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Cerner Tops List Of Hospital Vendors For Medicare EHR Incentive Program

Posted on September 28, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Research from the ONC concludes that Cerner systems are in use by the most hospitals using certified technology to participate in the Medicare EHR Incentive Program. It’s interesting to note that this list includes players that rarely appear on overall lists of top hospital EHR vendors, though admittedly, there’s no one way to measure market dominance that produces consistent results every time.

According to ONC statistics, there were 175 vendors supplying certified health IT to 4,474 nonfederal acute-care hospitals participating in the Medicare EHR Incentive Program. Ninety-five percent of these vendors have 2014 certified technology.

The report notes that six of these vendors (Cerner, Meditech, Epic, Evident, Medhost and McKesson) provide 2014 certified technology 92% of hospitals using the technology. When you throw in athenahealth, Prognosis and QuadraMed, bringing the list to 10 vendors, you’ve got a group that supplies 2014 technology to 98% of eligible hospitals.

According to the data, the vendors at the top fall in as follows. Cerner tops the list of total hospitals using its certified health IT, with 1,029 hospitals;  Meditech was next with 953 hospitals; Epic came in third with 869 hospitals; CPSI’s Evident (formerly Healthland) was fourth with 637 hospitals; McKesson fifth with 462 hospitals; and Medhost sixth with 359 hospitals.

As is usually the case with any attempt to look at market share, the data comes with its own quirks. For example, when looking at ONC’s data as of July 2016 on ambulatory healthcare providers choice of certified technology, Epic was way ahead of the pack with 83,674 users. Allscripts came in at a distant second with 33,123 users. Cerner came in sixth with 15,100 ambulatory users. In other words, vendors one might class as “enterprise” focused are doing well among clinicians. (See more data along these lines in a Medscape survey I summarized previously.)

Then consider data from HIMSS Analytics, which concludes that Epic has 40% of the hospital health IT market, followed by Cerner at a distant second with 13%, Allscripts at 10%, Meditech at 7% and eClinicalWorks at 5% and NextGen with 4%. Why the big difference in numbers? It seems that HIMSS Analytics includes the size of the hospital in its calculations versus the ONC data above which talks about the number of hospitals.

No doubt the buying patterns vary when you look at the number of beds a hospital has. For example, according to research done last year by peer60, CPSI and eClinicalWorks held the biggest share of the market among facilities with less than 100 beds, MEDITECH, McKesson and Siemens dominated the mid-sized hospital categories, and as the number of beds rises from 250 to 1000+ plus, Cerner and Epic emerge as the top players.

The truth is, market share numbers are interesting, and not just to the vendors who hope to emerge on top. Everyone loves a good horse race, after all. But it’s good to take these numbers with a large dose of context, or they mean very little.

Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Rolling out a hospital EMR can be very disruptive. The predictable problems that can arise – from the need to cut back on ambulatory patient visits to the staff learning curve to unplanned outages – are bad enough. And of course, when the implementation hits a major snag, things can get much worse.

Just to pull one name out of a hat, consider the experience of the Vancouver Island Health Authority in British Columbia, Canada. One of the hospitals managed by the Authority, which is embroiled in a $174 million Cerner implementation, had to move physicians in its emergency department back to pen and paper in July. Physicians had complained that the system was changing medication orders and physician instructions.

But fortunately, this experience is definitely the exception rather than the rule, according to a study appearing in The BMJ. In fact, such rollouts typically don’t cause adverse events or needless deaths, nor do they seem to boost hospital readmissions, according to the journal.

The study, which was led by a research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, looked at the association between EHR implementation and short-term inpatient mortality, adverse safety events or readmissions among Medicare enrollees getting care at 17 U.S. hospitals. The hospitals selected for the study had rolled out or replaced their EHRs in a “big bang”-style, single-day go-live in 2011 and 2012.

To get a sense of how selected hospitals performed, the team studied patients admitted to the studied facilities 90 days before and 90 days after EHR implementation. The researchers also gathered similar data from a control group of all admissions during the same period by hospitals in the same referral region. For selected hospitals, they analyzed data on 28,235 patients admitted 90 days before the implementation, and 26,453 admitted 90 days after the EHR cutover. (The control size was 284,632 admissions before and 276,513 after.)

Apparently, researchers were expecting to see patient care problems arise. Their assumption was that in the wake of the go-live, the hospitals would see a short increase in mortality, readmissions and adverse safety events. One of the reasons they expected to see this bump in problems is that some negative problems related to time and season, such as the “weekend effect” and the “July effect,” are well documented in existing research. Surely the big changes engendered by an EHR cutover would have an impact as well, they reasoned.

But that’s not what they found. In fact, the researchers wrote, “there was no evidence of a significant or consistent negative association between EHR implementation and short-term mortality, readmissions, or adverse events.”

I was as surprised as the researchers to learn that EHR rollouts studied didn’t cause patient harm or health instability. Considering the immense impact an EHR can have on clinical workflow, it seems strange to read that no new problems arose. That being said, hospitals in this group may have been doing upgrades – which have to be less challenging than going digital for the first time – and were adopting at a time when some best practices had emerged.

Regardless, given the immense challenges posed by hospital EHR rollouts, it’s good to read about a few that went well.  We all need some good news!

Is It a Hot or Cold Hospital EHR Buying Market? – Response

Posted on August 15, 2016 I Written By

For the past twenty years, I been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

This article is in response to John Lynn’s recent posting, Is It a Hot or Cold Hospital EHR Buying Market?

In his recent posting, John Lynn asked the question “Is it a Hot or Cold Hospital EHR Buying Market?”. In it he highlights a recent KLAS report that over 490 hospitals, a staggering 10% of the entire market, were involved in an EHR decision in 2015. After reading his posting, I wanted to take a moment to share my observations.

2015 was indeed an amazing year for EHR sales, partly driven by the pending sunset date of Mckesson Horizon forcing many customers to switch EHR solutions. Some of those customers are going to Paragon, but many more purchased or are evaluating other solutions. During a recent trip to Epic University, I was surprised to find that nearly half of the attendees of the classes were hospitals switching from Mckesson Horizon to Epic – and all had just recently completed their purchases (late 2015/early 2016) and were facing the same live dates of late 2017/early 2018.

Hospitals who have purchased and implemented Epic or Cerner are very unlikely to make a change. Regardless of which solution is preferred, the investment in these solutions and the level of effort required to switch from one to another is so high, that it would take a significant triggering event for a hospital to make that change. Therefore it is likely that customers on these solutions will not be making a change in the near future.

However, KLAS reports that nearly 40% of MEDITECH customers would change EMR’s if they could, and that Paragon customers also report unrest. Therefore in addition to the shrinking number of those that have not implemented a viable EHR solution, the possibility that there will be a wave of customers switching from one of these solutions to Epic or Cerner remains a consideration. There is also the question of how the recent spin-off of Mckesson’s software division will impact the future of Paragon. If Paragon were discontinued or sold, it could lead to another explosion of EHR decisions. If instead there was a significant investment in the solution, it could become a more viable alternative as customers look to switch from one EHR to another.

I suspect that 2016 will be another strong year from EHR sales in general and for Epic and Cerner in particular. Beyond that, much will depend on the strength of the other solutions and which ones break out into the top tier. Regardless, the recent explosion of EHR sales and the rush to replace Horizon will in many cases lead to minimized installs – where the bare minimum work was completed and there is significant opportunity to improve business processes, implement new modules, and roll out advanced functionality within those solutions. As a result I believe that within a few years, the market will be more stabilized with fewer customers switching solutions, and instead focusing on maximizing what they have.

Unless another player comes in and disrupts the marketplace or a significant shift in the industry creates a reason to make a change yet again…

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Hospitals Using Market-Leading EHR Have Higher HIE Use

Posted on July 29, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study concludes that hospital engagement with HIEs is tied with the level of dominance their EHR vendor has in their marketplace. The study, which appeared in Health Affairs, looked at national data from 2012 and 2013 to look at how vendor dominance related to hospitals’ HIE involvement level. And their analysis suggests that the more market power a given vendor has, the more it may stifle hospitals’ HIE participation.

As researchers note, federal policymakers have expressed concern that some EHR vendors may be hampering the free flow of data between providers, in part by making cross-vendor HIE implementation difficult. To address this concern, the study looked at hospitals’ behavior in differently-structured EHR marketplaces.

Researchers concluded that hospitals using the EHR which dominated their marketplace engaged in an average of 45% more HIE activities than facilities using non-dominant vendors. On the other hand, in markets where the leading vendor was less dominant, controlling 20% of the market, hospitals using the dominant vendor engaged in 59% more HIE activities than hospitals using a different vendor.

Meanwhile, if the dominant EHR vendor controlled 80% of the market, hospitals using the leading vendor engaged in only 25% more HIE activities than those using a different vendor. In other words, high levels of local market dominance by a single vendor seemed to be associated with relatively low levels of HIE involvement.

According to the study’s authors, the data suggests that to promote cross-vendor HIE use, policymakers may need to take local market competition between EHR vendors into consideration. And though they don’t say this directly, they also seem to imply that both high vendor dominance and low vendor dominance can both slow HIE engagement, and that moderate dominance may foster such participation.

While this is interesting stuff, it may be moot. What the study doesn’t address is that the entire HIE model comes with handicaps that go beyond what it takes to integrate disparate EHR systems. Even if two hospital systems in a market are using, say, Cerner systems, how does it benefit them to work on sharing data that will help their rival deliver better care? I’ve heard this question asked by hospital financial types, and while it’s a brutal sentiment, it gets to something important.

Nonetheless, I’d argue that studying the dynamics of how EHR vendors compete is quite worthwhile. When a single vendor dominates a marketplace, it has to have an impact on everyone in that market’s healthcare system, including patients. Understanding just what that impact is makes a great deal of sense.

Creating Alliances with Large Health IT Vendors – Benefits and Challenges

Posted on June 13, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare Scene recently sat down with Nancy Hannan, Philips Relationship Director at Augusta University Health System (formerly known as Georgia Regents) to talk about their alliance with Philips Healthcare and the impact it’s had on their healthcare organization.

Along with talking about the benefits and challenges of creating a long term contract with a healthcare IT vendor, we also dive into the details of how medical device standardization has impacted their organization. Not to be left out, we also talk about how this relationship has impacted patients and doctors. If your organization is looking at how to standardize your medical equipment, this interview will give you some insight into creating a long term alliance with your vendor.

In the second part of my interview with Nancy Hannan, Philips Relationship Director at Augusta University Health System (formerly known as Georgia Regents) we discuss how they’re taking the lessons learned from the Philips alliance and applying them to their agreement with Cerner. We also talk about how cybersecurity is better having a vendor representative on site like they have with Philips.

Mayo Clinic’s Shift To Epic Eats Up Most of IT Budget

Posted on May 6, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Mayo Clinic has announced that it will spend about $1 billion to complete its migration from Cerner and GE to Epic. While Mayo hasn’t disclosed they’re spending on software, industry watchers are estimating the agreement will cost hundreds of millions of dollars, with the rest of the $1 billion seemingly going to integration and development costs.

The Clinic said in 2014 that it would invest $1.5 billion in IT infrastructure over multiple years, according to the Minneapolis/St. Paul Business Journal. Then last year, it announced that it would replace Cerner and GE systems with an Epic EMR. Now, its execs say that it will spend more than $1 billion on the transition over five years.

Given what other health system spend on Epic installations, the $1 billion estimate sounds sadly realistic. Facing up to these costs is certainly smarter than lowballing its budget. Nobody wants to be in the position New York City-based Health and Hospitals Corp. has gotten into. The municipal system’s original $302 million budget expanded to $764 million just a couple of years into its Epic install, and overall expenses could hit $1.4 billion.

On the other hand, the shift to Epic is eating up two thirds of the Mayo’s $1.5 billion IT allowance for the next few years. And that’s a pretty considerable risk. After all, the Clinic must have spent a great deal on its Cerner and GE contracts. While the prior investments weren’t entirely sunk costs, as existing systems must have collected a fair amount of data and had some impact on patient care, neither product could have come cheaply.

Given that the Epic deal seems poised to suck the IT budget dry, I find myself wondering what Mayo is giving up:

  • Many health systems have put off investing in up-to-date revenue cycle management solutions, largely to focus on Meaningful Use compliance and ICD-10 preparation. Will Mayo be forced to limp along with a substandard solution?
  • Big data analytics and population health tech will be critical to surviving in ACOs and value-based payment schemes. Will the Epic deal block Mayo from investing?
  • Digital health innovation will become a central focus for health systems in the near future. Will Mayo’s focus on the EMR transition rob it of the resources to compete in this realm?

To be fair, Mayo’s Epic investment obviously wasn’t made in a vacuum. With the EMR vendor capturing a huge share of the hospital EMR market, its IT leaders and C-suite execs clearly had many colleagues with whom they could discuss the system’s performance and potential benefits.

But I’m still left wondering whether any single software solution, provided by a single vendor, offers such benefits that it’s worth starving other important projects to adopt it. I guess that’s not just the argument against Epic, but against the massive investment required to buy any enterprise EMR. But given the extreme commitment required to adopt Epic, this becomes a life-and-death decision for the Mayo, which already saw a drop in earnings last year.

Ultimately, there’s no getting past that enterprise EMR buys may be necessary. But if your Epic investment pretty much ties up your cash, let’s hope something better doesn’t come along anytime soon. That will be one serious case of buyer’s regret.

Looking Into the Future of Hospital EHR

Posted on April 11, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been thinking a lot lately about where the world of hospital EHR software is going to head. At the top of the market we have Cerner and Epic taking most of the share. As we go down the market we see a lot of other large players, but we still only have 20 or so EHR vendors playing in the hospital EHR world.

In the last year we’ve seen aggressive moves by athenahealth and eCW to enter the hospital EHR space as well after previously only providing ambulatory EHR software. I’ve heard predictions that entrants like these are going to charge significantly less for their EHR software and that’s going to really shake up the market. You can imagine how the discussions in most hospitals will go if there’s an EHR alternative that’s 1/10th the price of their current EHR.

What’s interesting is that I haven’t seen any major moves by the large competitors to really accelerate the services, features, and functions they provide a hospital in order to justify the large premium. If I were Epic or Cerner, I’d be thinking about something really special that we could create that would be cost prohibitive for these new entrants to create. No doubt the Innovator’s Dilemma is at play here. Hard to fight against so much proven history around business dynamics.

Something that’s shocking to me is that these new entrants into the hospital EHR space aren’t really leveraging new technology either. They’re not building new features or functionality that doesn’t exist today (for the most part). They’re using things like cloud and mobile that are now relatively old technologies, but haven’t been applied to healthcare.

Said another way, will doctors love this new breed of hospital EHR any more than the current breed? I believe the answer to that question is no. Doctors will hate this new breed of EHR just as much. With this insight, I could imagine some other companies coming along and creating true innovation with new technologies that today we can’t even imagine. Although, it won’t likely be just technology innovation, but in healthcare it will likely include business model innovation as well.

GE Healthcare Is Still In The Game

Posted on March 14, 2016 I Written By

David is a global digital healthcare leader that is focusing on the next era of healthcare IT.  Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

Below is the recent press release from GE Healthcare.  Their EMR will be used in the Rio 2016 Olympics which is a great win for GE.  The product has come a long way and they are making some great strides.  The challenge is where will the product fall in a healthcare EMR ecosystem that is predominately Epic and Cerner.   Personally I know of a few organizations that are evaluating a transition away from the GE Centricity platform due to either a merger with a bigger healthcare system that already has an enterprise EMR or they had a bad experience with Centricity and are moving on.  It will be interesting to see in the next 2-3 years how many EMR vendors we will have left.  I will definitely keep an eye on GE to see whether the recent win with the Olympic games will help create positive momentum in 2016.

LAS VEGAS–GE Healthcare announced today the International Olympic Committee (IOC) has selected the company’s Centricity Practice Solution as the official electronic medical record (EMR) to be used by the medical teams of the Rio 2016 Olympic Games. This marks the first time that all athletes and spectators at the Olympic Games will have their health interactions managed by an electronic medical record. The announcement was made at the 2016 Health Information Management Systems Society (HIMSS) conference in Las Vegas.

Centricity Practice Solution will be used for managing data related to injuries and illness for athletes competing in the games as well as spectators, officials, athlete family members and coaches who require medical assistance throughout the Rio 2016 Olympic Games. For the competitors, the data managed during the Games will be used to help drive optimal, individualized care to help athletes compete at a world-class level.

“The Olympic Games is about providing the best possible service to athletes,” said Dr. Richard Budgett, Medical and Scientific Director for the IOC. “The gold medal of medical services is something that is integrated and comprehensive: a total package. Adding access to an electronic medical record is key to our drive towards the prevention of injury. Without a proper medical, longitudinal record, it’s difficult for us to do surveillance and see what injuries are most common in certain sports. This would impact our ability to prevent and measure our effectiveness. The EMR is going to be a cornerstone for our medical services going forward.”

Centricity Practice Solution will be available in English and Portuguese and will provide access to next generation workflows, analytics and data to potentially help optimize athlete performance. The information will be analyzed to spot patterns and provide insights for future Games planning. Additionally, medical teams will be able to access diagnostic images and reports from within the EMR to assist in providing world-class care quickly and efficiently. GE’s EMR will be accessible at any of the multiple medical posts throughout the Games and at the central Polyclinic in the Olympic Village where more complex care is delivered.

“By selecting Centricity Practice Solutions EMR, the IOC is extending the clinical care and data management capabilities pioneered by the United States Olympic Committee (USOC), which has used GE’s EMR platform for the past two Olympic Games in London and Sochi,” said Jon Zimmerman, General Manager, GE Centricity Business Solutions. “Incorporating an EMR platform into the healthcare services will enable medical staff at the Rio 2016 Olympic Games access to real time data, analytics and health information to help their athletes perform at peak capabilities.”

If you’d like to receive future health care C-Level executive posts by David in your inbox, you can subscribe to future Health Care CXO Scene posts here.

Hospital EMR Buyer Loyalty May Be Shaky

Posted on February 22, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

When it comes to investing in enterprise software, just about any deal can turn sour. If you’re acquiring a mission-critical platform, there’s an even bigger risk involved, and the consequences of failure are typically dire. So any company making such a purchase may feel trapped after the contract is signed and the die has been cast.

One might hope that when hospital and health systems buy an EMR — probably the most expensive and critical software buy they’ll make in a decade — that they feel comfortable with their vendor. Ideally, hospitals should be prepared to switch vendors if they feel the need.

In reality, however, it looks like many hospitals and health systems feel they’re trapped in their relationship with their EMR vendor. A new study by research firm Black Book has concluded that about a solid subset of hospitals feel trapped in their relationship with their EMR vendor. (Given what I hear at professional gatherings, I’m betting that’s on the low side, as their EMR has driven so many hospitals deep into debt.)

Anyway, Black Book compiles an HIT Loyalty Index which assesses the stability of vendors’ customer base and measures those customers’ loyalty. For its current batch of stats, Black Book drew on 2,077 hospital users, asking about their intentions to renew current contracts, recommend their inpatient EMR/HIT vendor to peers and the likelihood of their buying additional products like HIE and RCM tools from their existing vendors.

The results shouldn’t give any great pleasure to HIT vendors. All told, loyalty to inpatient EMR/HIT vendors fell 6%, from 81% to 75% committed clients. While it’s not horrible to have 75% truly happy with your product, this is not a metric you want to see trending downward.

When you combine these numbers with other signs of dissatisfaction, the picture looks worse. Roughly 25% of respondents said that they were only loyal to their vendor because they were forced to follow administrative directives. And as we all know, ladies and gents of the vendor world, you can’t buy love. These 25% of dissatisfied professionals will do their job, but they aren’t going to evangelize for you, nor will they be quick to recommend more of your products.

All is not bleak for EMR vendors, however. Some HIT vendors saw year-to-year growth in hospital client loyalty. Vendors with the biggest loyalty increases included Allscripts, Cerner, CPSI, NTT Data and athenahealth/RazorInsights.

By the way I noted, with a touch of amusement, that mega-costly Epic doesn’t appear on the latter list. Just sayin’.

EMR Usability A Pressing Issue

Posted on January 29, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A few months ago, in a move that hasn’t gotten a lot of attention, the AMA and MedStar Health made an interesting play. The physicians’ group and the health system released a joint framework designed to rank EMR usability, as well as using the framework to rank the usability of a number of widely-implemented systems.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

  • User Centered Design Process:  EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.
  • Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).
  • Summative Testing Results:  These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.