I support over 3000 clinicians in heterogeneous sites of care - solo practitioners, small offices, multi-specialty facilities, community hospitals, academic medical centers, and large group practices.

In every location there is some level of dissatisfaction with their EHR. Complaints about usability, speed of documentation, training, performance, and personalization limitations are typical. Most interesting is that users believe the grass will be greener by selecting another EHR.

I've heard from GE users who want Allscripts, eClinicalworks users who want Epic, Allscripts users who want AthenaHealth, and NextGen users who want eClinicalWorks.

The bottom line from every product I've used and everyone I've spoken with is that there is no current "perfect" EHR. We're still very early in the EHR maturity lifecycle.

What is the perfect EHR? I've written about my best thinking, which has been incorporated into the BIDMC home built record, webOMR (and has dissatisfied users too).

However, after listening to many "grass is greener" stories, I believe that what a provider perceives as a better EHR often represents trade offs in functionality. One EHR may have better prescribing functionality while another has better letters, another is more integrated and another has better support. The "best" EHRs, according to providers, varies by what is most important to that individual provider/practice, which may not be consistent with enterprise goals or the needs of an Accountable Care Organization.

My experience is that organizations which have given clinicians complete freedom of EHR choice now have an unintegrated melange of different products that make care standardization impossible.

My advice - pick an EHR for your enterprise that meets your strategic goals, providing the greatest good for the greatest number. Apply a maximum effort to training, education, sharing of lessons learned, user engagement, and healthcare information exchange.

There will always be dissatisfaction and a claim that something is better. However, I've never seen a change in product fix workflow and process issues. BIDMC's strategy is to do our best  to ensure providers are educated and use their EHR optimally. I do not believe that there is a better choice than our current mix of built and bought products that makes sense for our pioneer ACO and individual providers within the organization.

John Halamka, MD blogs regularly at Life as a Healthcare CIO.