On the Rebound

Edition: September 2013 - Vol 21 Number 09
Article#: 4326
Author: Will Foltz

After embracing electronic medical records, some doctors and hospitals feel they deserve better. That’s creating opportunities for EMR vendors to sell new systems. Repertoire readers, meanwhile, need to stay alert to their customers’ changing preferences and demands.

In June, the U.S. Department Health and Human Services reported that electronic medical record (EMR) adoption rates already exceeded the agency’s predictions for 2013, with over 50 percent of physicians and eligible professionals and 80 percent of hospitals nationwide receiving incentive payments for “meaningful use” attestation. But even as the first-time EMR market for physician practices becomes saturated, low physician satisfaction rates are driving the demand for replacement EMR systems.

A February 2013 poll from marketing research firm Black Book Rankings suggested 23 percent of physicians planned to switch their systems at some point, with another 8 percent reporting that they wanted to change EMRs but could not afford to. Subsequent surveys conducted by AmericanEHR, the American College of Physicians, and Software Advice have also attested to doctors’ frustrations with their EMR products, showing declining satisfaction rates in usability, productivity, and their system’s ability to improve patient care.

Who’s to blame?

The poor usability of their EMR system is a common complaint among physicians, leading many to switch vendors. Of those surveyed in the Black Book Rankings report who wanted to purchase a new EMR system, 80 percent said the product did not meet the needs of the practice, including its workflow requirements. However, 79 percent of those willing to change systems assumed at least part of the blame, saying their practice failed to properly assess its needs before buying the EMR. Attractive federal incentive payments may account for some of the problem.

“In some cases, they went out and looked for the lowest price point possible with a solution that would meet ‘meaningful use’ and didn’t do due diligence on what was going to be best suited for their practice workflows,” says Caleb Anderson, Cerner ambulatory sales director. He estimates that roughly 30 percent of his current client base has switched over from another EMR system. However, even those practices that analyzed their EMR needs may have underestimated the workflow changes that would be necessary.

“If they were coming off of paper, they didn’t know what they didn’t know,” Anderson adds. “I submit that even those that did a full due diligence process probably still didn’t always understand the dramatic impact that it would have on the way they were going to practice.”

Poor training and a lack of engagement can also plague physicians’ EMR experience, according to those with whom Repertoire spoke. Most vendors offer initial instruction and ongoing customer support, but not all practices take full advantage of their systems’ capabilities, nor do they spend the time to ensure every provider is using the EMR effectively.

“One of the biggest mistakes I think that physicians and healthcare systems make is that they make it an optional system or allow physicians to use it in many different ways,” says Dr. Joseph Scalia, a Raritan, N.J.-based family practice physician who uses the Cerner Ambulatory EHR. An experienced EMR user, he has lectured at several Cerner physician events on patient-centered medical homes and EMR implementation.

To ensure the best EMR utilization in his office, Scalia encouraged his staff to train with the Cerner EMR on an ongoing basis, even after the system launched. “About three months after we had gone live, we brought the trainers back because there’s only so much that you can actually absorb in the initial training process. Physicians are able to get through the basic aspects of entering data, but there are so many nuances in a very complex system, as most EMRs are, and you want to be able to utilize it to the best of your ability. We felt it was important to bring our trainers back to bring on a secondary and tertiary level of training.”

The effectiveness of an EMR ultimately depends on what physicians enter into the system, Scalia adds, and doctors must use it consistently, entering patient data in the same way every time.

Lack of necessary features

Another segment of physicians are willing to switch vendors because their current EMR simply doesn’t fit their practice’s needs. They seek products that will allow them to experience the more efficient workflow, customized content, and broader connectivity that EMR vendors promise.

“As these physicians implemented EMRs in their offices, they became more sophisticated in terms of their demands of an EMR,” explains Anderson. While many physicians initially operated what was essentially a paper-based workflow in electronic form, they soon recognized EMR’s potential to help coordinate care with other practices, offer specialty-specific features to improve reporting, and provide other clinical benefits.

“When we have clients come to us that are switching off of another EMR, very rarely are they saying it doesn’t have prescribing or the core elements of what an EMR should do,” says Anderson. “It’s ‘It doesn’t fit my practice,’ or ‘It doesn’t allow me to connect with others that are using different systems,’ or ‘I can’t get lab data into my EMR.’ So I think the sophistication and demand from the consumer has gotten more robust, and that’s where the dissatisfaction is coming from. Their vendor is not meeting those needs.”

Most vendors recognize the need to address physician customers’ changing product demands. Anderson estimates that Cerner releases updates to its ambulatory EMR system every three to six months, and many of the new features and workflow improvements are driven by customers who not only give input, but in some cases actively participate in the design process. The growth of mobile EMR applications from companies such as Epic, Allscripts, and eClinicalWorks is another example of major vendors responding to physicians’ requests.

Simplicity of packaged EMRs

At the same time, vendors are sprucing up their offerings to help providers adapt to healthcare reform. In addition to electronic medical records, the packages include revenue cycle management software, automated reporting tools, patient portals, population health programs, and other tools specifically suited to meet provisions of the Affordable Care Act.

According to Bruce Lieberthal, vice president of emerging technologies at Henry Schein, it’s critical to view developments in the EMR industry against the backdrop of healthcare reform, not only in terms of a particular EMR’s compatibility with Meaningful Use Stage 2 and the pending ICD-10 transition, but in how physicians want to run their practices.

“There’s just so much intensity in the marketplace now, and doctors are just very [nervous about finding] themselves in a place they don’t want to be,” Lieberthal says. “Their business is under pressure because of consolidation, because of healthcare reform. They have to buy all this technology that is not necessarily top-of-mind, and they have to start using it.” Lieberthal predicts that packaged solutions – such as Henry Schein’s MicroMD system – will grow in popularity as physicians cope with deadlines for meaningful use attestation, reimbursement changes, and reporting guidelines.

EMR vendors, including Henry Schein, have taken steps to minimize physicians’ investment risk, adds Lieberthal. “Some vendors in the market are essentially offering their technology at no charge, by agreeing to file the practice’s claims and collect on their behalf in exchange for a percent of the collections. The doctors can then continue to focus on patient care. This is an interesting model that is attracting attention in the market.”

Not all vendors are adopting the same packaged marketing approach to EMR. North Kingstown, RI-based Amazing Charts offers a solution designed exclusively for physicians in small practices who are dissatisfied with the fundamental operations of their current EMR systems. While it has relatively few meaningful use attestations compared to major companies like Epic and Allscripts, physicians consistently give top ranks to the Amazing Charts system in terms of usability and satisfaction, according to surveys conducted by The American College of Physicians, Black Book Rankings, and Medscape.

“What we’re seeing is that when people switch, it’s because they’re dissatisfied on a much more fundamental level,” says Charlie Schachter, senior director of marketing, Amazing Charts. “They’re not worried about little features and functionalities; it’s usually not enough to get someone to switch, because they’ve usually invested a lot into their existing system.” Physicians, Schachter continues, want the system’s basic capabilities to be “done right.” By targeting small practices with less than 10 physicians, it’s easier for the company to tailor the EMR to the workflow and usability needs of a very specific customer base.

What’s ahead

Like most other aspects of healthcare delivery, the EMR industry is undergoing rapid changes. While usability is a critical issue for many physicians, greater EMR compatibility with other systems will be an important product requirement in the future, as more providers enter outcomes-based reimbursement models that reward coordinated care and population health management.

The number of EMR vendors will probably dwindle as well. There were nearly 480 EMR companies whose users had attested to Meaningful Use Stage 1 in 2012, and nearly a quarter of all ambulatory EMR attestations were spread between 446 vendors. Bankruptcies, acquisitions, and the “sunsetting” of products as their vendors cease offering support for successive meaningful use stages will likely force physicians to abandon their old systems and buy new EMRs. With any luck, they might just find what they’re looking for.

Will Foltz is an analyst at U.S. Lifeline, part of MDSI, publisher of Repertoire.


What is ‘meaningful use?’

Eligible healthcare professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives, per the Health Information Technology for Economic and Clinical Health (HITECH) Act. Four regulations have been released, two of which define the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and two of which identify the technical capabilities required for certified EHR technology.

“Meaningful use” objectives are intended to evolve in three stages over the next five years.

Stage 1 (2011-2012): Data capture and sharing

• Electronically capturing health information in a standardized format.

• Using that information to track key clinical conditions.

• Communicating that information for care coordination processes.

• Initiating the reporting of clinical quality measures and public health information.

• Using information to engage patients and their families in their care.

Stage 2 (2014): Advance clinical processes

• More rigorous health information exchange (HIE).

• Increased requirements for e-prescribing and incorporating lab results.

• Electronic transmission of patient care summaries across multiple settings.

• More patient-controlled data.

Stage 3 (2016): Improved outcomes

• Improving quality, safety, and efficiency, leading to improved health outcomes.

• Decision support for national high-priority conditions.

• Patient access to self-management tools.

• Access to comprehensive patient data through patient-centered HIE.

To find out more about “meaningful use,” go to www.healthit.gov/policy-researchers-implementers/meaningful-use