KLAS assessed physician satisfaction with the ambulatory-care products of 18 vendors. In a section entitled "Inpatient and large group analysis", it compared the results for Allscripts, Cerner, eClinicalWorks, Epic, GE Healthcare, and NextGen EHRs. These EHRs have a broad coverage of specialties and have either limited or full ability to share data with inpatient systems.
Across all products, internal medicine and family medicine scored 7.6 and 7.5, respectively, on a scale of 10 in physician satisfaction with EHRs. Pediatrics scored 7.2, ob/gyn 6.8, urology 6.4, and nephrology 6.2. Oncology (5.8) and ophthalmology (5.8) were among the lowest-rated programs.
Mark Anderson, a health IT consultant in Montgomery, Tex., told InformationWeek Healthcare that specialists like their EHRs less than primary care doctors do because most systems were developed for primary care and lack many of the features and templates that the specialists' work requires.
"Ophthalmologists, for instance, have to take pictures of the eye and do all these eye tests, so they need totally different things in an EHR," he said. "Oncology is really hard because of the way oncologists do their chemotherapy and the supplies that they have to track." As for surgical specialists, he noted that few EHRs have templates designed to document procedures in the ways that surgeons require.
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Epic Systems' EHR was the top-ranked system in the KLAS survey, with four specialties in the top quartile. Neither Allscripts Enterprise nor Cerner received the highest ratings from any specialties, although each had 10 specialties in the mid-range quartiles. GE had one top ranking and nine in the mid-range. Two specialties ranked eClinicalWorks in the top category, and six in the middle tier. NextGen got one top score and six in the middle. The vendors with the most bottom-quartile rankings were Allscripts (five) and NextGen (seven).
Aside from Cerner, Epic is the only reviewed vendor that makes a fully integrated product for inpatient and ambulatory care. That's one reason why many hospitals and healthcare systems prefer it--they don't have to worry about interfacing disparate systems.
That interoperability also pleases specialists, Anderson said. "Most of the time, Epic is installed in very large organizations where they're all sharing data. If I'm a cardiologist or an ophthalmologist, all the data from primary care is already coming to me, and I have it all in my EHR. I'm not a freestanding ophthalmologist who has to put all of this data in myself. That's why a lot of people like Epic."
That is not to say, however, that Epic makes the best EHRs for every specialty. Two smaller vendors produce the top-ranked EHRs for orthopedists: e-MDs scores at 8.3, and SRS leads the field at 8.8. Greenway and Vitera (formerly Sage) are tied at 8.1 for ob/gyn and 8.3 for surgery; Vitera is number one in gastroenterology at 8.3; and Praxis and Amazing Charts are most prized by internists at 8.8.
Anderson offers some explanations for these results. "Greenway started off with ob/gyn, and that's all they did until they branched out to other specialties later on. They focused on ob/gyn needs and spent extra time on implementation, training, and configuration. So it wasn't just a matter of software but of making sure that it worked for ob/gyns."
Similarly, he notes, Vitera focused on surgery and cardiology and has created better procedural templates than most vendors have.
Most healthcare organizations, the KLAS report points out, would prefer a single EHR that encompasses most specialties to a patchwork of "best-of-breed" tools. The challenge lies in finding an EHR that meets the needs of most specialties.
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