EHR Rankings Hint at Physician Revolt

February 03, 2014

When it comes to electronic health record (EHR) systems, many physicians are clicked off.

Study after study shows that point-and-click, template-driven EHR systems have sparked a big backlash against the technology. Physicians complain that the intensive data entry required in most programs, made even more intensive by federal meaningful use requirements, transforms them into clerks, slows them down, and turns face time with the patient into screen time.

It may come as no surprise, then, that SRS EHR, a program that does not depend on a lot of mouse-clicking, is the top system for practices with 1 to 10 physicians in the 2013 Best of KLAS Awards from research firm KLAS.

SRS EHR supplanted Athenahealth's EHR as the number 1 program in the small practice market, although Athenahealth still shone as the top overall medical software vendor and physician practice vendor in the KLAS rankings. Otherwise, the pecking order in digital medicine remained the same as last year: EpicCare Ambulatory Electronic Medical Record from Epic repeated as number 1 among practices with 11 to 75 physicians and among those with more than 75 physicians, and it also reigned once again in the acute care EMR category.

Based in Orem, Utah, KLAS polls healthcare providers not only about the quality of their EHRs but also about make-or-break issues such as training, implementation, and support. Questions such as "Would you buy this product again?" yield brutal, but enlightening, answers.

The answers turned out well for the EHR from SRS (short for SRSsoft), which was originally designed for scanning and organizing handwritten notes and other hard copy documents. The software has gotten more sophisticated since its debut in 2000, but not too much more — there is still a lot of scanning of hard copies involved. In addition to handwriting chart notes, physicians can dictate or use voice recognition for data entry. Filling in little boxes on the screen is kept to a minimum.

"It's all about physician efficiency and productivity," said SRS Chief Executive Officer Evan Steele in an interview with Medscape Medical News. At the same time, the firm's software has evolved to the point of satisfying both stage 1 and stage 2 requirements of the federal meaningful use program.

Roughly 80% of the 6000 clinicians who use the SRS program work in high-volume, high-revenue specialty practices that value speed, Steele said. "They're a lot harder to please than primary care physicians."

To EHR consultant Jeffery Daigrepont, the ascendancy of SRS in the KLAS rankings says a lot about the competition.

"The fact that SRS is showing up indicates that EHRs are still somewhat difficult to use," said Daigrepont, senior vice president of the Coker Group in Alpharetta, Georgia. "It tells me that we have the challenge of making systems physician-friendly."

He calls SRS EHR "a great blend of structured data and paper" that flies in the face of the marketplace.

"Everybody is talking about structured data, Big Data, analytics, clinical integration, and cost-based reporting," Daigrepont said. "SRS generally doesn't come to mind as a vendor to solve those problems. But the market still supports vendors like SRS that [focus] on physician productivity."

"Nobody Is Going to Get Fired if You Go With Epic"

The preeminence of Epic in hospitals and group practices with more than 11 physicians, experts say, tells another story — that of the corporatization of medicine.

Epic gets tough competition from Cerner in the acute care market, but it is nevertheless "the IBM of its time," said David Kibbe, MD, a senior advisor to the American Academy of Family Physicians.

"The feeling is, 'Nobody is going to get fired if you go with Epic,' " Dr. Kibbe told Medscape Medical News. "They deliver a product that works."

By virtue of dominating the inpatient EHR market, Epic has become the leading vendor of EHRs for medium and large group practices. The reason? Hospitals are hiring physicians as fast as they can, and whether they like it or not, those physicians become users of Epic's ambulatory EHR for the sake of system integration.

Daigrepont said Epic's ambulatory EHR has its pros and cons but nevertheless earns high marks from hospital-employed physicians in part because they didn't pay for it.

"Your tolerance threshold of problems is lower if you're on the hook financially for the system," he said.

Athenahealth, Epic Are Tops Again in Practice-Management Software

Another closely watched KLAS ranking is for practice management systems that physicians use to schedule patient visits, send out bills, and monitor collections. Once again, the status quo prevailed in the latest Best of KLAS Awards. Athenahealth stayed on top in the categories of groups including 1 to 10 physicians and 11 to 75 physicians, whereas Epic was number 1 again in groups with more than 75 physicians as well as the hospital market.

KLAS hands out blue ribbons to a wide variety of specialized medical software. Here is a sampling of other categories.

  • Cardiology: Merge Healthcare Cardio

  • Speech recognition: Dolbey Fusion Speech

  • Radiology (ambulatory): FUJIFILM Synapse RIS

  • Computer-assisted coding: 3M 360 Encompass System

  • Surgery management: Epic OpTime

  • Oncology: Elekta MOSAIQ

The KLAS report can be purchased on the company's Web site. Physicians who complete an online survey about the medical software, equipment, or computer services that they use can look up survey data about individual vendors free of charge.

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