is free online directory that concentrates on aiding healthcare providers in EHR selection and implementation. One could compare it to the Consumer Reports of EHR – the organization collects a large amount of certified EHR data and product recommendations from providers. Alan Brookstone, MD, co-founder of AmericanEHR Partners, has a unique perspective on EHR adoption and what providers are currently looking for from their EHR.
How does AmericanEHR Partners collect data from healthcare providers?
The site is vendor agnostic, what we do is help physicians provide feedback on the vendors and products irrespective of whether they decide they want to participate on the site or not. We still collect and present that data, so any product that’s a nationally-certified product can be rated [on the site] by a physician. So what we’ve done is set the bar at the level of 10, where we don’t publish feedback unless we have a minimum of 10 verified ratings on a particular product. The reason we did this is twofold: First, we want to provide a reasonable level of confidence that if [physicians] are recommending a specific product, there’s a decent body of evidence around their experience. Anything under 10, we didn’t think it was statistically strong enough to hold up. We’ve got about 45 vendors with a minimum of 10 ratings.
How we collect the data is we work with the professional societies to survey their members. They receive an invitation from the society in conjunction with AmericanEHR Partners to come in and provide feedback – it’s an extensive survey that collects data across 150 questions. We get data on Stage 1 and are starting to collect information for Stage 2 Meaningful Use
performance. It’s going to be interesting because some of that functionality is not consistent across all products, particularly in the area of portals and the ability to provide copies to patients. We’re sort of in a collection cycle right now and, with these societies, expect to collect another 3-4,000 user experiences across the span of products. We already have 3500. What will happen is we’ll have data that extends over a 2-3 year period showing performance of the EHR market prior to meaningful use. Now you have the ability to look at data based on trends of how the products are actually performing now that meaningful use is in place compared to when [analysis] was started. And what does this mean in terms of the various specialties? It’s good to have products that are popular, but if they’re not custom for that particular specialty, then it’s not a good fit for the practice. Having lots of data, we can start slicing the data in ways that will be relevant to specific specialties.
How do you handle collecting product data tied to Stage 1 Meaningful Use from providers once Stage 2 attestation begins?
We’ll actually be collecting both; we haven’t removed anything that we were collecting [with Stage 1]. The approach that we take with this is in order to not invalidate prior data that we’ve collected, as things become less relevant, we may hide certain questions that we were previously collecting, obviously holding onto that prior data. But we’ve added in a new set of questions that speak to the meaningful use Stage 2. So we’ll be collecting [Stage 1 data on requirements], particularly from physicians that started later. But as the meaningful use experience starts to evolve to Stage 2, we’ll be collecting that data in real time as people begin to report on those requirements. We can look back at the data and look at the impact of the requirements.
Have you been able to get a general consensus from users on Stage 1 EHR software experiences and expectations for Stage 2 Meaningful Use?
I think that the users are struggling – there’s no question about that. [Providers] have to do more, there’s more administration and oversight for them around these requirements and things that they have to do to report on the requirements. One of the things that we did recently was take our satisfaction survey data and took the top 10 products based on overall satisfaction rankings and we matched it up against the CMS attestation data. And what we found was that the most popular products are not necessarily the ones that are most highly attested. The interpretation of that is products that have a high attestation level where vendors have to build a lot of functionality into products to meet meaningful use requirements. It’s happening so quickly that there’s not a lot of time to build it in so that it optimizes workflow and usability. So the satisfaction level goes down as the attestation level goes up, meaning that highly-attested products are ones that physicians aren’t happy with from a usability standpoint. We discussed this with vendors and they’re aware of this. They say they have to build these things in or they can’t meet meaningful use requirements. At the same time, it does have an impact on usability and satisfaction.
What do you think is most important to users?
– I think the primary role of a clinician is an information exchanger. They exchange information with multiple other entities (such as specialists) in order to manage patients. The users can optimize their system around data collection or the actual internal operations of the practice – you can automate processes and improve efficiency. But the interoperability is the key requirement because if you can’t move the data around, you’re on an isolated island.
How has vendor selection changed for providers?
I think what we’re seeing is two things. We’re in the middle of the first wave of adoption where individuals who have now made the jump are right around the 65 percent mark. We’ve seen that the late adopters are still reticent about selecting and watching what happens with the large middle group. What’s interesting is that the satisfaction level of users with their existing products is not very high. In our survey data, we ask “would you recommend this product to a colleague?” And only 47 percent of physicians would recommend their EHR product to someone else. Our estimation is that those who are actively looking at moving [EHR systems], we’re looking at the 20 percent mark. Those who are dissatisfied is higher than that, around 30 percent. So I think the big purchasing difference is that we’ll see a lot of people moving systems and are looking for ways to identify a more appropriate system.
Why do providers want to move between systems?
Vendors are growing incredibly fast because there’s so much money available. It’s a bit of a distorted market right now because you have many organizations with regional extension centers (RECs) that are encouraging EHR adoption. So the vendors are drinking from the fire hose in many respects; they’ve got so much coming at them. Supporting existing clients, upgrading clients to meet Stage 1 meaningful use etc… And having more than one product is tough as well. For example, Allscripts
coming out and saying that they’re going to be consolidating and will not be supporting MyWay product upgrades to Stage 2 meaningful use, there’s going to be attrition with multi-product companies.
What’s the biggest EHR challenge for healthcare providers?
Usability is a massive challenge. Just fitting it into the workflow so they can maintain their relationship between the physician and the patient and it’s supportive toward what they’re trying to do: care provision. And just behind is the data interoperability we just talked about.
Brookstone offers some interesting insight into what providers need from EHR vs. what they’ve been able to receive so far. Vendors seem to be aware that interoperability and usability are keys to driving EHR adoption. Hopefully for providers, changes start being made to the software with their needs and meaningful use requirements in mind.
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