Practices big and small are finding themselves in the tough position of having to reevaluate their original choice of electronic health record system. The reasons? Acquisitions and mergers, physician satisfaction, meaningful use compliance, and cost. Not only does having to choose a new EHR present new problems, it resurfaces old headaches from when you made your first EHR choice and why.

Welcome back to square one.

Acquisitions are one of the more frequent reasons for a core system replacement discussion. We are seeing large health systems buy up smaller practices and large health systems being bought out by payers. These mergers create a new issue for the groups: "We have been on our EHR for 10 years and we don't want to leave it." No one wants to set up and manage interfaces, spend thousands of dollars on staff and technology, so that a group of 10 providers can use their old system. But if your physicians are pleased and productive on that system and don't want to change, why make them?

[EHR not clicking with your clinicians? Read Doctors Can Go Back To Tech School.]

You can make a business case either way as to what works and both might be right. Each situation involving multiple EHRs needs to be decided on a case-by-case basis. There isn't a cookie cutter approach. You can only evaluate each instance and make sure your EHR systems are meeting business needs.

Nothing frustrates me more than listening to a practice say they are changing EHRs because they had a failed implementation. Complaints generally sound like, "Frankly, the system sucks" or there are "too many clicks" or, "This wasn't an upgrade, it was a downgrade." Chances are, the system isn't the problem. The system probably works fine and either the implementation didn't go as planned or it didn't meet the business needs.

When I hear a doc say, "This has too many clicks and doesn't fit into my workflow," my immediate response is: at this point in practicing medicine, the system is not about you and your workflow. Instead, it is about the patient and connectivity.

It doesn't matter what system you use: they all have too many clicks. Some physicians say that their go live was so bad they couldn't see 15 patients a day, but the same system in a practice a few miles away is doing fine. The same doctors who didn't finish their paper charts are the same ones complaining about their EHR charts. Either doctors want to do it or they don't, end of discussion.

If a core system replacement is due to satisfaction issues, then you are setting yourself up for the same battle (assuming you survive this one) three years later. Physician satisfaction is not a reason for a core system replacement. Satisfaction can be controlled at home.

If your system doesn't meet Meaningful Use federal requirements, the decision is easy. It's time to look at alternatives. Many EHR systems that came out of the woodwork four or five years ago didn't have the capital or the resources to be able to tackle Meaningful Use. Although some of those EHR systems might have been excellent, they were unfortunately a lost cause. Undoubtedly, there will be more to follow as the Meaningful Use program progresses. So in short, it is time to change out your system.

There are high-cost EHRs (the Mercedes-Benz) and low-cost EHRs (the Honda Civics). No matter what the story, they all come with a price, even if they are advertised as "free." You can have a private jet or a bicycle. Both work well, but they serve two very different purposes. Practices are always looking to improve their bottom line (this is a business) and when vendor bills arrive, you might start to look at some cost-saving options.

The discussion is the same when practices evaluate the price of upgrading their current system to something that's compliant with Meaningful Use and ICD-10. Is your legacy system worth the price that you're paying? Will that "free" Web-based EHR really do the trick? These questions can go right back to the same choices presented in the first topic of acquisitions. Each instance has to be decided case by case. There is no right or wrong answer or a crystal ball. You need to evaluate what is important and look to the future your practice is heading toward.

These situations are no longer avoidable. Fear not. Tackle it head on and weed out the complaining by paying attention to the business needs. If you show your C suite or board a compelling case to switch or stay and you do your homework, then you are doing it for the right reasons.

Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, an InformationWeek Healthcare digital issue.