution will follow.

What Vendors Recommend

Vendors offer their own advice about creating these critical partnerships. EHR company Capterra advises clients to look for five things:

  1. Adequate staff training and support
  2. A smooth implementation and transition plan
  3. A full list of costs
  4. Compliance and security features
  5. Clear termination clauses and data transfer plans.

EHR giant Athenahealth said in a white paper that “The HITECH Act and the federal incentives it has made available will drive thousands of practices to adopt EHRs” but given the tough road to adoption, practices must “make calm, rational decisions in selecting an EHR rather than sprinting blindly into a potentially destructive arrangement.” The company recommends that care providers look at key factors in selecting an EHR vendor, namely: implementation process and track record, data migration approach, workflow design, and total cost of ownership.

Many practices such as Full Circle are struggling with EHRs and meeting meaningful use criteria. According to Kareo’s Physicians Practice 2014 Technology Survey, “nearly 17% of practices say that EHR adoption and implementation is the most pressing problem” and “11% have heard too many horror stories.” However through careful planning, and by following a few key steps, provider-vendor relationships can be optimized, helping patients to get the quality of care they deserve.