Are EHRs getting better? Readers rank vendors higher than last year in new survey
In the year since we unveiled the results of Healthcare IT News' inaugural EHR Satisfaction Survey, the nature and perception of electronic health records has changed. So too has much of what the providers who use EHRs and the vendors who make them think is important.
But many of the complaints about the systems remain the same. For instance, just like in the first survey, one of the most common pieces of anecdotal feedback was a variation of the following sentiment: "Too many clicks!"
Once again, we sought those of our readers who manage EHRs every day to tell us how they really feel. We reached out to CIOs, CTOs, VPs of IT, CMIOs, CNIOs, CSOs and more – in addition to directors of radiology, lab services, cardiology, oncology, pathology and other clinical chiefs.
We sent the survey to professionals at hospitals, health systems, academic medical centers, ambulatory care facilities, group practices, long-term care facilities, the Department of Defense, the VA and other provider sites.
Then we asked them to weigh in on an array of features: interoperability with clinical systems and medical devices, interface and design, quality of installation support, quality of ongoing support services, security features and user experience.
The 340 who responded did not hold back when assessing the strengths and weaknesses of their systems. They cheered good UX design and robust security settings, but they jeered at intrusive alerts and elusive interoperability.
[Comparison chart: How readers rated their EHR in 2016 vs. 2015]
After tallying the vendors that had a critical mass of reviews, that left the same nine companies as in 2015: Allscripts, Cerner, eClinicalWorks, Epic, GE Healthcare, NextGen, McKesson, MEDITECH and Siemens. The difference this year was the order in which they were ranked.
Except, that is, for the number one spot: Once again, Epic was voted the all-around best EHR – not just in overall satisfaction (with a score of 7.7 out of 10), but in every category our readers rated. Cerner was a close second in the overall scoring, with GE Healthcare ranked third. Allscripts, eClincialWorks, MEDITECH, Siemens, McKesson and NextGen rounded out the list.
Here's what readers said about each.
Click on the buttons below to read what readers said about their vendors and view the scores.
Overall Satisfaction: 7.7
It's become an infamous (if hotly disputed) knock against Epic that it doesn't play well with others. And it was not an uncommon refrain in our survey: "More interoperability, interface capabilities with other systems," pleaded one user. "Cooperate with other EHR vendors and medical device vendors for integration," another humbly suggested. "It would be nice if it were possible to have exchange data from 3rd party EHRs be incorporated as structured data," wrote a third. Design and UX was another complaint. One manager said a "recent upgrade has been challenging as visual appearance has changed and end users have complained." Another hoped for a "more intuitive GUI." Still, one respondent called the user interface "reasonably inviting" and another said simply: "Nice colors." Meanwhile, Epic drew high marks for its versatility ("There is more than one way to accomplish just about everything in Epic"), its "reliability" and – proving that opinions can vary widely and sometimes contradictorily – its interoperability. "It provides the highest level of satisfaction with our providers who use multiple EMRs," wrote one poll-taker. "Most hospitals in our geographic area are currently on the product or switching to it making interoperability real and functional with minimal effort.”
Overall Satisfaction: 7.1
"Not enough consistency in the ordering system," wrote one frustrated clinician of the Cerner EHR. A nurse, meanwhile, weighed in that the system was "not user friendly," specifically with regard to how it's set up for RNs to perform functions for docs, such as "placing alarms for nursing because providers 'can't be expected to remember' things like expiring restraints and/or medications." And while one provider said Cerner's implementation support "should be better prepared to advise pros and cons of design decisions in the short and the long term," they did quite like the "ability to customize the view and add buttons for features that I use" – a BMI calculator, for example. Another noted that, although it's a "very complex EHR, there are several features I like." Among them? "The PowerNotes for the ED FirstNet product, message center that mimics an email server where providers can sign their orders and documents, and the CDS program for medication safety." Another respondent simply applauded a "more complete integration of the patient record than we had in our previous system."
Overall Satisfaction: 6.8
GE may have announced the phase-out of its Centricity Enterprise for hospitals in 2015, but its large practice-focused Centricity EMR product is still going strong – and getting some good reviews from our readers. Complaints about the product ran the gamut: One user wanted quicker "application response," another wished it was "easier to maintain." Indeed, a third wrote that "installing upgrades and service packs requires the client to be installed by an administrator on each of 150 workstations. There has to be a better way!" Still, others had high praise. "Good functionality and I've always gotten good response to my service requests," said one manager. An end user appreciated the "inclusiveness and thought put into workflow." And one respondent said the system functions at a "best of its class" level.
Overall Satisfaction: 6.4
One review complained that the software was "too complex" for clinical end users, with "too many different ways to do the same task." It added that "some of the new modules are immature, not complete." Another said it was "very hard to maintain/enhance the software using our internal IT resources," and that "upgrades of software involve significant downtime." The EHR is "too 'busy,' not easy on the eye," said a third, adding: "Too many clicks." On the other hand, some reviewers very much liked the UX and usability. "Extremely customizable, and able to add automation as we wish," enthused one respondent. Another touted the "dynamic customization capabilities that allow us to tailor the look and workflow to meet the physicians' needs and preferences." A third liked the fact that "all parts of the chart (are) accessible from one screen," and said documentation is "very uniform and simple."
Overall Satisfaction: 6.1
Ongoing support was a big complaint for one eClinicalWorks client. Technicians have "remote (access) into your computer to fix problem which ties up the computer," they wrote, noting he "was on the phone with customer support over two hours with them remote to my computer and still did not fix the problem." He said he could only recommend the EHR for "standalone clinic (with) a full-time IT staff to deal with the multiple problems." Meanwhile, this same person applauded the fact that eCW offers an integrated system with practice management and EHR in one – and, even better, "it's easy to navigate." They called it a "well-written application that fills needs you didn't know you had, from the front staff to the providers."
Overall Satisfaction: 6.0
One MEDITECH client suggested the company consider an "increase ease of use and efficiency" for the the EHR system. Another called the UI "outdated" while another wished for improvements in mobility and "better clinical decision support." One manager of an EHR at a long-term care provider had qualms about that product's efficacy, especially as LTC grows in importance to the care continuum: "Would like to see software that is more adapting to this healthcare setting," he wrote, saying the product looked to be "primarily for acute setting" with an LTC label on it. On the positive side, users liked the fact that "all patient data readily available in a single source" and it's "easy to write custom reports to pull data based on specific needs." "The interoperability between applications and ease of transitioning between them is excellent," wrote one. "It is incredibly reliable. We have less downtime than any other system in the market," wrote another. The MEDITECH system is also reportedly "difficult to hack," wrote a third, adding to its security bona fides.
Overall Satisfaction: 5.4
"The system should be more interactive," was the feedback from one Siemens customer. "Too many clicks before getting what you need." Another hoped for better "testing by development prior to release of upgrades." Wrote a third: "Clunky use. Has no flow to it. Their own interfaces are highly patched between two modules and it still needs workarounds." In the plus column, various Healthcare IT News readers liked Siemens' "customizability," "data density," "accessibility" and "maturing clinical workflows.
Overall Satisfaction: 5.1
"Functionality and service" left something to be desired for one McKesson client. One offered a laundry list of complaints: "database, interface, usability, integration, instability, daily downtime, customer support." Another complained the EHR's "system of using doctor-generated templates for entering information during patient visits is inefficient, slow, antiquated and does not utilize the capabilities of computers," while still another said the system is "not meeting (the) needs of (a) complex, multi-hospital system." On the other hand, there were some bright spots: "Well integrated with ICD10," said one respondent. Another liked "consistency between applications (general look and feel)" and said it was "easy to learn basic functionality." A third applauded McKesson's "safety mechanisms, alerts and overall care guidance."
Overall Satisfaction: 4.4
Atop the list of one NextGen user: Lack of "interoperability between different EHR systems." The EHR "does not communicate with many other systems," they wrote, "therefore, staff are forced to do manual data entry at times or duplicate work." Another echoed the point: "Better HIE connectivity with other vendors." Reconsidered workflow configuration and reduced number of necessary clicks were cited by numerous survey respondents. But some managers had come to appreciate NextGen's strengths. One applauded flexibility, "specialty content" and the fact that the "vendor provides client education on regulatory changes." (More than one appreciated the company's webinar guidance on constant CMS changes.) Said another: "It took four years to fully understand it, but it is a good hefty application. It's like an EMR in a T-Rex body."
Read more of our EHR coverage
⇒ Comparison chart: How readers rated their EHR in 2016 vs. 2015
⇒ 2015 Healthcare IT News EHR satisfaction survey
⇒ Health IT executives have a new favorite dirty word
⇒ EHR interoperability: Ripe for disruption?