EHR User-Friendliness Ranked (and Spanked)

June 07, 2013

Ambulatory electronic health record (EHR) systems from Athenahealth and eClinicalWorks ranked first and second, respectively, as the easiest to use in a new report issued last month by the research firm KLAS. McKesson was ranked the lowest.

Choosing a user-friendly EHR is critical for physicians who don't want clunky technology to slow down the pace of their office visits — and diminish their revenue in the process. Productivity suffers, for example, when finding clinical information in a patient's record requires umpteen mouse clicks and umpteen glances at a confusing screen layout, said report author Mark Wagner, a senior director of clinical and ambulatory systems at KLAS. His firm surveyed 163 physician leaders of groups of more than 25 physicians about 9 ambulatory EHR programs and their vendors.

"If it takes 3 minutes to review the chart for every visit, as opposed to 1 minute, those extra minutes add up over the course of the day," Wagner told Medscape Medical News.

The user-friendliness of the Athenahealth and eClinicalWorks programs hinges in large measure on the support and guidance that physicians receive from the vendors. After all, software makers can't just drop off their products at the front door and let physicians figure out how to adapt them to patient care. The quality of training makes a difference. So does sharing best practices gleaned from old customers with new ones. Some EHR vendors offer a large library of vetted electronic forms, or templates, for office visits — tailored to individual specialties — so that clinicians don't have to bother designing their own, said Wagner.

KLAS found that 85% of Athenahealth users thought that the vendor did an above-average job helping them master the program — the highest mark earned by any company.

At the bottom of the list was McKesson, which received a "good" rating on usability guidance from only 27% of physicians on its Practice Partner EHR.

McKesson and its EHR system also received the lowest score on the percentage of clinicians who eventually achieved high usability, at 55%. Athenahealth came in first, at 85%, with eClinicalWorks a few percentage points behind. This performance category is the best gauge of overall user-friendliness, according to Wagner.

The KLAS report also broke down ease of use by 6 different EHR functions. Seven of the 9 programs under the microscope — those from Athenahealth, Epic Systems, GE Healthcare, NextGen Healthcare, Allscripts, Cerner, and eClinicalWorks — earned a score of 4 or higher on a 5-point scale for electronic prescribing.

Beyond e-prescribing, however, the pack separated. When it came to how well clinicians can view patient data, just 5 systems — from Athenahealth, Epic Systems, GE Healthcare, Greenway Medical Technologies, and Cerner — earned at least a 4, and only Athenahealth and Greenway Medical Technologies scored at least a 4 for ease of documentation.

Athenahealth posted the highest overall score — 4.2 — for the 6 EHR functions, followed by Epic Systems at 4. GE Healthcare and Greenway Medical Technologies tied for third at 3.9.

Easy to Use Out of the Box

Similar to anybody else in the market for software, physicians want something that they can use right out of the box. Accordingly, KLAS asked about first-day usability in its survey. Athenahealth topped this performance category, with roughly 70% of users saying that they could navigate the company's EHR fairly well from the start. In last place was McKesson's EHR program: Only about 10% of physicians were satisfied with their initial experience.

Ease of use — or rather, the lack of it — is a troublesome issue in the world of EHRs. The percentage of physicians who say that their electronic charts are cumbersome rose from 23% in 2010 to 37% in 2012, according to a recent survey conducted by the American College of Physicians and a group called AmericanEHR Partners. In addition, the percentage of physicians who had not returned to their pre-EHR levels of productivity increased from 20% to 32%.

Wagner is among a number of experts who say that some vendors have sacrificed user-friendliness in the rush to comply with the evolving Medicare and Medicaid program that rewards physicians for "meaningful use" of EHRs.

"They don't do a good job of reviewing new versions of their software for bugs," said Wagner. "The code isn't clean. And so usability goes down."

The KLAS report on EHR ease of use can be purchased on the company's Web site. Survey data on individual vendors are free if physicians complete a survey about the medical software, equipment, or computer services they use.

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