Breaking Up is Hard to Do, or Caveat Emptor
I’ve been doing change management work for longer than I care to admit, so I’ve seen firsthand that change is never easy. It’s human nature to be risk-averse to some degree, and many people have deep-seated feelings that change is risky. I’ve enjoyed my work helping physicians and their staff members through the challenges of implementing EHRs and expanding their use of technology, moving them from the “no way” group to the “I can’t manage without it.”
I’ve watched some physician friends move through that transition and it’s been gratifying even though I haven’t been involved in their projects. As an EHR proponent, I’ve been on the receiving end of a lot of complaints about technology, and seeing people reach the point where it enables their work instead of causing heartburn keeps me going. Relying on EHRs has its own challenges, though, particularly when a practice breaks up.
One of my closest friends has spent the better part of the last three years going through such a breakup. Her group of three surgical subspecialists had been stable and productive for years when one of the partners became disabled and could no longer perform surgeries. They held it together while they recruited a replacement physician, taking on extra work to cover the portion of the overhead no longer funded by the departing partner. Unfortunately, the new physician didn’t work out and debts mounted. The remaining partner simply decided to stop working, forcing my friend to terminate the partnership rather than take on debt trying to keep the doors open.
The stress has been significant, but she was starting to see light at the end of the tunnel as she agreed to join another group in town. Since they were on the same EHR vendor, her hosting team promised her an easy conversion. She ran the pricing past me and I thought it looked low. Digging into the agreement, I noticed that it was only a demographic conversion and no clinical data was to be converted. Instead, the clinical data was going to be converted to PDF and added to the imaging portion of her new practice’s EHR. We talked through the ramifications of that, and whether she would rather have the data converted or abstracted. Due to the episodic nature of most of her patient relationships, she was willing to risk it.
I expected her to call after a week or two in the new practice, asking for an abstraction vendor. It wasn’t two hours into her new practice before she was inundating me with text messages and emails. The conversion wasn’t the problem – the EHR was the problem, along with the practice staff.
In a small practice, there may be only one or two super users. In this case, both of them had quit since the last time a new physician joined the practice. No one in the office knew how to add her to the provider master file, so they simply added her as a user since that’s all they knew how to do. As a physician, she didn’t know that was an issue until she started trying to issue prescriptions and apply her electronic signature to office notes. No one in the office knew how to contact the help desk, so she called me, knowing that I’ve worked with her vendor before.
I gave her the help desk number and some pointers on what to ask for and hoped for the best. I felt so bad for her. The average physician looking for a new practice situation is more focused on questions about the call schedule and how expenses are shared than he or she might be on asking about the number and availability of super users or system admins. Especially if we’ve come from a highly functional EHR support framework, it might never cross our minds. We take it for granted that things just work, not remembering all the hard work and setup that it took to get the system to the place where we could see patients.
We may also take it for granted that every installation of a given vendor’s system is the same. Although there may be core modules that are the same, practices and hospitals often customize and configure many portions of their system, unknown to the average end user. Additionally, not every installation is on the same version of a given piece of software. In my friend’s situation, her new practice was on an older version of the system. The visit documentation templates were nearly unrecognizable to her, as they pre-dated her previous system by several major releases. I’m sure asking for their release version and the number of their most recent content patch wasn’t part of her interview questions, either.
Fortunately, I was able to call in a couple of favors and get her some immediate help, although we haven’t been able to get her set up with electronic prescribing or updated letterhead for her patient plan documents. She’s not yet present in the patient portal and can’t order labs, but at least she can print prescriptions, document her visits, and bill out her charges.
Although the old adage about “buyer beware” certainly applies, these are uncharted waters for most physicians. Most physicians that are making moves are consolidating into larger groups or are being acquired by hospitals and health systems. It’s not as common for them to move from one small practice to another, but even in that situation, groups may be on a hospital’s community EHR offering or on a fully hosted solution. It’s rare to see a small practice trying to maintain their own client-server system and I think many physicians would fail to deduce that arrangement if they were in her shoes.
Back in the day when EHRs were just coming on the scene, I started my “on the side” consulting business by helping small practices with system selection and implementation. I’m thinking I may need to consider a new business line helping physicians on the move who need help teasing out potential EHR pitfalls during the practice selection process. It would definitely be a niche offering given the number of new grads joining hospital-owned practices, but for those physicians faced with a situation like hers, it would be worth it. Once the match was made, it would lend itself nicely to conversion and/or abstraction services.
My friend has given me permission to use her experiences to create checklists and questionnaires to help prevent other physicians from going through similar circumstances. I’m sorry she had to go through it, but I’m going to be ready for the next physician who needs help evaluating a practice opportunity.
How do you onboard new physicians? Email me.
Email Dr. Jayne.