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EHR Roulette: Gambling On Medicine's Future

As medical practices look to replace clunky ambulatory electronic health records systems, picking a winner can seem like risky business.
9 Mobile EHRs Compete For Doctors' Attention
9 Mobile EHRs Compete For Doctors' Attention
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Many medical groups are not happy with the EHR systems they initially invested in and are looking for a better option. One survey by consultancy Software Advice, for instance, found that the number of medical groups purchasing new electronic health records to replace existing EHRs grew from 21% in 2010 to 31% in 2013. The vast majority switched because they were dissatisfied; in 2010, almost 59% were changing vendors for that reason, but that figure jumped to 74.2% in 2013.

That kind of bleak data tracks with findings from KLAS and Black Book surveys, whose customer satisfaction surveys can make vendors cringe. Such data can make the process of choosing a replacement EHR system feel like a hit-or-miss gamble. Listening to the divergent views of physicians who have put EHR systems into practice only confirms the feeling.

"We all see fewer patients since implementing EHRs two years ago and take more time to do it," said Dr. Dave Denton, a pediatrician in Idaho.

"We're excited about employing patient self-check kiosks ... Being able to implement [EHR] technology gives us a competitive advantage," said Dr. John Bender, a family physician from Colorado.

"My office manager quit because the [EHR] was so difficult," said Dr. Robert Joseph, an anesthesiologist from Florida.

"Though people complain about electronic records, no one wants to go back to paper," said Dr. Michael Lee, director of informatics at Atrius Health.

[ More lousy reviews for EHRs? See Hospitals Struggle With EHRs For Quality Reporting, AHA Says. ]

Given these hot-and-cold reviews, what's the key to success? There's lots of good advice and helpful resources to turn to when making the decision. Surveys from the likes of KLAS and Black Book are one place to start.

Both KLAS and Black Book gave high marks to Athenahealth. When asked, "How successful have you been in getting your system to a high overall level of usability?" respondents to KLAS's "Ambulatory EMR Usability 2013" surveygave the vendor an 85% rating. Similarly, in Black Book's soon-to-be-released survey, Athenahealth was one of three ambulatory EHR systems that rose to the top of its usability satisfaction scale, along with Cerner and Greenway. But on a more negative note, the KLAS survey found that only 55% of McKesson users reported success in achieving high usability. And more than half of clients using McKesson's Practice Partner program were "unhappy with go-live usability."

Asked about the KLAS survey, a spokesperson for McKesson said it is "committed to improving the customer experience with McKesson Practice Partner and has made a number of financial and staffing investments in the software over the last 12 months," and it expects customer satisfaction to improve as a result.

On a more positive note, the KLAS survey discovered that vendors are more inclined than they once were to hold buyers' hands along the road to usability. Epic got relatively high marks in that regard, as did Athenahealth. But it's interesting to note that sometimes physicians are their own worst enemy in using software to improve operations. One KLAS client said, "Athenahealth has an approach that they think is most efficient and best, and it may be, but getting doctors to agree on things is like herding cats."

Is Meaningful Use Getting In The Way?

A growing concern is that the most powerful driving force behind EHR implementation nationwide -- the federal government's Meaningful Use (MU) program -- may now be slowing down the push for better usability. According to the American Medical Association, the MU "certification process must be retooled in order to address a variety of problems many physicians are experiencing with their use of certified EHRs." The AMA letter complained that many systems require several tedious steps to perform simple functions, and the need for usability is not something factored into the review and certification process.

One way to fix the problem, says AMA, is to "stop adding measures to the Meaningful Use program and allow vendors to work on usability concerns." As any provider who has tried to meet MU stage 2 criteria knows, there's a long list of performance measures that must be met to qualify.

Make no mistake about it, choosing an EHR system can be risky business, and if it's an EHR replacement it only increases the stakes. High upfront costs, ongoing maintenance fees, lack of vendor support, disruptions in workflow and clunky interfaces are all possibilities that make choosing a vendor a high-stakes decision. It's time that the feds slowed down on MU requirements and let vendors concentrate more on creating better interfaces, writing better code and spending more time fixing glitches. That would at least improve the odds a bit in favor of the EHR implementers.