Lots of EHR systems—and some churning

In a story in Modern Healthcare magazine this week are some numbers from the CMS on electronic health-record systems that hospitals, physicians and other "eligible professionals" are using to meet their meaningful-use obligations under the Medicare EHR incentive payment program.

There were more than 77,600 records in the CMS database, with basic product information on "complete" EHR systems used by 1,027 hospitals and 71,183 EPs.

The CMS data shows that hospitals have used complete EHRs from 27 developers and EPs have used EHRs from 327 different vendors to qualify for federal payments.

Facing "a plethora of options" has long been the rule for office-based primary-care physicians shopping for EHRs, with variables including cost, functionality, service and vendor size, according to Dr. Steve Waldren director of the Center for Health Information Technology at the American Academy of Family Physicians.

Since 2007, the Leawood, Kan.-based medical specialty society has run a website with not only an EHR guide but also a library where members can post peer reviews of their EHRs.

"We've tried to educate our members on the key things they need to look at," Waldren said, adding that one of those is "creating a peer network of people" to help them in their decision-making.

Another is advising physicians to investigate in advance how they'll be able get their patients' records out of their EHR system when their developer goes belly-up.

"Some of these vendors are not going to be around, and I think that’s always been the case," Waldren said.

Regardless of the EHR developer's size, providers should devise a data-migration strategy they can adopt should their vendor go out of business, given that lack of interoperability among EHR systems is still a problem, he said.

Waldren said the churn rate for replacing existing EHRs may not be as high among family practitioners as that found by market watchers KLAS Enterprises in a report it released earlier this month, but it's there.

"We’re definitely hearing a bit of rumbling about churning," Waldren said. "I've heard numbers of up to a quarter of users are switching systems."

"I think if we actually solved some of these interoperability problems for real, I think we'd see a lot more people switching systems," Waldren said. "But the cost of change is just enormous. It's just too costly, even if the system isn't working."

The Office of the National Coordinator for Health Information Technology's acting chief medical officer, Dr. Jacob Reider, said the government is aware of the problem.

"In our proposed rule for Stage 2 we had described a functionality that would enhance the portability of the data in the electronic health record," Reider said, so that if there is a market exit, the providers at the hospital (or office) are not left high and dry.

"This is a policy goal of ONC," he said. "I think we will iterate toward perfection over time."

Follow Joseph Conn on Twitter: @MHJConn.