Five EMR Questions That Should Be Part of Board Deliberations

Making the right electronic medical record (EMR) vendor decision can help enable high performance in hospital systems.

Accenture research shows that 4-4.5 percent of hospitals will make an electronic medical records (EMR) buying decision each year. This could exceed 110-plus EMR contracts or 200-250 hospitals per year. This trend is expected to continue well into the future. What’s influencing the trend? According to Accenture—several factors.

Hospitals are mandated to demonstrate meaningful use of electronic medical records, while at the same time, address pressures to cut costs and enhance quality of patient care. As hospital boards and administrators consider making changes to what has been a significant investment, they must do so with care.

Accenture recommends that hospital boards weigh the quantitative and qualitative benefits to switching EMR vendors.

This point of view outlines the five questions that boards should consider when making an EMR decision.

EMR vendor switching is more frequent than ever. This trend is expected to continue. In fact, in 2012, 50 percent of EMR deals are replacements, up from 30 percent in 2011.¹

Several factors are influencing the trend. According to Accenture research, EMRs may translate into annual industry-wide expenditures of up to $13 billion per year in software, hardware, labor and support services.²

EMR vendor decisions have staffing, financial and patient outcome implications. To make such an important decision and to ensure proper governance, it is imperative to weigh the quantitative and qualitative benefits to switching EMR vendors. By carefully evaluating the perceived benefits and costs, and conducting an independent analysis of EMR vendors, hospital boards and administrators will have the answers they need to make an informed decision.

1 KLAS Research, HIT Trends, June 2012.
2 “Examining the Cost of Implementing ICD-10,” Hay Group, October 12, 2006.

As hospital boards and administrators consider making changes to what has been a significant investment, they must do so with care for a variety of reasons. EMR systems can solve current needs, and also position the health system for the future by helping the organization to:

• Optimize performance.

• Increase top-line revenue.

• Improve quality of care.

• Minimize IT expenditures.

• Ensure compliance with government and private payer mandates.

• Use analytics to drive decision making.

• Share medical information to ultimately facilitate better patient outcomes.

• Create connectivity across the health ecosystem (especially with the upsurge of accountable care organizations).

Accenture recommends that boards ask, weigh and prioritize five questions to ensure proper governance of their EMR system and respective vendors:

1. Is our current EMR system delivering the functionality we need?

2. Is our organization’s strategy in line with our vendor’s development strategy?

3. Are we on track to meet mandates and regulations?

4. Do we have the necessary organizational bandwidth?

5. Can we afford to switch?

These five questions should be an important part of board deliberations:

1. Is our current EMR system delivering the functionality we need?

The Centers for Medicare & Medicaid Services has added to its list of core EMR functionality objectives for meaningful use. For example, calling for the ability to provide accessible imaging results and patient family health histories, and also the ability to report specific cases to specialized registries. As hospitals work toward meaningful use requirements, their systems—and their EMR vendors—must keep up with such changes.

2. Is our organization’s strategy in line with our vendor’s development strategy?

Boards should ask of the EMR vendor: do they have adequate resources to help complete the business roadmap on time and successfully? Can the vendor ensure that future product functions are strategically aligned to the healthcare systems’ key initiatives?

3. Are we on track to meet mandates and regulations?

Meaningful use and changes to Stage 2 requirements, as well as adoption of ICD-10, may drive hospital boards to make EMR vendor decisions faster. However, the decision to switch to a different vendor should be dependent on whether the EMR system meets the clinical and functional needs of the hospital organization.

4. Do we have the necessary organizational bandwidth?

Healthcare organizations need bench strength to manage switching EMR vendors. However, amid the competitive labor market for healthcare and IT professionals, most hospitals will be unable to meet IT resource needs for implementation. A national estimate shows an IT staffing shortage of between 30,000 and 40,000 full-time employees.³

5. Can we afford to switch?

The direct costs include software licensing, implementation and new technical support, service and maintenance fees. Ongoing support costs should be estimated at 20 percent of implementation labor costs, per year. The indirect costs such as clinical fatigue, potential attrition and productivity loss, can also deal a blow to the bottom line.

3 Hospital EMR Strategy Executive Update, online at http://www.himss.org/Content/Files/CSC_US_Healthcare_Workforce_Shortages_HIT.pdf