10 EHR failure statistics: Why you need to get it right first time

Organizations in healthcare and other industries tasked with large-scale technology projects often hear cautionary tales of massive failures. EHR project failures frequently gain press attention due to associated catastrophic events like financial losses or widespread system failures. While these dramatic failures are rare, less noticeable EHR implementation failures are more common. In such cases, the consequences aren't dramatic and often go unnoticed by outside observers.

When considering EHR failures, it's important to understand that "failure" covers a wide range of situations. One might think of an EHR implementation failure as rare cases where the EHR disrupts operations or causes significant financial harm. These are examples of failure but are uncommon. Instead of focusing on extreme cases, note that EHR failures vary widely. Classification as a failure depends on context and should be viewed through its impact on an organization. 

Defining EHR implementation failure

EHR failure can be defined as an inability to perform its required function, or subjectively as a failure to live up to expectations. The definition of failure is subjective and is contingent on the expectations attached to a project. Success, or inversely failure, is tied to meeting objective milestones such as on-time and on-budget delivery or a project’s ability to further an organization’s goals. In sum, the definition of failure is contextual and will vary from each organization. As such one can envision cases where an organization’s failure would be considered a successful implementation, depending on expectations. 

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How often does EHR failure occur?

Across all industries, estimates indicate that 25% of technology projects fail outright. 20 to 25% don’t show any return on investment, and up to 50% of technology projects will require massive reworking after being launched. Among EHR projects, estimates reveal similar failure rates. According to the Fox Group, a healthcare consulting firm, 20% of EHR system installations could be considered a failure. 

Other estimates of EHR failure, indicate a much higher failure rate. More than 50% of EHR systems either fail or fail to be properly utilized. Research published in the journal Procedia Computer Science, shows healthcare technology projects fail at a rate of up to 70% of the time when failure is defined as when a project results in an unintended negative consequence, such as a “project delay, a substantial cost overrun, a failure to meet an intended goal, or complete abandonment of the project.”

Ten EHR failure statistics

As discussed previously, EHR failures can take on many forms and involve a broad scope of areas, and often involve failures in multiple areas. The following statistics touch on topical areas that are commonly cited in the context of EHR failures.

1. Patient safety risk 

When an EHR compromises patient safety, dire consequences can result. Quantros, a private healthcare analytics firm, states that in the period between 2007 and 2018, it logged 18,000 EHR-related patient safety events. Of these events, 3% resulted in patient harm, including seven deaths. Further, a 2016 study by The Leapfrog Group, a patient-safety watchdog group discovered that the medication-ordering functionality of hospital EHRs failed to flag potentially harmful drug orders in 39% of cases in a test simulation, 13% of those cases, the mistake could have been fatal.

2. High clinician burnout 

Clinician burnout is a serious concern from a human resources and quality of clinical care perspective. A poorly planned workflow or incompatible system interface can cause clinicians to suffer from burnout.

Stanford University reported that 74% of clinicians noted increased work hours post-EHR implementation, with 71% attributing burnout to EHRs. Recent surveys show that 63% of physicians are concerned with EHRs affecting work-life balance. Half feel they spend too much time on EHRs at home, doubling their burnout odds compared to those with minimal home EHR use.

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3. EHR as a contributor to low job satisfaction

Job satisfaction among clinicians is an important component of a successful organization. If an EHR is contributing to dissatisfaction on the job, an organization may need to examine its EHR strategy. In another survey conducted by Stanford University, 54% of those surveyed showed that their EHR detracted from professional satisfaction. Job satisfaction issues remain high due to ongoing usability and integration hurdles.

4. Declines in clinical effectiveness

Just as professional satisfaction is important if clinical staff believe an EHR is hindering their ability to perform their job an organization may need to examine whether its EHR implementation has gone according to plan. In the Stanford survey referenced previously, 49% of clinicians surveyed indicated that their EHR reduced their clinical effectiveness. 

5. EHR-related financial problems

Many practices experience implementation failure based on their failure to model costs that can arise during implementation and afterward. Given the data available on implementations, a sizable majority of practices showed that financial problems plagued their implementation.

Financial strain due to EHR costs continues, particularly among small and rural hospitals. While cloud-based systems offer some relief, initial implementation costs and ongoing maintenance fees remain a point of contention.

6. Poor usability

In a study published in Mayo Clinic Proceedings, the question of EHR usability was examined. In a large-scale survey of US physicians, one-quarter of the respondents also rated their EHR’s usability on a standard technology usability measure known as the System Usability Scale (SUS).

The scale assigns a letter grade to usability with highly usable systems receiving an A and an unusable system receiving an F. The study noted that users in other studies ranked Google’s search engine with an “A” for usability. Microwave ovens, ATMs and Amazon’s website received “Bs.” Microsoft Word, DVRs and GPS platforms received “Cs.” EHRs were among the worst rated in usability receiving an F.

7. Productivity and efficiency loss

Productivity and efficiency drops can be expected during implementation. However, if these declines last beyond the implementation period they can be considered symptoms of an EHR failure. For example, a survey conducted by American EHR Partners and the American Medical Association found more than half of the survey's respondents reported their EHR was the cause of a negative impact in their practice with regard to cost, productivity, and efficiency.

8. Patient engagement failure

One of the primary areas of focus among policymakers crafting standards for EHR use involved engaging patients more actively in their care through patient portals whereby they could communicate with providers and access their own records. Despite efforts to encourage healthcare organizations to implement patient portals, patients still overwhelmingly do not use them. A study analyzing patient portal use among insured patients found 63% of survey participants reported not using a patient portal during the past year, and 60% reported not having been offered access to a portal. 

9. Patient dissatisfaction

When an EHR is not implemented properly the negative impact is not only felt by those working on the inside. Rather, when a healthcare organization does not use its EHR in a meaningful way, patient satisfaction can decline. A Black Book survey revealed that 89% of patients under the age of 40 were dissatisfied with their organizations’ use of patient engagement technology. 

Another 84% of patients said they are specifically looking for providers who use advanced health IT that helps patients communicate with their doctors and engage with their own health data.

With healthcare technology like wearables becoming more prominent, patient sentiment has improved. A recent Google Health and NHS Confederation Study showed that over 8 in 10 (83%) adults use some form of technology to manage their health, rising to nearly 9 in 10 (89%) for those with long-term conditions. However, just over half are satisfied with the current tools available.

Nearly three-quarters (73%) of patients want their doctors to provide the "best technology available," with three-fifths (58%) wishing their doctor offered technology to monitor their health.

10. Financial risk for hospitals

According to credit rating firm Moody’s, hospitals that roll out a new EHR put themselves at significant risk of financial losses through incurring operating losses, lower patient volumes and receivables write-offs. Although this is not the case for all hospital EHR rollouts, these large organizations are at a higher risk of these financial losses due to their scale.  

Conclusion

The statistics presented above provide both context and an illustration of the causes and symptoms of EHR failure. These statistics offer a way to examine the cause of failure and ways to mitigate the risk of a failure occurring.