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Report: Despite Widespread Usage, Docs Relatively Dissatisfied with EHRs

August 29, 2016
by Rajiv Leventhal
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Medscape’s latest health IT report reveals the latest trends and challenges with EHR usage across the U.S.

Very few physicians these days operate their practices without an electronic health record (EHR), but satisfaction levels with the technology have dropped some, according to Medscape’s EHR Report 2016.

For the report, Medscape surveyed more than 15,000 physicians across more than 25 specialties this summer, asking about usage, specific system ratings, and vendor satisfaction. Indeed, in the survey, more than 91 percent of physician respondents said they use and EHR. Two percent of respondents are currently installing or implementing an EHR, and 3 percent plan to purchase or start using an EHR within the next two years, meaning that it won't be long before nearly every physician is using an EHR.

This is compared to Medscape’s 2012 report, which revealed that 74 percent of participating doctors said they were currently using EHRs, and another 20 percent were either in the process of installing/implementing an EHR or planned to purchase or start using one in the next two years. Further, the 2016 report found that more than two-thirds (68 percent) of physicians use a hospital or health EHR system, whether they work within these systems (63 percent) or are in independent practices that use them (5 percent). A third of independent practices have their own system, the data showed.

While physicians certainly have many complaints about EHRs, they also recognize the positive effects of having one, according to the report. Over half (56 percent) of respondents said that EHRs improve documentation, and just under a third believe that they improve patient service (30 percent), clinical operations (32 percent), and bill collections (31 percent). On the flip side, 21 percent of physicians said that EHRs have made the documentation process worse, and 25 percent cited detriments to patient service and clinical operations. Only 7 percent said they make the collection process worse.

To this end, since the 2012 Medscape survey, satisfaction rates have dropped a bit. This year, 41 percent of physicians said they were somewhat to very satisfied, compared with 45 percent in 2012. The difference over the past four years regarding physicians who were somewhat to very dissatisfied is even more pronounced: 27 percent in 2016 versus 21 percent in 2012. But, despite relative dissatisfaction with most EHR systems, 81 percent of physicians plan to keep their current EHRs. And although 17 percent plan on switching, only 5 percent cited dissatisfaction as their reason.

Also in this year's report, 57 percent of respondents said that EHRs reduce face-to-face time with patients, and 50 percent noted a reduction in the number of patients they can see. Still, this is better than the corresponding percentages reported in the 2014 survey—70 percent and 57 percent, respectively.

Regarding the highest rated and most widely used EHRs, in 2012, Epic was the most widely used EHR (22 percent) and was still on top in 2016 (28 percent). However, there was a big change in the second spot. In 2012, Allscripts held that position, at 10 percent, but in 2016 it didn't even appear in the top five. Possibly this was fallout from the 2012 decision to drop its small-practice software, MyWay, because of design flaws that prevented users from meeting meaningful use requirements, the report’s authors concluded.

Further, EHR systems typically differ between large institutions, such as hospitals, and independent practices. Those used in larger organizations require complex networks and software to manage more activities, more specialties, and more reporting than typically needed in independent practices. Epic dominates the EHR market for hospitals and health systems, with 41 percent of users—more than three times as many as Cerner (13 percent), its next largest competitor. All other EHR systems were each used by 2 percent to 6 percent of hospitals or health networks. Of note, about 5 percent of independent practices use hospital or health network systems and were included in these responses.

For independent private practices with their own EHRs, including many smaller practices, generally use a different set of products. eClinicalWorks was rated first in usage (12 percent), and Practice Fusion and NextGen tied for second place, with 8 percent each.

Survey participants were then asked to rate their EHRs by several key criteria, including ease of use, vendor support, overall satisfaction, connectivity, and usefulness as a clinical tool. The scale used in this report is 1 to 5, where 1 equals poor, and 5 equals excellent. Individual ratings were then averaged to come up with an overall score. The systems in this chart include both hospital- and small practice–based EHRs. The Veterans Affairs Computerized Patient Record System (VA-CPRS) received the top rating (3.7) while, interestingly, at the bottom of the list (2.7) was AHLTA, the EHR used by medical providers in the US Department of Defense. The VA system was also rated first in the 2014 report; Epic, which is in second place this year, did not appear in the top five in 2014. Among independent practices using their own EHR systems, Epic was also in first place with a score of 3.5.

For the ease of use category, Amazing Charts and Practice Fusion, which are used in independent practices, were highest rated at 3.9 and 3.7, respectively. Meanwhile, the two EHRs with the highest satisfaction rating (tied at 3.8) were again Practice Fusion and Amazing Charts (used mostly in independent practices). This criteria includes not only staff and overall satisfaction, but also value for the money and the usefulness and appearance of the patient record.

Regarding exchange of information, Medscape asked about EHR connectivity across four domains: with diagnostic devices, practice management, reference and hospital labs, and for supporting referrals. All of the top five responses are systems for large networks: VA-CPRS (3.7), Epic (3.6), Cerner (3.1), athenahealth (3.0), and AHLTA (2.9). But it also should be noted that most scores were below average, with many of the small-practice systems leaning toward "poor" on the scale.

What’s more, nearly two thirds (62 percent) of physicians found e-prescribing to be most helpful EHR feature, and 57 percent indicated being able to locate and review patient information more easily. About half (49 percent) cited incorporating lab results, allowing for drug/allergy checks, and enabling other physicians to access patient records.

Additionally of note in the report is the highly controversial copy-and-paste functionality in EHRs, which attorneys say creates a host of problems. Interestingly, many physicians say it's a necessary practice in order to move through their day, according to the report. And indeed, 31 percent of physicians often copy and paste, 11 percent always do so, and 24 percent do so occasionally.

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