If you were a healthcare provider and all you did was read press releases, you'd be tempted to think that transitioning to a new EHR involved little more than opening the package and plugging in the contents.

Naturally, things are a little more complicated than that, but many providers aren't aware of just how much more complicated the truth really is.

As Michael Gleeson, senior vice president of product strategy for Arcadia Solutions, a Boston-based health IT consulting company, put it recently, "We've found that using technology is really new for a lot of practices."

Given that naiveté, Gleeson said, many practices struggle with performance issues related to their workflows, largely because their care delivery structures aren't always suited to taking advantage of EHRs and they're not clear on the proper steps toward greater efficiency.

As Gleeson sees it, there are four generally unanticipated issues that providers encounter when they transition from paper records to EHRs.

1. Network issues. "This," said Gleeson, "is one of the most difficult areas." He went on to explain that if a practice uses a hosted EHR, accessing it through the Internet, it could cause delays as the information gets loaded slowly. That, naturally, leads to provider frustration.
2. Untested upgrades. Upgrades make things better, right? Maybe. The problem, according to Gleeson, is that "the upgrade might come from the vendor, but the customer has customized the original system and the upgrade hasn't been tested within their own (now customized) ecosystem."
3. Ineffective template design. Templates are a love 'em or hate 'em proposition. On the one hand they allow for data input uniformity, while on the other they often restrict the capacity of providers to make comprehensive notes. On an operational level, Gleeson pointed out, templates are often just plain inefficient, and they offer too many distracting alerts. Providers new to EHRs may not understand how to solve either of those problems.
4. Genuine application performance issues. Many problems, Gleeson said, stem from how the EHR has been deployed. Again, these aren't plug-and-play systems, a fact which too many providers don't realize until they're knee deep in impediments to productivity. The good news, however, is that systems can be analyzed, with an eye toward determining what modules need to be tweaked or moved to different parts of the system.

While there are few problems that can't be solved post-implementation, Gleeson pointed out that often providers don't realize they have problems to correct until their systems have been in place for some time. In large part, that's because even less than optimally installed EHRs can help with upcoding right away. Consequently, providers who may now be able to bill for services that once fell by the wayside may not realize until later that, in reality, their overall productivity has decreased.

The truth, Gleeson said, is that the problems listed above can lead to up to a 30 percent decrease in productivity.

"These aren't out of the box solutions," he said. "There are other activities and services that need to take place, so providers should plan for them at the beginning."

[See also: EHRs are inevitable, experts say]

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