9 Mobile EHRs Compete For Doctors' Attention

Athenahealth, a Watertown, Mass.-based vendor that is better known for its revenue cycle management software than electronic health record products, beat eight bigger vendors for ambulatory EHR usability in a survey performed by KLAS Research. Eighty-five percent of Athenahealth's clients said they had achieved usability, compared to only 55% of the customers of its most distant competitor.

KLAS polled physician leaders of 163 practices with more than 25 doctors. Athenahealth received the highest ratings in usability at launch, current usability, and overall functionality.

The runners-up in out-of-the-box usability were eClinicalWorks, GE Healthcare CPS, Greenway and Epic, with Cerner, NextGen, Allscripts Enterprise and McKesson Practice Partner bringing up the rear. In current usability, Athenahealth was followed by eClinicalWorks; GE; Epic and Cerner in a tie; NextGen; and Allscripts and McKesson in a tie.

In functionality, Athenahealth received an overall score of 4.2 on a scale of five, doing especially well in physician documentation and support for a mobile device. The other vendors, in descending order of their ratings, were Epic, GE, Greenway, NextGen, Allscripts, Cerner, eClinicalWorks and McKesson.

[ Mobile EHR apps are more popular than ever, according to the companies that sell them. Read EHR Makers Answer Doctors' Calls For Mobile Apps. ]

Vendors who helped their customers use the software they bought scored higher. Both Athenahealth and Epic excelled in this area. "The best screen layouts and workflows cannot compensate for poor code quality," the report also noted. Those kinds of issues were "usability show-stoppers" for some EHRs because they required extensive customer efforts to make systems usable, the report said.

Jasmine Gee, a spokesman for Athenahealth, said the vendor had achieved its results partly through its emphasis on tracking physician performance. Because the EHR is a "software as a service" product hosted by the company, Athenahealth's staff can see the data that's being entered in the EHR. In addition, a feature of the system tells them how long it takes physicians and their staff to perform specific functions in the EHR. Athenahealth uses that data and doctor interviews to improve its system and help users who are having problems.

"If a physician spends a lot of time on the exam portion, we ask what's going on -- is it a software or a training issue -- and use the data to intervene," said Gee. This is similar to what the company does with office managers who use its revenue cycle management software. "We use best practices to figure out whether you're doing well, and if you're doing poorly, you'll get a phone call," she said.

Michelle Holmes, a senior manager at ECG Management Consultants in Seattle, said Athenahealth's victory was surprising, given its short time selling an EHR. But she gave credit to the company for its ability to respond quickly to the market. As for why all of the hospital information system vendors except for Epic did poorly in the survey, she noted that they'd started out behind on the ambulatory side and are still trying to catch up. That's actually not quite true of Allscripts, which began as an ambulatory vendor and later bought in-patient EHR vendor Eclypsis.

Recently, she noted, Cerner and Meditech decided to ditch their old ambulatory-care EHRs, which weren't working well for most customers, and build entirely new systems. Cerner's new model is pretty good, she said, but isn't well known yet in the industry. Meditech's new entry won't be on the market for another year, she added.

Overall, she said, the usability of EHRs has been slow to improve. "One of the downsides of Meaningful Use has been the lack of progress across the board on usability. There's hasn't been progress anywhere, unless somebody is doing a new rebuild [of their EHR]," she noted.

EHRs from the major vendors tend to be poorly suited for specialists, she said, a point also made in the KLAS survey, which showed significant percentages of specialists were unhappy with the usability of their systems. The vendors need to overhaul their software entirely to fit the workflow of those specialties, she said, but they're not likely to do that soon. The "easy fix" is to integrate voice recognition with the EHRs and let specialists dictate into boxes for the subjective, objective, assessment and plan parts of the patient exam, she said.

Evan Steele, president of SRS Software, an EHR vendor that was not rated in the KLAS survey, agreed that specialists have received short shrift. As a result, primary care doctors are generally happier with their EHRs than specialists, and some specialists such as ob/gyns are happier than others, such as orthopods and ophthalmologists.

Asked whether the KLAS survey was representative, as it focused on large practices, Steele said that a recent SRS survey about physician satisfaction with EHRs found that practice size was not correlated with whether doctors would recommend their system to a friend. So he doesn't think it makes any difference.

However, he said, the small sample size of the KLAS survey might have led to some skewing of the results. "With 163 groups and nine vendors, there are 17 to 18 data points per vendor, so you can get a lot of variability. You might get three doctors that love the Athena interface, and that drives their score. With 150 to 200 practices [per vendor], you're not going to get that variability and volatility."