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Survey: EDs Increasingly Replacing EHR Systems due to Dissatisfaction with Interoperability

October 29, 2015
by Heather Landi
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A survey of emergency department (ED) physicians and staff found pervasive dissatisfaction with usability and interoperability of emergency department information systems (EDIS).

Black Book surveyed 738 ED administrative and nursing managers and 1,104 ED physicians and found that “89 percent of ED leaders believe their hospitals rushed to purchase new electronic health records (EHRs) and ED systems between 2010 and 2013 for meaningful use dollars, just to see productivity fall, liability rise and connectivity stall.”

The widespread dissatisfaction with ED systems is resulting in a fast growing replacement market.

Of the ED physicians and staff surveyed, 35 percent of hospitals with 150 beds or more are currently replacing or plan to replace their EDIS in 2016. The majority of those replacements (69 percent) will be those now using enterprise EHR emergency modules, opting for best-of-breed EDIS systems that can integrate with the hospital’s EHR, according to the survey report authors.

And, the Black Book survey found that 39 percent of hospitals with enterprise EHR emergency modules identify themselves as “moderately to highly dissatisfied” with their current EDIS, yet 90 percent of those managers and physicians claim they are stuck with making hospital-wide generic EHR systems work, and/or they have been denied budget funds for 2016 EDIS replacements.

According to Doug Brown, managing partner of Black Book, many of those EDIS purchases were made as part of EHR systems, some hospitals dedicated six months to two years in implementations, just to remove those systems for significant issues with patient satisfaction, physician productivity, even safety issues.

"Most best of breed EDIS solutions, not all, are fined tuned for the emergency department environment and workflows," Brown said. "In contrast, enterprise EHR solutions have typically been very generic with difficult customization processes and long implementations for emergency departments."­

"As hospitals and emergency room physicians grapple with intense pressure to optimize processes with ED visits predicted to rise by double digits again in 2016, EDIS has emerged as a powerful solution to the challenges of a rapidly changing healthcare model," Brown said.

The survey also found that of hospitals that implemented a replacement EDIS in mid 2014 to the first quarter of 2015, 78 percent claim they have seen improved reporting capabilities in less than three months post deployment.

Seventy-six percent of hospitals that implemented a replacement EDIS in the same time period report improved customer services outcomes attributable to some feature or benefit of the replacement EDIS.

And, 44 percent of hospitals with 200 beds or more that implemented a replacement EDIS reported reduced visit costs of between 4 to 12 percent as compared to the same period the year prior.

The survey, conducted August through October, found hospitals polled utilizing Epic Systems' enterprise EHR solutions were most dissatisfied with the inability to integrate with best of breed EDIS solutions (86 percent) or provide widespread connectivity to obtain external records (83 percent).

Cerner, Allscripts, Healthland, Evident CPSI and Meditech enterprise EHR solutions faired much higher, as 79 percent of collective users of those EHR systems credit substantial enhancements in usability since 2010.

Hospitals employing the EDIS solutions from best of breed vendors T System and Optum (Picis) rated their experiences the highest, including usability by ED nurses and order entry by ED physicians.

Hospitals also ranked their six most desirable features in a 2016 replacement EDIS, either best of breed or enterprise EHR based system. The top features were interoperability and connectivity (93 percent); tablets and smart phones (87 percent); physician productivity improvements (89 percent); ease of use (86 percent); diagnosis enhancements (70 percent); patient satisfaction (68 percent) and reporting improvements (66 percent).

“Obvious game changers in the EDIS replacement environment are developments in EDIS interoperability and mobility," Brown said.

Black Book estimates that the U.S. EDIS market now exceeds $235 million and is expected to grow to $420million in 2018.

The survey also found that hospital administrators are increasingly including the ED physician and nursing staff on the EDIS decision. In 2010, Black Book surveys reported that only 7 percent of ED physicians and 2 percent of ED nursing staff were involved on the EDIS selection teams where enterprise EHRs were given as the only technology option for their respective EDs. In 2015, and 2016 pending EDIS selection processes, by contrast, 70 percent of ED physicians state they are involved in the selection process as well as 16 percent of ED nurses.




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