The usability of electronic health-record systems varies widely, and EHR developers that do a lot of handholding after the sale score highest on usability ratings, according to a report by health information technology market researcher KLAS Enterprises.
“It’s definitely not a plug-and-play world,” at least not yet, said Colin Buckley, director of research strategy at KLAS and a co-author of “Ambulatory EMR Usability 2013, More Nurture than Nature.” The 224-page report is based on KLAS interviews with 163 providers, targeting leaders at practices with more than 25 physicians. But with only a couple of exceptions, “the greatest frustration that we encountered was about vendor relations, rather than the software itself,” he said.
Clinicians have long griped about clunky EHRs, though Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology at HHS, said the carping often drowns out expressions of provider satisfaction.
Mostashari expects market forces to reward those vendors who best work the bugs out of their systems, and punish those who don’t.
“I’d like to see usability drive the market,” Mostashari said at the Healthcare Information and Management Systems Society convention this year in New Orleans.
Athenahealth was top-ranked out of nine vendors in a composite score based on physician responses to questions about how well “the typical physician” can efficiently and effectively perform on six common EHR tasks or functions. Those were: e-prescribing, medication reconciliation, physician documentation, problem lists, viewing patient information and supporting mobile devices.
Athenahealth, a provider of Web-based systems, ranked tops for getting providers to usability at first use, or “go-live,” and second best in the handholding department—that is, guiding clients who purchased their systems on how to use them.
Epic Systems Corp., runner-up in the composite ranking, topped all comers when physicians were asked how effective their vendor was in guiding them to usability, with 86% giving Epic a “good” rating. That mark came even though Epic’s EHRs are highly configurable and are often customized, making the learning curve steeper and lengthening the time it takes for physicians to gain proficiency. But Epic’s model installation “gives clients a head start,” according to KLAS.
GE Healthcare and Greenway Medical Technologies tied for third in the scoring on the six-task test.
Both Allscripts‘ flagship Enterprise EHR and McKesson Corp.‘s Practice Partner EHR were rated by their customers as high-effort products for physicians to use out the gates. Allscripts, though, did a better job getting its customers comfortable with its system—with 74% ranking the company good or okay compared with 54% of McKesson customers. McKesson also had the most customers of any vendor in the survey reporting that the company was “not good” at helping them use its technology.
“Nobody said that things are perfect,” Buckley said. “Anybody that writes the check has the right to complain. But we specifically targeted in the report the medical leadership who looked at the big picture. It wasn’t about their personal preferences, but was (EHR) efficiency good enough to accomplish the task.”
Buckley said he didn’t sense a mass mutiny brewing among the EHR-using masses. Most respondents to the survey saw opportunities to work with their vendors to configure the systems to fit their needs, so, “they zeroed in on those opportunities,” Buckley said. “I think they feel a sense of control.”
Dissatisfaction levels among smaller practices could be a different story. “We weren’t talking to the one- or two-doc practices that might have a greater sense of victimization,” Buckley said.
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