How long does it take to switch EHRs?
Plan for months of configuration before go-live and for productivity that can stay below baseline for a year or longer after it. Published studies vary widely: Cleveland Clinic's Cole Eye Institute spent eight months customizing its EHR before go-live, while UC Irvine otolaryngologists' average monthly work RVUs fell from 334 to 284 in the year after they moved to a new EMR.
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Definition
An EHR switch timeline is the elapsed time from contract signature with the new vendor to full operational and financial stabilization on the new platform.
The detail
EHR switching runs in four phases, and published data on how long each takes is thin, so plan conservatively. Phase one is vendor selection: demos, reference checks and contract terms. Phase two is build: data mapping, interfaces, workflow design and training. Most projects underestimate this phase; Cleveland Clinic's Cole Eye Institute spent eight months personalizing and customizing its system before go-live, according to a 2015 JAMA Ophthalmology study. Phase three is go-live, when productivity drops and error rates rise. Phase four is recovery, and it can take longer than vendors suggest. In a 2017 JAMA Otolaryngology study of five UC Irvine otolaryngologists, monthly work RVUs fell from a mean of 334 to 284 and monthly clinic visits from 132 to 121 in the 12 months after the move to a new EMR. At a University of Washington eye clinic, visits per provider ran 16.9 percent below the pre-EHR level on average over four years, and no provider had returned to the old volume by the final year. Results vary: the Cleveland Clinic study found no significant change in revenue or productivity after its conversion. All three studies come from academic practices. A frequent timeline risk is data migration, because legacy data is often messier than expected.
In the 12 months after five UC Irvine otolaryngologists moved to a new EMR, monthly work RVUs fell from a mean of 334 to 284 and monthly clinic visits from 132 to 121.
Source: JAMA Otolaryngology Head & Neck Surgery (2017), PubMed
At a University of Washington academic eye clinic, patient volume per provider was 16.9 percent lower on average over the four years after EHR adoption, and no provider had returned to pre-EHR volume in the final year.
Cleveland Clinic's Cole Eye Institute spent eight months personalizing and customizing its EHR before implementation and found no significant change in revenue or productivity afterward.
What this means for clinic owners
From Sorso
Build the cash flow model on a year of below-baseline productivity, not a month. The published studies range from no measurable dip to a drop that had not recovered four years later, so plan for the bad case and treat a fast recovery as upside.
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How much does it cost to switch EHRs?
We found no current national survey that prices an EHR switch, so the best published anchor is a first-time implementation: about $162,000 up front plus $85,500 of first-year maintenance for a five-physician primary care practice, or about $32,400 and $17,100 per physician (Fleming et al., Health Affairs, 2011). On top of that comes lost productivity: go-live studies that measured a drop found visits or work RVUs roughly 8% to 15% lower afterward, with a learning period of about six months at one clinic and lower volume lasting a year or more at others.
What financial KPIs should I track for my clinic?
The core 8 financial KPIs every clinic should track monthly are revenue, EBITDA, net collection rate, days in AR, denial rate, revenue per provider, overhead ratio, and rolling 13-week cash forecast.
How do I improve my net collection rate?
Improve net collection rate by working denials promptly, reconciling payments against your contracted rates, collecting patient balances at the point of service, and requiring sign-off on write-offs. The target is at least 95 percent, with 97 to 99 percent optimal (HFMA), and each point you recover is worth $50,000 a year on $5 million of allowed charges.
What are the most common billing errors in healthcare?
The most common healthcare billing errors are eligibility verification failures, missing prior authorization, incorrect or missing modifiers (especially modifier 25 and 59), upcoding/downcoding, missing documentation for medical necessity, and timely filing failures.
What does switching EHR systems actually cost in lost clinical productivity?
Studies that measured a drop after an EHR go-live found visits or work RVUs roughly 8% to 15% lower, with a learning period of about six months, though some practices were still below their old volume a year or two later and one study found no drop at all. Five otolaryngologists at UC Irvine averaged 121 clinic visits and 284 work RVUs a month in the year after the change, against 132 and 334 before, and a Duke orthopaedic clinic was back to its old labor cost per visit after six months. The revenue impact is lost visits times your revenue per visit, and none of it appears in the vendor's quote.
Founder of Sorso and a CFA charterholder. Before Sorso, Stan spent 19 years in corporate finance at institutions including UniCredit and Société Générale — managing a $450M loan portfolio and making senior partner at a major mezzanine lender by 29 — then built a fractional CFO firm exclusively for outpatient healthcare clinics.
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