Just the facts, please. And the facts show those organizations that have ripped and replaced their electronic health records have gained little in the way of productivity or satisfaction for doing so. Thus says a new report from Florida-based research firm Black Book.

The firm, known for a variety of studies related to health IT issues, paints a picture using reviews compiled since the EHR replacement frenzy went into fifth gear around 2013, comparing comments from then to current 2016 feedback. The good news is that present satisfaction "outcomes reflect on mild successes balanced with higher-than-expected costs, layoffs, declining inpatient revenues, disenfranchised clinicians and doubts the benefits of switching systems."

High cost of ownership for the replacement of the systems didn't seem to hinder investment in them. However, Black Book says well over 80 percent of "financially threatened hospitals" regret the decision to change systems. Also, while smaller in representation, about 15 percent of all hospitals that replaced their original EHR this decade are not making enough money back to validate the replacement costs.

For those professionals at the level of care, most said they still think EHRs had a negative impact on patient care, including 90 percent of nurses. "In contrast, only 5 percent of the hospital leaders responded that the EHR replacement process impacted care in any negative way," the research firm said.

Finally, the cost of replacing an EHR system goes deeper than just the potential impact on patient care and revenue, expanding to the level of job security for executives at the highest level. Caregivers, who were not considered in the decision to purchase a specific system and don't face the scrutiny for a successful launch or failed implementation of the system, don't have to worry about whether the implementation of a new system fails.

To that point, more than 60 percent of executive-level respondents said they or their peers "felt in employment jeopardy through the EHR replacement process."

Also, nearly 20 percent said some staff layoffs were "directly caused by implementation delays, cost overruns, budgets underestimated, or trained personnel unavailable." Given the level of investment financially, which can be in the multiple millions, this is not surprising.

In closing, much like the initial rollout, EHRs didn't always live up to the preshow hype, a common criticism in the years that have followed the EHR boom. Nearly 80 percent of executives said clinical buy-in was oversold. Nearly 90 percent said they saw no positive improvement once their second system was in; no outward competitive advantage, that is.

And (is this shocking?) 80 percent of IT staff said they felt they had to coerce network physicians into adopting replacement EHRs. Apparently, such is life in the big business of electronic health record implementations and redux.

"It was a risky decision (replacing an existing system) as hospitals were facing the fact that they would not be back to their pre-EHR implementation patient volumes, inpatient or ambulatory, for at least another five years," Doug Brown, managing partner of Black Book, said in a statement. "No other industry spends so much per unit of IT on the part of the business that is shrinking the fastest and holds little growth as did inpatient revenues.

"In our experience polling, most executives will not admit they were oversold or that their IT decisions had adverse bearing on patient care. On the other hand, workflow changes and productivity issues may have added to the disappointment nurses felt after being left out of replacement EHR product evaluations."