HIMSS13 — EHR Satisfaction Diminishing

Based upon AmericanEHR data collected from 2010 to 2012, user satisfaction levels with EHRs are dropping in multiple areas. These findings were presented at HIMSS13 on March 5, 2013.

Highlights from the presentation:

  • Surveys were conducted in conjunction with 10 different professional societies between March 2010 and December 2012.
  • AmericanEHR Partners worked with each society to identify appropriate membership to be surveyed.
  • Clinicians were either verified by their professional society or via the AMA’s Physician Verification Service (PVS).
  • The survey was distributed to both users and non-users of EHRs.
  • 71% of respondents were in practices of 10 physicians or less.
  • The average length of time that survey respondents had been using their EHRs was more than three years at the time of completing the EHR satisfaction survey.
  • Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors.
  • Overall EHR user satisfaction reveals a 12% drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10% for the same period.
  • In 2012, 39% of clinicians would not recommend their EHR to a colleague.
  • Satisfaction with the ability to improve patient care revealed a drop in very satisfied users from 2010–2012 of 6% and an increase of very dissatisfied users of 10% for 2010–2012.
  • Average satisfaction level with the ability to improve patient care decreased from 2010–2012 for all specialty groups; (primary care, medical sub-specialties, and surgical specialties); however, the least satisfied group were the surgical specialists, with primary care the more satisfied, and medical sub-specialties in between primary care and surgery.
  • Satisfaction with ease of use dropped 13% between 2010–2012 and 37% reported increased dissatisfaction in 2012, compared with 23% in 2010.
  • The length of time to overcome initial productivity challenges typical with beginning to use an EHR — 32% had not returned to normal productivity levels in 2012 compared to 20% in 2010.
  • 34% of users in 2012 were very dissatisfied with the ability to decrease workload compared to 19% in 2010.
  • Only 3 of the Top 10 rated products — e-MDs, MEDENT, and Practice Fusion (based upon AmericanEHR satisfaction ratings as of January 13, 2013) — were in the top 10 attested ambulatory EHRs (based upon CMS attestation data as of October 2012) . The three top-rated EHRs comprised only 6.48% of attestations.

Why is this happening? The following hypotheses may explain some of these findings:

  • With Meaningful Use, users may have lost some of their workarounds or have new ones that they have to do, e.g. clinical visit summary that now takes 10 clicks; as a result, workflow may feel more cumbersome.
  • Increasing amounts of administrative burden — parts of the EHR may not work correctly. For example, the E-Prescribing module may not handle prior-authorization for drugs or which drugs require prior-authorization even though the drug is listed on formulary and could be as simple as tablet vs. capsule version of the drug, with one requiring prior authorization and the other one not.
  • The difference between cognitive versus procedural specialists. If one asked the majority of physicians how they would rate the quality of care they provide, most would likely say very good to excellent. Unless these physicians regularly use dashboards and reports, they do not know whether they are doing better using an EHR. This is more challenging with procedural specialists such as a thoracic surgeon or orthopedic surgeon. It is not clear how the EHR helps with improving quality of care for proceduralists.
  • As we have further analyzed the data related to satisfaction with the ability to improve patient care by duration of EHR use prior to completing the EHR satisfaction survey, there appears to be a strong correlation between length of use of an EHR and ability to improve patient care especially in those who have been using an EHR for five+ years. This could suggest that there is a minimum period of time that someone has to use an EHR before beginning to demonstrate improvements in patient care.
  • Dissatisfaction may also be a result of being asked to do something with an EHR that previously was not required (prior to Meaningful Use).
  • There continues to be an inability to complete certain tasks electronically despite having an EHR. For example, ACOs that require a paper form to be completed for registration of each patient in a pay-for-performance program, resulting in increased workload and decreased productivity/satisfaction.

Additional observations:

  • The speed of change in relation to the Meaningful Use program may be too much too fast for many practices who are unable to cope the demands and workload.
  • Different populations have different expectations. The pioneers and early adopters have a greater tolerance for the problems and challenges of implementing an EHR vs. those in the mid or late majority.
  • EHR systems clearly have usability issues that need to be addressed, even with respect to basic functionality. For example, 13% of respondents reported difficulty in documenting a progress note using their EHR in 2010, versus 21% in 2012.
  • We observed differences between specialties in terms of their satisfaction levels with EHRs. Primary care specialties were most satisfied with their EHRs, with surgical specialties the least satisfied, and medical sub-specialties in between. It is important to note that all specialties reported a drop in satisfaction levels with their EHRs from 2010 to 2012.


  • There is a need for increased awareness and greater vigilance in monitoring user satisfaction trends pertaining to EHRs.
  • Both government and EHR vendors should manage and address problems in relation to policies and EHR requirements to better match the needs of today’s care providers.
  • Training is a significant deficiency. Training is required at all stages of adoption, both at time of implementation and as more advanced functionalities are required or integrated with EHRs. Almost 50% of respondents in a 2011 AmericanEHR report on the correlation of training duration with EHR usability and satisfaction reported receiving less than three days of training to use their EHRs or no training at all.
  • Dissatisfaction levels with basic EHR functionalities highlight the need to improve existing technologies rather than just focus on adding new features and capabilities.
  • Clinician workload within the practice must be re-balanced. Providers are working harder and face numerous additional challenges including the impact of payment reform and the need to comply with multiple incentive/penalty programs.
  • Relevant reportable Clinical Quality Measures should be better aligned with specific specialties. The alternative is that clinicians will be required to complete tasks that are irrelevant based upon their specialty.

If these issues are not recognized and addressed, the alternative is that clinicians will do the bare minimum in order to meet Meaningful Use requirements. The result for the Meaningful Use program will be an inability to achieve the intended goals of improvements in efficiency, quality of care, and clinical outcomes.

Listen to the Podcast on Physicians Practice

What do you think? Do these findings mirror your experiences? Add your thoughts below:


19 responses to "HIMSS13 — EHR Satisfaction Diminishing"
  • Pingback: EHR Satisfaction Diminishing, According to AmericanEHR Survey | Electronic Health Reporter

  • March 7, 2013
    Michael S. Barr, MD, MBA, FACP

    News outlets are picking up on AmericanEHR’s presentation…

    Medpage Today
    Dissatisfaction with EHRs Rising, Survey Finds
    The number of physicians who said they would not recommend their EHR to a colleague rose to 39% in 2012 from 24% 3 years ago, the survey found. It was released Tuesday by the American College of Physicians (ACP) and AmericanEHR Partners, the web-based resource arm that ACP helped create. Much of the physicians’ dissatisfaction was due to EHRs’ failure to increase productivity.
    “Dissatisfaction is increasing regardless of practice type or EHR system,” Michael Barr, MD, who leads ACP’s medical practice, professionalism, and quality division, said in a news release.

    EHR Intelligence
    EHR usability, satisfaction are falling among physicians
    In their presentation titled “Challenges with Meaningful Use: EHR Satisfaction & Usability Diminishing,” William Underwood, [former] senior associate at the American College of Physicians and Alan Brookstone, MD, chief executive officer of Cientis Technologies, examined the results of survey data collected from 2010 to 2012, when AmericanEHR Partners queried 4,279 physicians from ten different professional societies.

    Becker’s Hospital Review
    Survey: EHR User Satisfaction Has Fallen by 12% From 2010
    Survey results, revealed by the American College of Physicians and AmericanEHR Partners in a presentation called “Challenges with Meaningful Use: EHR Satisfaction & Usability Diminishing,” at the Healthcare Information Management Systems Society Annual Conference in New Orleans, March 3-7, 2013, indicate that satisfaction and usability ratings for certified electronic health records have decreased since 2010.

  • March 9, 2013
    Deena Greenblatt

    Well written, on point and so true especially within the recommendations.
    Training is a significant deficiency. Training is required at all stages of adoption, both at time of implementation and as more advanced functionalities are required or integrated with EHRs.

  • March 9, 2013
    Joseph J Muscato, MD

    I wholeheartedly agree. We have been using our office EHR (IKnowMed) for 6 1/2 years and we are quite good at it. However, our main hospital is going live this week with electronic orders. The weakness of old systems and the unwillingness to reprogram for ease and safety is overwhelming. Many things feel patched on and there are some safety issues. I suspect that usability was the last thing that the vendors looked at and then expect that the users will just conform. And I am an enthusiastic user!

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  • March 12, 2013
    John Bowery, DO

    It is obvious that Meaningful Use has changed the EHR economy to a seller’s market. Ironically, as more providers are being forced to surf the MU tsunami, the EHR vendors have shifted their priorities from improving usability to marketing. This is always the problem when a technology is pushed by a third party onto a market rather than allowing the technology to mature to the point where the customers actually WANT to buy it. If the federal government had mandated the use of cellular phones in 1990, do you think we would EVER have had an iPhone? Don’t kid yourself.

  • March 12, 2013
    Mark Freeman, MD

    The lack of foresight and lack of appreciation of the actual workflow of the physician practices by the current products available is astounding.

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  • April 15, 2013

    I agree with Dr. Freeman above. With the flood of funding coming with the race for MU, EHR organizations are making the same fundamental mistakes that other enterprise software firms made (and still make). The are creating “engineering centric” designs — that require LOTS of training

    EHRs will be successful only when they are built with a focus on the end user, designed to solve end user tasks, using end user workflows, and matching end user mental models.

    It is called “User-Centered” design and it has been the foundation of usability and user experience teams for decades.

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