Poll: Will EHR users have mass exodus to another vendor?

Active EHR users uncovered one in six medical practices could exchange out their first choice EHR by year's end, according to an annual poll of 17,000 end-users, conducted by Black Book Rankings. The majority of frustrated end-users blame themselves for not properly assessing practice needs before selecting their first EHR vendor with the narrow goal of receiving government incentives.

With unmet expectations in system features, implementations, deliverables and client support issues mounting, up to 17 percent of all currently implemented physician practices gear up for changing out technologies, in what may become the Year of the Great EHR Vendor Switch.

“The high performance vendors that will emerge as viable past 2015 are those dedicating responsive teams to address customers’ current demands,” said Black Book’s Managing Partner Doug Brown.

Those demand lists are growing longer and longer according to the survey responses. Users foretell of dozens, if not hundreds, of software firms underperforming badly enough to lose major market share as the industry evolves and struggling vendor solutions don't keep pace, according to the New York City-based Black Book.

The independent responses that Black Book gathered indicated many EHR firms have been so busy with backlogged implementations and selling product that development issues are being left on the back burner. Most concerning to current EHR users are unmet pleas for sophisticated interfaces with other practice programs, complex connectivity and networking schemes, pacing with accountable care progresses, and the rapid EHR adoption of mobile devices.

Brown upholds that the “meaningful use incentives created an artificial market for dozens of immature EHR products”. The sweeping Black Book survey also revealed that some popular "one size fits all" EHR products have not met the needs of several specialists and cannot continue to satisfy their client base with a lack of customizable or bespoke tools.

Nearly half of all Black Book EHR survey respondents scoring their respective vendor performances also answered the following set of questions on vendor switching.

The following aggregated responses are provided:

Are you dissatisfied enough with your EHR to consider making a change, and if so when?

• 35 percent: No
• 8 percent: Yes, but we cannot afford to abandon first/current EHR choice
• 2 percent: Yes, within three months
• 7 percent: Yes, within six months
• 8 percent: Yes, within one year
• 34 percent: Not sure, neither overly satisfied or dissatisfied
• 6 percent: Yes, but no time frame

Of those debating or confirmed to be changing EHR vendors in the next year, from what type current EHR solution would you most consider switching to?

• 51 percent: Web-based/ASP/SaaS/Hosted to another Web-based/ASP/SaaS/Hosted
• 12 percent: Web-based/ASP/SaaS/Hosted to On-premises solution
• 19 percent: On-Premises Solution to Web-based/ASP/SaaS/Hosted
• 6 percent: On-Premises Solution to another On-Premises Solution
• 12 percent: Unsure

Select top three compelling reasons for your practice to be considering vendor switch from current EHR?

• 80 percent: Solution does not meet the Individual Needs of this Practice, including workflow
• 79 percent This Practice did not adequately assess our needs before selecting the original EHR
• 77 percent: Design of solution is not suited for this Practice Specialty/Specialties
• 44 percent: Vendor not responsive to requests and needs
• 20 percent: Current EHR does not adequately communicate with other EHRs
• 16 percent: Concerns that current EHR will not meet Accountable Care requirements
• 12 percent: Current vendor is too focused on meaningful use achievement
• 11 percent: Other practice software modules are not integrating with EHR
• 5 percent: Setbacks have caused delays in reimbursement or disrupt work
• 14 percent Other

Black Book also conducted more than 550 telephone interviews to drill down on the specifics of client complaints to note trends.

What three red flags are so currently compelling that current users would not consider a different EHR vendor as an option to replace the problematic vendor solution?

• 32% Mergers or Acquisitions occurring in this company
• 26% Senior Management in Disarray
• 22% Dissipating Market Share and Market Value
• 22% Internal staff have not mastered system
• 16% Disloyal customer base
• 15% Bad integrations evidence
• 14% Product Delays
• 12% History of abandoning clients
• 12% Past Customizations were Unaffordable
• 6% Overdependence on consultants for implementations and training

Features that were on EHR buyer wish lists three years ago are typically considered as basic system features now, according to those surveyed. First system implementations were decided on “must haves” of (in order): Document Management/Scanning/Storage, Electronic Prescribing, Order Management, Implementation Support, System Cost and Alerts.

With these basic EHR fundamentals met, experienced users now seek innovative vendors who meet the compounding demands of practices, according to 2013 Black Book responses.

What are the top ten criteria you consider “must haves” in 2013 beyond basic EHR functionality? (in priority order)

• 84 percent: Vendor viability
• 83 percent: Provider data integration and network data sharing
• 78 percent: Demonstrable return on investment and clinical improvements
• 75 percent: Adoption of mobile devices including iPad, iPhone, Android and tablets
• 66 percent: HIE support, connectivity/Interoperability
• 65 percent: Perfected interfaces with lab, pharmacy, radiology, rehabilitation, post-acute care
• 65 percent: Perfected interfaces with medical billing partners/outsourcers and revenue cycle
• 59 percent: System financing assistance
• 58 percent: Patient portal
• 54 percent: Customized workflow management
• 53 percent: Role-based security
• 50 percent: Enhanced data security, HIPAA compliance and patient privacy measures
• 42 percent: Sharing billing and financial data between disparate systems
• 36 percent: Expert coding
• 35 percent: Practice management expertise
• 32 percent: Support evolving accountable care demands
• 31 percent: Automated patient outreach
• 26 percent: Clinical analytics
• 23 percent: Higher specialty usability
• 23 percent: Decision support and population management
• 20 percent: Internal messaging
• 20 percent: Online managed care/insurance eligibility and terms
• 17 percent: Customizable templates
• 12 percent: EHR mobility applications and IOS support

Black Book reported that specialists reported the highest level of dissatisfaction with their EHRs.

Does your EHR meet the needs of your individual practice specialty? “NO”

• 88 percent: Nephrology
• 85 percent: Urology
• 80 percent: Ophthalmology
• 75 percent: Gastroenterology
• 72 percent: Orthopedics
• 71 percent: Allergy & immunology
• 71 percent: ENT
• 54 percent: Small practices

Are you seeking a vendor who has demonstrated capabilities and success with vendors in your specialty as a replacement EHR?

• 92 percent: Yes
• 1 percent: No
• 7 percent:  Unsure

Specialties with the EHR satisfaction. Is your practice satisfaction with current EHR vendor at a point where you would NOT consider vendor switch in the next 12-24 months? "YES"

• 89% Internal Medicine
• 85% Family Practice
• 82% General Practice
• 80% Pediatrics
• 77% Oncology & Hematology
• 72% OB/GYN
• 70% Large Practices
• 62% Geriatrics
• 59% Cardiology
• 56% General Surgery