EHR Software Buyer Report – 2014

Every year, Software Advice talks with thousands of medical practices that are searching for electronic health record (EHR) software. This provides us with unparalleled insight into the needs of EHR software buyers, and thus the most common EHR software buyer trends.

We recently analyzed a random selection of 385 of our interactions from Q1 2014 (January through March) to uncover physicians’ most common pain points and their reasons for purchasing new software.

Key Findings

  1. A growing number of buyers—40 percent—are looking to replace existing EHR systems.
  2. Buyers replacing existing software are looking for integration between applications in an EHR suite.
  3. Mobile support tops the list of requested features, with nearly 40 percent of buyers requesting it.


More Buyers Are Replacing Existing EHR Software

In Q1 2010, only 19 percent of the buyers we spoke to were looking for new software in order to replace an existing EHR system. The majority of buyers were making first-time purchases, transitioning from paper-only to an EHR.

By Q1 2013, the proportion of buyers replacing existing software had jumped to 30 percent. Just one year later, in Q1 2014, that figure has risen to 40 percent—30 percent growth year over year. (Thirty-four percent of buyers are replacing only commercial EHR software, but an additional 6 percent are replacing a combination of commercial EHR software and paper.)

Percentage of Buyers Replacing EHR Software Over Time

Paper remains the most commonly used method for record-keeping among the EHR buyers we spoke to. Forty-two percent of our sample were looking to move away from being a paper-only practice.

EHR Buyers’ Current Charting Methods

However, note the yellow slice of pie, which represents the additional 6 percent of buyers (mentioned above) who were using a combination of commercial software and paper methods. These buyers demonstrate that simply adopting an EHR doesn’t always mean a practice gets rid of paper altogether. But based on the cited pain points of the buyers we spoke with, the desire to eliminate paper completely was a major driver for practices currently using a paper-software hybrid charting method.

Fourteen percent of the buyers in our sample were opening new practices, and wanted to implement an EHR from the beginning. A small share of buyers (2 percent) were replacing commercial software that was not specifically designed for medical charting. And a final 2 percent were replacing proprietary systems—software they’d designed and built themselves that was no longer meeting their needs.

Existing EHR Users Want Better Performance and Integration

We’ve established that the percentage of buyers replacing existing software is on the rise. So why are these buyers seeking new software solutions?

Among buyers replacing a commercial EHR product (including those replacing a paper/EHR combination), the most common reasons for doing so are that their current solution is too cumbersome (too slow, requires too many click-throughs, etc.), and/or that they need integration between applications (for example, wanting the EHR to integrate with billing or scheduling functions).

Reasons for Replacing Existing EHR Software

We also saw a substantial percentage of buyers concerned with complying with “government regulations.” Most commonly, this referred to the Medicare and Medicaid EHR Incentive Programs for the “meaningful use” of EHR software.

The Incentive Programs don’t technically constitute a government regulation; rather, users of EHR software who attest to meaningful use of that software are rewarded with increased Medicare or Medicaid reimbursements, while physicians who don’t attest will eventually face decreased reimbursements. In other words, there are monetary incentives and penalties, but no law is on the books requiring the use of EHRs.

However, it’s telling that many of the physicians we talk to consider the Programs to be regulatory in nature. Additionally, most of the buyers who mentioned the Programs simply touched on wanting to be in compliance; only a handful specifically mentioned wanting the stimulus dollars.

It’s also telling that so many owners of existing EHR software wanted to replace it in order to attest to meaningful use. This suggests their current systems either weren’t certified for meaningful use attestation, or weren’t allowing the physicians to accomplish meaningful use criteria tasks as successfully as they’d like.

In some cases, non-certified systems may seek certification and require users to pay to upgrade to the newly-certified version of the software, which we’ve seen prompt users to look for other alternatives (see “want to explore options” in the chart above).

First-Time Buyers Want to Improve Organization and Efficiency

Buyers purchasing an EHR system for the first time were primarily concerned with improving their practices’ organization and efficiency, with many mentions of wanting to “streamline” operations.

In close second place was the desire to comply with government regulations—again, this is mostly related to meaningful use. A minority of responses in the compliance category also referenced needing software that would help them comply with HIPAA regulations and/or assist with Physician Quality Reporting System (PQRS) reporting.

Another major factor for first-time buyers was the general desire to go electronic. This included references to the practical need to reduce or eliminate paper (there were several references to “mountains of paperwork”), as well as the higher-level desire to “join the 21st century” or modernize the practice.

Reasons for First-Time EHR Purchases

Mobile Support Tops List of Requested EHR Features

The buyers we talk to typically have an idea of what features they’d like an EHR system to include. Many mention vague preferences, such as wanting an easy-to-use system, or not needing “bells and whistles.” But most buyers also reference specific features.

The most prominent feature requested in our sample was mobile support, with 39 percent of buyers explicitly stating a desire for systems that would allow them access from tablets or smartphones.

Some of the buyers in this category expressed great urgency; others simply planned to integrate mobile devices into their practices in the future, and wanted a system that would support such a move when it was time.

Most-Requested Features Among EHR Buyers

Interestingly, when asked why they were looking for a new EHR, 28 percent of all buyers mentioned a desire to comply with government regulations—yet when asked about specific features they’d require, only 18 percent of buyers specifically mentioned wanting to evaluate EHRs certified for meaningful use (i.e., ONC-ATCB certified).

In order to qualify for the meaningful use incentive programs, EHR users must use systems that are certified by one of a handful of government-designated certifying bodies.

The discrepancy between buyers seeking software in order to participate in the incentive program and buyers who explicitly mention wanting a certified EHR system suggests that buyers may not be fully aware of meaningful use requirements. This possibility is supported by the fact that several of the buyers we spoke with had questions about or requested more information on meaningful use requirements.

Most Buyers Want New Software in Place Within 3 Months

Most of the buyers we spoke to had a fairly tight timeline for implementing the EHR solution they were looking for. Nearly a quarter of the buyers in our sample wanted to get a new system in place as quickly as within the month. One-third had a one- to three-month time frame in mind.

Altogether, 55 percent of buyers wanted their software in place within three months.

Time Frames for EHR Implementation

Another quarter of buyers had a three- to six-month outlook. Only 16 percent had a longer-term time frame.

Five percent of buyers had not determined a specific timeframe. Among that 5 percent, most mentioned being willing to wait “as long as it takes” to find the right system. This finding, coupled with the increasing percentage of buyers replacing software from year to year, suggests that very few buyers are willing to commit up front to the amount of time it may take to thoroughly evaluate a purchase.

EHR Buyers Prefer Integration

The vast majority of buyers in our sample (89 percent) were interested in EHR software that could integrate with medical billing and/or patient scheduling applications.

In other words, they didn’t just want a standalone EHR; they wanted an EHR that could facilitate practice management functionalities.

Buyers’ Integration Requirements

Only 9 percent of buyers were looking for a “best-of-breed” EHR—a standalone EHR application that does not include other applications, such as billing or scheduling. And 2 percent of buyers were open to evaluating either a standalone EHR or an integrated suite.

Buyers with a Preference Prefer Web-Based EHR Software

Most of the buyers we spoke to didn’t have a preference between software that is installed locally, on the practice’s own servers (an on-premise deployment), and Web-based software (which is hosted online, in the cloud). A full 60 percent of buyers in our sample stated no preference between these two deployment models.

However, among the 40 percent who did state a preference, buyers overwhelmingly preferred Web-based systems. Eighty-five percent of buyers with a deployment preference requested Web-based software—an increase of 14 percent from 2010, when only 70 percent of buyers wanted Web-based solutions.

Buyers’ Deployment Preferences

Demographics

Almost half of the buyers we spoke with were medical practitioners (doctors, dentists, mental health counselors, etc.). More than one-third of buyers were high-level decision-makers within the practice (for example, director or managerial level—including IT directors and managers—as well as practice owners and co-owners).

Titles of EHR Buyers

Most of the buyers in our sample came from practices with one to three doctors. Just under 15 percent came from practices with between four and 25 doctors. Only a very small percentage of buyers came from practices with more than 25 doctors.

EHR Buyers’ Practice Sizes

Conclusions

In 2009, Software Advice predicted that the Health Information Technology for Economic and Clinical Health (HITECH) Act which offered stimulus money to physicians for adopting EHR software would lead to implementation failures. In 2013 our research found that, indeed, the proportion of buyers replacing EHRs was on the rise. This trend shows no sign of slowing in 2014, with our data indicating that an even greater proportion of buyers are replacing software this year versus in 2013.

The timeframe most buyers have in mind coupled with the increasing proportion of buyers replacing software suggests this trend may continue. Most buyers we speak with are eager to get a system in place within a specific, usually fairly short timeline. Instead of rushing to implement a product and trying to make the product fit their needs once implemented, we recommend buyers allow themselves ample time to fully evaluate products and determine before purchasing whether a system adequately addresses all the practice’s needs.

Finally, our research also suggests mobile support will be a key determinant in EHR purchasing decisions for many buyers in 2014. Products that offer tablet or smartphone applications—and particularly those that also integrate with billing and scheduling—will be well-positioned to win business this year.

The detailed methodology for this report can be found here. For help evaluating an upcoming EHR purchase, email gaby@softwareadvice.com.

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