According to the 2016 Medscape survey on electronic medical record systems, use has become near universal, with only 9% saying they don’t currently use an EHR, and most saying they plan to do so in the near future. (Medscape Survey) The survey, which covered over 15,000 doctors in 25 specialties, found usage increased to the 91% figure from 74% in 2012. 68% are using a system provided by a hospital or health system and the remainder a system provided by their practice. The top five vendors in 2016 were Epic with 28% use, Cerner at 10%, eClinical at 7%, NextGen at 5% and Meditech at 4%. In 2012, Epic was at 22%, Cerner at 95 and eClinical at 6%. In 2012 Allscripts was in the top five with 10% usage, but has dropped significantly. Among large institutions, Epic dominates with 41% usage, Cerner is at 13% and Meditech at 6%. The independent practice setting is more competitive and diffuse, with eClinical having 12% share, Practice Fusion 8%, NextGen 8%, Allscripts 6% and Greenway 6%.
In rating on a 1 to 5 scale, no vendor does great. The VA system is actually highest at 3.65, which is ironic because the other military system, AHLTA, is lowest at 2.7. The other highly ranked vendors are Epic at 3.45 and Practice Fusion at 3.44. Hospital and health systems rank the VA highest at 3.66, Epic at 3.46, AthenaHealth at 3.13 and eClinical at 3.09. NextGen brings up the bottom at 2.67. For independent practices, Epic also leads at 3.47, MEDENT at 3.44, and Practice Fusion at 3.43, with NextGen the lowest ranked here as well at 2.92. There are a number of ratings on specific features as well. Overall satisfaction with EHRS dropped slightly from 2012 to 2016, indicating that length of use doesn’t necessarily improve happiness. The most helpful features were e-prescribing, cited by 62% of physicians, the ability to locate and review patient information, by 57% and enabling multiple physicians to review and share information, by 49%.
56% said their documentation got better with the EHR, versus 21% who said it got worse. 30% said the EHR allowed them to serve patients better, versus 25% who said service declined, and 32% said clinical operations improved versus 25% who said they got worse. Overall, across all ages, large majorities of physicians said the EHR slowed workflows, although the effect was more pronounced among older doctors. In regard to the effects on actual patient encounters, 11% said they had more face time with patients as a result of EHR implementation, compared to 57% who said they had less. 38% said it allowed better management of treatment plans, compared to 14% who said management declined, and 14% said it increased the number of patients the doctor could see, versus 50% who said the number of patients seen declined. Not an entirely rosy picture, lots of interesting data.