From The Editor | July 23, 2013

The EHR Honeymoon Is Over

ken congdon

By Ken Congdon

Follow Me On Twitter @KenOnHIT

Healthcare providers have never had a “romantic” relationship with EHRs. On the contrary, many physicians despise the technology. However, the HITECH Act and Meaningful Use (MU) incentives did create an environment of unprecedented EHR demand among the provider community. This initiative achieved the desired result of increasing EHR adoption, but it also created an artificial market for dozens of immature EHR products. There are literally hundreds of EHR products on the market today, and many of them, quite simply, don’t meet expectations. Unfortunately, many hospitals and physicians practices didn’t realize the shortcomings of their EHR systems until after the investment was made and the solution was implemented. For financial reasons, many are stuck with their sub-par EHR systems. Others, however, are making the tough (and often costly) decision to rip and replace their existing EHRs. Simply having an EHR is no longer good enough. The realization has set in that these systems need to possess sophisticated features and capabilities in order to deliver value to the health provider (or at a minimum, not disrupt their workflows).

The EHR unrest that currently exists in the provider community was clearly captured in Black Book Rankings’ 2013 State of the Ambulatory EHR Market report. Nearly 17,000 EHR users from physicians practices of various sizes (solo practitioner-100+ physicians) were surveyed for this report, and the findings are telling. For example, 31% of respondents said they were dissatisfied enough with their EHR to consider making a change, and 18% said they were looking to change systems within the next 12 months. Interestingly enough, many providers blame themselves for their failed EHR investments — citing that short-term MU rewards rushed them into an EHR decision without properly assessing the needs of their practice. As a result, many practices installed systems that they now find “clunky” and “frustrating.”


Poor EHR usability is a primary complaint for most providers unhappy with their current EHRs. Excessive clicks and data entry requirements are impeding physician workflows. Moreover, providers state that many underperforming EHRs are not evolving with the pace of the market. In other words, many systems continue to deliver only “basic” EHR features (e.g. document management, e-prescribing, order management, etc.). Providers today want an EHR with sophisticated interfaces to other practice programs, complex connectivity and networking schemes, and mobile device compatibility. In fact, providers ranked the following criteria as “must have” EHR functionality in 2013:

  • 84% Vendor Viability
  • 83% Provider Data Integration and Network Data Sharing
  • 78% Demonstrable Return on Investment and Clinical Improvements
  • 75% Adoption of Mobile Devices including iPad, iPhone, Android, and Tablets
  • 66% HIE Support, Connectivity/Interoperability
  • 65% Perfected Interfaces with Lab, Pharmacy, Radiology, Revenue Cycle, etc.
  • 58% Patient Portal

Not surprisingly, a definite age gap exists when it comes to EHR usability — with 91% of physicians over age 55 disapproving of EHR usability and only 29% of doctors under the age of 40 disapproving. However, the vast majority of all respondents (94%) dissatisfied with their EHRs believe that more government direction is needed to define and standardize EHR usability.


As the Black Book Rankings’ report notes, 2013 is likely to be “The Year Of The Great EHR Switch,” with several software firms underperforming badly enough to lose major market share. In fact, it’s likely that many EHR products on the market today won’t survive this industry-wide overhaul — let alone meet future MU requirements. It’s clear the industry will see a fair share of consolidation and thinning in the coming years.

EHR software vendors hoping to survive would be wise to focus less on selling product and more on improving their solutions in line with provider expectations. In addition to the EHR feature sets outlined earlier, it appears today’s healthcare providers are also leaning toward cloud-based EHR options. Of those respondents debating or confirming to be changing EHR vendors within the next year, 51% are looking to switch from a Web-based/SaaS solution to another Web-based/SaaS solution and 19% are looking to switch from an On-Premises solution to a Web-based/SaaS solution. Only 18% of respondents are looking to switch to an On-Premises EHR solution.