Upload
others
View
8
Download
2
Embed Size (px)
Citation preview
Physicians' Take on EHRs
Research and report by
2
Healthcare Providers: Receive all peer60 exclusive reports when anyone in your organisation participates in our research (care givers, tech & support personnel,
and leadership).
Reproduction or distribution of any part of this report without authorisation is
prohibited without consent from peer60.
Contact Chris Jensen at [email protected] for report content
distribution conditions and guidelines.
Find Out More Here
AN INVITATION TO HEALTHCARE PROVIDERS
3
Premium Content Not Included In this report• Net Promoter Scores associated with each supplier
•In depth look at most considered EHR suppliers for replacement business
•Most considered EHR suppliers by first-time adopters
•In depth look at EHR suppliers most ast risk of losing clients
•Detailed outline of top ways EHR suppliers can save “at risk” clients
4
Table of ContentsExecutive Summary
Demographics
Ambulatory Care Participants
Ambulatory EHR Adoptions
Main EHR Suppliers Among Acute Care Participants
Primary EHR Suppliers Among Ambulatory Care Participants
Damage Control - The Replacement Market
Top Physician Priorities
The Holdouts
Net Promoter Scores
Conclusion
6
7
10
13
15
17
19
24
26
29
33
5
Vendors Covered in this Report
6
Executive Summary
For years, politicians have pitched the move to EHR as some sort of magic elixir that would solve all of America’s healthcare problems. Less than a decade after the HITECH Act sought to stimulate investment into Healthcare IT, EHRs have become a regular feature of American medicine; but problems still remain.
This report subjects the EHR market to a demanding physical examination from the often ignored frontline users--physicians. We take the temperature of current customers, to see how happy they are with their supplier, send them through a full body CT scan to determine strengths (if any) and weaknesses, and even have them turn their heads and cough, to discover painful problems that are holding back this market from truly meeting real needs an EHR platform ought to be addressing.
In August 2016, we received feedback from 1,053 physicians who gave their unique perspective on the state of the market — and we determined there is nowhere for EHR suppliers to hide. Specifically this report covers:
•Prominent players in both ambulatory and acute EHR settings•EHR replacement market dynamics•How EHR suppliers can save at risk clients•Top EHR frustrations among physicians•Plans of the ever-shrinking first-time adopter market
The results are very revealing. Among other things, this report finds:
•Most physicians are highly dissatisfied with their EHR•Frustrations are driven by poor usability and lack of desired functionality•The EHR market for acute care facilities is consolidating quickly •While fragmented, Epic continues to make inroads in the ambulatory EHR market
As with all things peer60, we recognize that one size does not fit all. Accordingly, this report breaks down the results by title, organization type, size of organization, and IDN a�iliation. The result? A report with lots of information that EHR consumers and suppliers should find enlightening (and those who don’t can go back to sleep).
7
Demographics
Reports should never be a black box— you should know where our information is coming from. The following data comes from 1,053 physicians representing a wide range of facilities. Here are the percentages, broken down in a number of ways.
26%
74%
Participants by Organization Type
Acute
Ambulatory
8
Demographics Cont.Acute Care Participants
19%
11%
11%
8%
8%
8%
5%
4%
4%
3%
2%
2%
15%
Emergency Medicine
Internal Medicine
Anesthesiology
Orthopedics
Pediatrics
Surgery
Neurology
Radiology
Psychiatry
Physician Leaders
Ophthalmology
Pathology
Other Physicians
9
Demographics Cont.Acute Care Participants (by Organization size)Acute Care Participants (by Organization size)
15%
14%
27%
13%
30%
Acute Participant AffiliationAcute Participant Affiliation
74%
26%
IDN
Non-IDN
0-300 beds
300-450 beds
451-600 beds
601-750 beds
751+ beds
10
Ambulatory Care Participants
16%
11%
9%
8%
8%
6%
5%
5%
4%
4%
3%
3%
3%
Pediatrics
Internal Medicine
Orthopedics
Psychiatry
Surgery
Anesthesiology
Family Medicine
Ophthalmology
Otolaryngology
Neurology
Obstetrics and Gynecology
Dermatology
Urology
Ambulatory Care Participants by Most Common Specialties
11
Ambulatory Care Participants Cont.
67%
14%
8%
4%3% 3%
67%
14%
8%
4%3% 3%
67%
14%
8%
4%3% 3%
67%
14%
8%
4%3% 3%
67%
14%
8%
4%3% 3%
67%
14%
8%
4%3% 3%
67%
14%
8%
4%3%3% 3%
67%
14%
8%
4%3% 3%
ambulatory care participants (by organization size)
1-10 Physicians
11-50 Physicians
51-200 Physicians
201-500 Physicians
501-1000 Physicians
1001+ Physicians
12
Ambulatory Care Participants
34%
66%
Ambulatory Participant Affiliation
Hospital-owned
Independent Physician Group
13
Ambulatory EHR Adoptions
EHR Adoption
Not surprisingly, the majority of the “have-nots” in terms of EHR adoption are small clinic organizations that often believe they don’t need an EHR (or just can’t a�ord one). See below. This represents a small growth opportunity; Because lack of adoption is primarily a small practice issue, many top suppliers choose not to vie for this segment of the market.
It is worth noting that ambulatory facilities are more likely to have an EHR when they have ties to a larger hospital. That probably comes as part of the relationship, but it means a supplier might be able to find a niche in small, unattached practices.
Note: When looking at data sets showing adoption based organization size, a small percent within larger organizations does not yet have an EHR system in place. This is typically a small facility which is part of a larger health system that has not yet gone live with EHR functionality.
85%
15%
Have EHR
No EHR
14
Ambulatory EHR Adoption Cont.
75%
97% 95%100%
95% 96%
25%
3% 5%0%
5% 4%
1-10 11-50 51-200 201-500 501-1000 1001+
EHR Adoption Among Ambulatory Organizations (by Physician Count)
89% 83%
11% 17%
Hospital-owned Independent
EHR Adoption Among Ambulatory Organizations
No EHR
Have EHR
Have EHR
No EHR
15
Main EHR Suppliers Among Acute Care Participants
50%
21%
9%
4%
Epic Cerner Allscripts VistA
Primary EHR Vendors Used by Acute Participants
When it comes to acute care participants, the market leaders were probably not a surprise. Epic, Cerner and Allscripts each distinguished themselves by garnering a significant amount of support. Obviously Epic is the 800-pound gorilla in the room, but it has not been able to box out its competitors entirely. Rather, things become much more competitive in the ambulatory space.
Note: Our participants from acute facilities disproportionately represented large IDNs and other large hospitals. As such, our results here certainly understate the market of many vendors (for example, Meditech mainly caters to smaller acute facilities).
*VistA is a unique case as its focus is on the Veterans Administration and United States Military. Still, we felt its data was interesting, and so it is included in this report.
16
Main EHR Suppliers Among Acute Care Participants
59%
53%
45% 44%
55%
24%
9%
27%
16%
21%
3%6%
9% 9% 9%11%
3%6%
0%
6%
0-300 beds 301-450 beds 451-600 beds 601-750 beds 751+ beds
EHR Vendors Used by Acute Participants (by Bed Count)
Epic
Cerner
Allscripts
VistA
17
Primary EHR Suppliers Among Ambulatory Care Participants
18%
7%6%
5% 4%4%
4%3%
3% 2%
Primary EHR Suppliers Used by Ambulatory Participants
With more than 1,000 participating physicians in this study, it’s hard to argue against Epic’s dominance in the ambulatory EHR market with almost three times the installs among participants than the next closest supplier, Allscripts. We might have expected a little more balance on this side of healthcare among suppliers. This confirms, once again, Epic’s goal of total world domination (and yes, that’s some serious hyperbole on our part, but we couldn’t help ourselves).
18
Primary EHR Suppliers Among Ambulatory Care Participants
7%
6%
3%
6%
5%
3%
4%
4%
4%
22%
7%
10%
6%
3%
12%
6%
1%
1%
40%
7%
11%
4%
4%
2%
4%
4%
54%
7%
14%
7%
4%
4%
50%
5%
5%
5%
5%
70%
9%
4%
Epic
Allscripts
Cerner
eClinicalWorks
athenahealth
NextGen
Greenway
e-MDs
Practice Fusion
Ambulatory EHR Suppliers (by Physician Count)
Each of the major suppliers appear to have a presence in most if not all sizes of ambulatory organizations. Given its proclivity to work with large organizations, it’s no surprise to see Epic’s install base drop o� significantly as the number of physicians in the organization decreases.
1-10
11-50
51-200
201-500
501-1000
1001+
19
Damage Control - The Replacement Market
9%
91%
Are you actively looking to replace your current EHR (Acute Care Participants)
The market for acute EHR replacement is small, but some opportunity yet remains. As the graph shows, 9% of acute facilities are actively looking to replace their current EHR. Scores found in this study are just the industry standard with no significantly better options available (like in the airline industry)..
Given the amount of money involved in a single EHR deal, this still represents significant potential for new revenue; But the market is clearly settling down with few facilities interested in making a change in any given year.
Finally, this data also makes clear that the change at acute facilities is not being driven by the smaller end of the market. Rather, the move to change appears to be driven by average and large acute systems with over 300 beds.
Yes
No
Acute EHR Replacement Market
20
Damage Control - The Replacement Market
7% 12% 14% 9%
100%93% 88% 86% 91%
0-300 beds 301-450 beds 451-600 beds 601-750 beds 751+ beds
Acute EHR Replacement Market (by Bed Count)
No
Yes
21
Damage Control - The Replacement Market
11%
89%
Are you actively looking to replace your current EHR? (Ambulatory Participants)
Ambulatory EHR Replacement Market
As you will see later in this report, despite extremely poor Net Promoter Scores across the board for all EHR vendors (yes, even Epic), providers aren’t planning a mass exodus (as evidenced by only 11% who have plans to kick their current EHR supplier to the curb). However, if things stay as they are, physician dissatisfaction will metastasize to encompass the majority of the organization and replacement rates will almost certainly increase in coming years. We’ve said it before—physicians and other caregivers are the sleeping giants of healthcare. So all suppliers, even Epic, should be forewarned—you can only disappoint physicians and other caregivers for so long…eventually, you will pay the piper.
Yes
No
22
Damage Control - The Replacement Market
10% 14%20%
7% 11%5%
90% 86%80%
93% 89%95%
1-10 11-50 51-200 201-500 501-1000 1001+
Ambulatory EHR Replacement Market (by Physician Count)
No
Yes
23
Damage Control - The Replacement Market
10%
14%
14%
8%
14%
8%
11%
12%
9%
15%
5%
19%
13%
8%
9%
11%
13%
20%
33%
90%
86%
86%
92%
86%
93%
89%
88%
100%
91%
85%
95%
81%
88%
92%
100%
91%
100%
89%
100%
88%
80%
67%
Pediatrics
Internal Medicine
Orthopedics
Psychiatry
Surgery
Anesthesiology
Family Medicine
Ophthalmology
Otolaryngology
Neurology
Dermatology
Obstetrics and Gynecology
Urology
Endocrinology
Administration
Plastic Surgery
Gastroenterology
Rehab
Radiology
Pathology
Nephrology
Infectious Disease
Cardiology
Ambulatory EHR Replacement Market (by Specialty)
Cardiology centers appear to present the biggest replacement business opportunities with 33% suggesting they are looking for a replacement EHR.
No
Yes
24
Top Physician Priorities
22%
30%
25%
15%
6%
Alternative payment models
Patient satisfaction data Accountable care Patient portal None
Top Priorities of Acute Care Physicians
Additional Needs
Physicians have several key future needs and it’s natural for them to first look to their existing EHR suppliers for these. This set of graphs gives suppliers a peek into what they need to address next: patient satisfaction, accountable care, and alternative payment models. While there is some variation by specialty, acute facilities of all sizes seem to agree on these priorities. (Hint: It is probably time for suppliers covered in this report to forward these three items to their development teams.)
25
Top Physician Priorities Cont.
24%
21%
15%
26%
33%
28%
29%
31%
35%
23%
20%
32%
24%
26%
23%
8%
21%
20%
21%
7%
9%
13%
3%
0-300 beds
301-450 beds
451-600 beds
601-750 beds
751+ beds
Top Priorities of Acute Care Physicians (by Bed Count)
Alternative Payment Models
Patient Satisfaction Data
Accountable Care
Patient Portal
None
26
The Holdouts
34%
66%
First-Time Adoption Plans of Ambulatory Organizations
While the market for first time EHR adoption is not significant in terms of size, one third of these holdouts appear to be jumping on the bandwagon with plans to acquire an EHR in the near future. This represents about 6% of our ambulatory participants who don’t have an EHR but are seriously considering adoption.
Considering an EHR Solution
Not Considering an EHR Solution
27
The Holdouts Cont.
46%
28%
25%
22%
17%
12%11%
7% 7%
Major Obstacles for First-Time EHR Adopters (Ambulatory Participants)
As we’ve seen in previous sections, there is a definite group of providers who won’t even consider adopting an EHR and are decidedly against ever doing so. So what keeps these first-time adopters (or non-adopters, more accurately) from moving forward? Several of their reasons for not acquiring an EHR are given below. The biggest reason, most understandably, is that it’s just too expensive and has no demonstrable ROI (even with government incentives and penalties). Could suppliers find a way to make the cost and go-live worth it for providers? Stated di�erently, is there a way to lower the TCO so true ROI is identifiable, realistic, and achievable?
28
The Holdouts Cont.50%
50%
50%
38%
50%
60%
75%
50%
100%
44%
67%
100%
25%
50%
25%
8%
38%
20%
33%
75%
50%
50%
33%
33%
50%
50%
23%
13%
40%
33%
44%
25%
54%
25%
20%
33%
25%
11%
33%
50%
15%
25%
50%
25%
33%
8%
25%
25%
22%
33%
25%
23%
25%
33%
15%
25%
11%
8%
25%
25%
11%
Pediatrics
Internal Medicine
Orthopedics
Psychiatry
Surgery
Anesthesiology
Family Medicine
Ophthalmology
Otolaryngology
Neurology
Dermatology
Obstetrics and Gynecology
Urology
Major Obstacles for First Time Adopters (by Specialty)
Too Expensive
Reduces Efficiency
Unnecessary
Retiring Soon
Reduces Patient Contact
Not-User Friendly
High Switching Costs
Security/Privacy Concerns
None that Fit Our Needs
29
Net Promoter ScoresNet Promoter Score Methodology:
The Net Promoter Score (NPS) measures customer satisfaction by asking one simple question: “How likely are you to recommend your EPR vendor to a peer or colleague?” and yields results that major academic research suggests is the most accurate measure of overall satisfaction.
A Net Promoter Score is displayed as a single number by subtracting the percent of detractors (those most likely to speak out negatively about the business) from the percent of promoters (those who sing praises). Passives are tossed out of the equation as they contribute no detriment or benefit to the overall equation. The formula looks like this:
% Promoters - % Detractors = Net Promoter Score (NPS)
With scores that range from -100 to 100, it’s pretty telling that physicians are extremely unhappy with all the major EHR suppliers, as you’ll see in the next page. None had glowing NPS scores— in fact, customer satisfaction from the physician perspective among all suppliers in this study were quite the opposite of glowing. This incredibly important finding is in stark contrast to almost all of the other customer satisfaction reports out there which are primarily from the perspective of IT leadership. The only bright side to this narrative is that providers are willing to say why they are so disappointed with their current EHR solution while also o�ering a chance at redemption.
14%
24%
11% 11% 10%13% 15%
9%
40%
18%
27%
8%
19%
33% 31%27%
9%
25%
65%
48%
78%
70%
57% 58% 58%
82%
35%
Ambulatory Promoters, Passives, and Detractors
Promoters Passives Detractors
Above graph includes (not in respective order):
Allscripts e-MDs Greenwayathenahealth eClinical Works NextGenCerner Epic Practice Fusion
30
Net Promoter Scores Cont.It’s worth noting that despite what many would assume, Epic does not have the high watermark NPS score of 5. It is in significantly negative territory. Yes, it’s more than a little comical that a score ever so slightly above neutral is worth bragging about but with almost all suppliers deeply in the negative among physicians, this supplier has a little breathing room.
-45
-51
-68
-48
-24
-73
-42
-59
5
Ambulatory EHR Net Promoter Scores
Above graph includes (not in respective order):
Allscripts e-MDs Greenwayathenahealth eClinical Works NextGenCerner Epic Practice Fusion
31
Net promoter scores cont.
4%
26%
70%
5%
23%
70%
18%
29%
56%
42%
17%
42%
Acute ehr promoters, passives and detractors
Promoters Passives Detractors
Above graph includes (not in respective order): Allscripts, Cerner, Epic, VistA
32
Net promoter scores cont.Once again, it would be natural to assume Epic fares most favorably among acute care physicians compared to its competitiors, but again, this is not the case. Epic indeed has an Achilles heel—physicians.
-65 -64 -38 0
Acute ehr net promoter score
Above graph includes (not in respective order): Allscripts, Cerner, Epic, VistA
33
ConclusionFor years, caregivers’ satisfaction with clinical documentation systems has been regarded as second class perspective. While the level of importance placed on improvements to EHR systems should be #1 patients, #2 caregivers, and #3 IT leadership, it feels as though caregivers and patients take a backseat to meeting the requirements of other stakeholders.
The EHR supplier that cracks the code of frontline user satisfaction (which doesn’t exist anywhere today) will have a competitive advantage unparalleled in this segment of healthcare. Imagine a supplier that had an army of caregivers behind it, spreading the sweet, sweet message of real usability? The bubble-up e�ect would be impossible to ignore. Until then, we’ll continue to ask key questions and o�er up the findings, and hope a small piece of the message being sent by providers will be given its proper weight.
For now, the story is that caregivers are almost universally unsatisfied with their EHR system, yet they have very few expectations of anything better on the horizon, which is confirmed by a very low replacement rate. In Economics 101, this is a rare occurrence. Look at it this way: what happens when your kids spot a better tasting cereal at the grocery store? Is there any end to their incessant pleas and complaints for something better, when it’s right in front of them? Alternatively, if everything tasted like cardboard any variation will do. It’s about taste, not the tiger, ephrechaun, or even Snap, Crackle, or Pop.