Surveys Differ on EHR Satisfaction Among Physicians

Mark Crane

August 25, 2015

Are physicians happy or miserable with their electronic health record (EHR) systems? The answer depends on which survey you look at, which physicians you ask, and whether the system is server- or cloud-based.

Physicians in large-group practices are having better EHR experiences, a new survey by Black Book Market Research states. More than two thirds of surveyed physicians report satisfactory experiences in the second quarter of this year. Only 8% of physicians felt that way in 2013, the survey shows. Similar gains were seen in practice productivity (from 7% in 2013 to 68% this year) and physician documentation (from 10% in 2013 to 63% now).

Small and solo medical practices also are reporting more satisfaction. Improvements in web-based EHRs have "reversed overall satisfaction from barely 13% meeting or exceeding expectations in 2012 to 81% overall contented small practice users this year," the report shows.

The Black Book survey is in stark contrast with a recent survey from AmericanEHR Partners and the American Medical Association (AMA), which found that just 34% of physicians were satisfied with their EHR systems in 2014, down from 62% in 2010. The percentage of physicians unhappy with their system stood at 54% in 2014.

The AMA survey of 940 physicians found that 72% said EHRs made it difficult to decrease their workload, 54% complained about higher operating costs, and 43% had not yet returned to their pre-EHR level of productivity.

The AMA survey also found that EHR satisfaction improves with time. Of physicians who'd used their software for 3 years of less, only about 25% reported any degree of satisfaction. But that percentage rose to 50% for doctors who've used their systems for more than 5 years.

Different Methodologies

What accounts for these nearly opposite findings between the Black Book and AMA surveys?

The AMA study focused on family physicians in small practices and included support staff and physician assistants, Doug Brown, managing partner of Black Book, told Medscape Medical News. "The Black Book survey is updated quarterly. We received 27,194 user responses in contrast with 940 for the AmericanEHR survey. There were many other significant differences in methodology," he said.

"The AMA report is a reflection of solo and small group doctors and their staffs in a narrow, year-old slice of time and specialties," Brown said. "Larger physician organizations are much more satisfied because of their resources and the offerings of larger EHR firms. Smaller practices bought inexpensive and/or free EHRs for meaningful use incentives with little or no support. That is a recipe which generates vocal, critical users.

"Large practices have staff and consultant trainers, cross-trained staff, implementation specialists, clinical [information technology] coordinators, data analysts to support EHR adoption and maximization. Small practices simply do not have the resources, or the time and sometimes interest in using the systems beyond meaningful use. Smaller practices are also much less likely to utilize the interoperability options (11%) of their systems to connect to other providers. In contrast, 62% of large practices use interoperability," Brown said.

The Black Book survey wasn't completely upbeat. It reported deep concerns and worries, especially among small practices. Nearly 40% of solo or small-practice physicians have moderate to serious concerns about the security and privacy of cloud-based EHRs. Conversely, 81% of physicians employing server-based EHR software claim they are concerned that their system, device, server, or files may be stolen or breached. Some 92% of small-practice users that switched to a cloud-based system in the last 6 months feel their chances of a major patient record data breach are lowered, but 52% report their fears of system downtime have increased since the switchover, the report shows.

Nearly 70% of small-practice physicians agree that first generation systems have not lived up to expectations, and are particularly dissatisfied with cost add-ons, affected workflows, and lost time with patients.

The Difference Between Big and Small

In a statement, the AMA defended its report. The findings are "representative and consistent with what we have heard anecdotally from the vast majority of America's physicians.

"The Black Book report also more narrowly focuses on more innovative cloud-based electronic health records. Several of the report's findings directly spotlight the barriers and strong dissatisfaction physicians find when using EHRs," the statement said.

"This includes Black Book's findings that 69% of small practice physicians agree that first generation EHRs have not lived up to expectations. Also, despite gains, 48% of small practices that switched EHRs between June 2014 and May 2015 report that the financial burden has put the practice in an unstable financial position."

The American Academy of Family Physicians (AAFP) participated in the AMA survey. Steven Waldren, MD, director of the AAFP's Alliance for eHealth Innovation, told Medscape Medical News that it's understandable that larger practices have better experiences with EHRs, echoing some of what Brown said. "They have greater resources and the ability to offload some of the administrative work from physicians.

"The lack of interoperability is a main driver of frustration with EHRs," he said. "A large practice is more likely to be involved with a hospital or integrated delivery system. The doctors who refer patients back and forth to each other are more likely to be on the same systems than a solo doctor or one in a small practice."

Most EHRs were designed as documentation models to meet meaningful use guidelines, he said. "The timelines were very short and vendors didn't have the time to think more deeply about how to integrate functions into the workflow of daily practice. So we have all these check boxes for things that should be automated. Doctors are still dealing with faxes and double entries. They have to pay for additional interfaces. That's what drives a lot of the dissatisfaction" detailed in the AMA study.

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