Physician Perspectives on EHRs

Here is another great health care initiative that hasn’t quite turned out as expected–more use of health information technology.  The most prominent aspect is the federal meaningful use effort, which was successful in getting most providers to use electronic medical records.  However, most research, including a recent survey of over 1050 doctors from peer60, suggest that EHRs are not having the beneficial effects they were supposed to.   (Peer60 Study)     The peer60 study also looks at specific vendors and physician perceptions of those vendors.   85% of physicians said they are using an EHR, and among those who are not, inability to afford one or a belief that they don’t need one are the primary reasons for foregoing use.  89% of hospital employed physicians use an EHR and 83% of those in private practice. Almost all of the non-use is in practices of ten or fewer doctors.  According to this survey, Epic has 50% of the market for hospitals and health systems, while Cerner has 21% and Allscripts has 9%.  For outpatient practices, Epic also leads, with 18%, but the market is less concentrated.  Allscripts has a 7% share, eClincalWorks 6%, Cerner 5%, athenahealth 4%, e-MDs 4%, NextGen 4%, etc.  In the outpatient market, Epic tends to be in larger practices.  About 9% of hospitals, mostly larger ones,  said they are actively looking to replace their current EHR, while 11% of outpatient physicians said they wanted to do so.  The outpatient desire to change varies widely across specialties, with cardiologists, dermatology, infectious disease, urology, orthopedics and internal medicine most interested in a different system.  Doctors in health systems reported their top HIT needs as being support for accountable care and alternative payment models and access to patient satisfaction data.    Physicians express great unhappiness with the current EHR vendors.  Only one vendor has a promoter score of 40% or more and most vendors have a detractor score above 50%, with several over 70%.  This reflects perceptions of negative impacts on productivity and lack of utility in the functionality and data produced by EHRs.  We apparently have a way to go to make HIT valuable for providers.