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:


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