Evidence is mounting that providers are dissatisfied with their EHRs—so much so that they are willing to switch.   I don’t see this as unexpected or problematic.  It is simply a sign of a maturing market and the growing sophistication of EHR users, which I think bodes well for innovative vendors.

According to a recent survey from The Profitable Practice, 31% of those purchasing EHRs were replacing existing systems. This was up from 21% in their 2010 survey.  The main reason cited for changing systems was dissatisfaction with current systems, which increased 11% from 2010. These findings concur with those reported  in early spring by American EHR Partners (AEHR).   They report:

  – Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors.

– Overall EHR user satisfaction reveals a 12% drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10% for the same period.

– In 2012, 39% of clinicians would not recommend their EHR to a colleague.

Of course, everyone has a theory to explain these findings. The Profitable Practice offers the following conclusion:

We want to emphasize that this study points to the importance of having a reliable plan for assessing software and its vendors before buying and should not be construed to discourage potential EHR buyers from going ahead with their purchase.

AEHR offers a series of potential explanations/hypotheses:

With Meaningful Use, users may have lost some of their workarounds or have new ones that they have to do, e.g. clinical visit summary that now takes 10 clicks; as a result, workflow may feel more cumbersome.

 – Increasing amounts of administrative burden — parts of the EHR may not work correctly.

– The difference between cognitive versus procedural specialists.

– …there appears to be a strong correlation between length of use of an EHR and ability to improve patient care especially in those who have been using an EHR for five+ years. This could suggest that there is a minimum period of time that someone has to use an EHR before beginning to demonstrate improvements in patient care.

– Dissatisfaction may also be a result of being asked to do something with an EHR that previously was not required (prior to Meaningful Use).

– There continues to be an inability to complete certain tasks electronically despite having an EHR.

While I agree that the pressures of Meaningful Use can have a negative impact on practices and that care should be taken when selecting systems, overall I think the effects of MU on vendors contributes much more to increased EHR dissatisfaction than anyone suspects.

MU is forcing practices to change how they operate. We hear a lot about this MU crunch, but it is usually from the standpoint of practices.   Other than statements made during comment periods for proposed rule changes, we hear little about how the MU crunch affects vendors.

Vendors find themselves in a very unusual set of circumstances.  The incentive programs sent them thousands of new customers almost overnight.   While this increased revenues, it also brought the challenges that go with a rapidly growing customer base.   Unfortunately, this influx of new customers brought with it the need to add functionality to existing products, quickly.  Taken together, these occurrences put many vendors into a bind.

Each new set of certification requirements means more resources dedicated to software development and more time spent training sales, implementation, and support staff on new product features.   Keeping in mind that MU changes require adjustments to multiple software components—user interface, database, reporting  — it is easy to see how vendors might have difficulty juggling software development imperatives and keeping customers happy (EHR Certification 2014—Darwinian Implications?).

There is a second factor at play that has nothing to do with the MU crunch — smartphone envy. This is a mindset typified by questions such as: “Why doesn’t Apple make an EHR?” or “Why can I do x, y, and z on my iPhone, but can’t get my EHR to…? “ (fill in your favorite).    Since the iPhone’s arrival in 2007, and especially the iPad’s in 2010, there has come to be a prevailing expectation that software should be easy to use and available everywhere.  Every healthcare professional I know of has a smartphone, and tablet ownership is catching up.   LAN-based EHRs that seemed quite acceptable in 2009 now seem clunky, limited, and outdated.

In a very brief time-span, healthcare professionals have developed very sophisticated software palates, and higher expectations can easily result in greater dissatisfaction.  With the rise of smartphones and tablets, simply maintaining a product’s certification is no longer enough; it must also be mobile and in the cloud.  Making matters even worse, mobile and cloud development are very different from LAN-based client/server.  For vendors, this translates into increased competition for development talent, greater product complexity, and additional training for sales, implementation, and support staff.  The incentive programs are both a blessing and a curse.  Ouch!

Here is where the opportunity part comes into play.  Obviously, practices are willing to switch EHRs. Meanwhile, only vendors who can keep up with technology, MU, and customer requirements can avoid being bad-mouthed and losing clients.  Far from being sewn up, the EHR market is opening up to better products and companies that can deliver the services  and support that practices need in order to realize the expected benefits of owning an EHR.

Now is a good time for a well-financed startup with a start-of-the art product to show up. Without the albatross of a 1990s LAN-based C/S product and no disgruntled installed base to please, new market entrants are free to innovate and test new ideas. They can learn from the mistakes of current vendors while waiting for the final MU requirements to appear (The EHR Market and Biology 101).

Providers are proving that they are willing to switch systems when they see a definite benefit.   Vendors who are capable of managing ever-changing software requirements while addressing customer needs have a definite advantage. And, in a rapidly changing environment, that’s all one really needs to succeed.


1 Comment

  1. For practices, the problem usually is workflow, and I certainly believe that better EHR systems with workflow engines would be a big help. That being said, there is a creative aspect to software design/development that cannot be overlooked. While many features that make systems more usable are likely doable as incremental changes, some, like adding a workflow engine to an existing product, are not. True innovation is a another matter entirely. It requires imagination and vision–neither of which can be produced on demand. Great software requires time, technical proficiency, imagination, and probably a little luck.

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