Each year, Software Advice speaks with thousands of medical practices looking for the right electronic health records (EHR) software. This provides us with unmatched insight into the needs of EHR software buyers.
We recently analyzed a random selection of these interactions to uncover the most common EHR software buyer trends, including physicians’ most common pain points and reasons for purchasing new software.
These findings will help guide the decisions of buyers in the market for an EHR solution.
- The number of buyers replacing existing EHR software has increased 59 percent since 2014—implying that many EHR products are failing to meet physicians’ needs.
- Billing is the top-requested application for the highest percentage of EHR buyers (45 percent). This could be due to the upcoming transition to ICD-10 codes, as 92 percent of buyers do billing in-house.
- Buyers in our sample most often request functionality for tracking patients, customizing templates and enabling regulatory compliance—capabilities other EHR buyers should consider.
EHR Software Buyer Trends and Benefits
Business is booming for many EHR vendors: Analysts predict sales of these systems will reach over $35 billion by 2019. This is largely thanks to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. HITECH offers federal stimulus money to practices that implement EHR systems—and penalizes those that don’t use the software by reducing their Medicare reimbursements.
EHR adoption rates may have gotten a big boost from Uncle Sam, but that’s not the only reason these systems have proven popular.
According to Software Advice’s 2014 EHR UserView report, 87 percent of clinicians believe the software makes patient records easier to access, while 85 percent say it makes those records easier to interpret.
Here are some other key EHR benefits available in many systems today:
EHR Functionality That Supports Care Improvements
Once a provider has decided to take advantage of these benefits, the process of selecting an EHR system begins. This report can help buyers by revealing what clinicians commonly look for in new software, the pain points associated with their current methods and tips for narrowing down the best system.
59% More Buyers Replacing Existing EHR Software in 2015
When buyers contact us, we determine whether they are purchasing an EHR for the first time or replacing an existing system. In 2014, 40 percent of buyers were already using EHRs, either on their own or in combination with manual methods (e.g., using paper charts for patient records and EHR software for billing).
This year, 60 percent of buyers are already using EHRs, either solely or along with manual methods: a 59 percent year over year increase.
It’s important to note that, in the six years we’ve been studying EHR buyers, 2015 marks the first time that the amount of clinicians looking to replace an existing EHR outnumbers the amount of clinicians looking to purchase an EHR for the first time.
Back in 2010, a full 63 percent of buyers were looking to replace paper methods—but in 2015, that number has dropped to 37 percent.
2014 vs. 2015: Buyers Replacing EHR Software
Five-Year Retrospective: Buyers Replacing EHR Software
It’s encouraging to see the proliferation of practices going electronic. On the downside, however, these findings also imply that a growing number of physicians are dissatisfied with their current EHR. Indeed, health economist and advisor Jane Sarasohn-Kahn, author of industry blog Health Populi, says frustration with a system can start as early as day one.
“Implementation is really the hardest part, because it’s so disruptive to the workflow,” she says. “It’s the job of the vendor to allocate as much passion, research and design to implementation as they do to a product release.”
That’s why buyers—especially first-timers—should explore product reviews written by real EHR users, paying special attention to feedback about the vendor’s customer support, to ensure their practice will be properly supported during the transition. (Here’s a list of EHR products you can sort by the number of reviews they’ve garnered on our site.)
Some practices don’t realize until the implementation process has already begun that their new system is bound to clash with their workflow—as was the case for Washington state practice Spokane Ears, Nose, and Throat.
When purchasing their EHR, system administrator Chris Youseph reports, the vendor promised the practice that customizations would be easy to implement. It was only after implementation that they realized making even minor changes to the EHR’s templates wouldn’t be possible until the next software update.
To minimize workflow disruptions, practices should consider a “workflow redesign.” This involves documenting all current processes for carrying out clinical and administrative tasks, then mapping out how those processes will change once health information technology (IT) is introduced.
The government has compiled a list of free resources for this purpose, including templates to help clinicians visualize EHR-related changes from check-ins to charting.
Nearly Half of Buyers Rely Solely on Existing EHR Software
In our interactions with buyers, we ask what methods they are currently using to handle operations. The highest percentage of buyers in our sample (44 percent) rely solely on commercial EHR systems, while 21 percent use only manual methods, including paper.
Prospective Buyers’ Current Methods
As Sarasohn-Kahn points out, the fact that the majority of our sample consists of solo and small providers (see “Demographics” section below) explains the large number of paper-only practices.
By comparison, according to a Healthcare Information and Management Systems Society (HIMSS) executive, only 6 percent of U.S. hospitals still use paper records.
For the nearly half of buyers replacing an EHR, the hard-learned lessons of others can help them avoid choosing the wrong system twice. Utah pediatrician Joseph G. Cramer, for example, cautions buyers to pay close attention to a product’s design.
The system his practice purchased was geared toward obstetricians, so his colleagues would have to click past too many irrelevant screens and templates to get to the ones that were pediatrician-specific.
On the other hand, sometimes a practice must replace its EHR even if the staff is perfectly happy with it. Some buyers noted their vendor had recently merged with another company or gone out of business: A common occurrence in this market.
As we pointed out in Software Advice’s 2014 EHR Meaningful Use Market Share report, it is notoriously fragmented, with five of the top 10 vendors claiming a market share of less than 3 percent each. Thus, buyers should try to choose a reputable vendor that has established trust and staying power.
For further guidance, The American Health Information Management Association put together a checklist of factors that indicate whether a vendor is likely to stick around:
- Good reputation and history (e.g., longevity of the company and its products)
- Ability to provide a list of current customers and references
- A percentage of research and development reinvested into the company
- Frequency of software product updates (at least one update a year is the American Academy of Family Physicians’ recommendation)
- Customer support availability
- CCHIT certification status
Billing Is the Top-Requested Application
Drilling down into the specifics of what buyers in our sample seek in new EHR software, 45 percent are interested in billing applications. These can help staff post payments, verify patients’ insurance coverage, provide reports on collections and more.
Only 8 percent use third-party medical billing services. Some of these buyers specifically say they want to purchase an EHR with billing applications so they can bring the process back in-house.
More than one-quarter (27 percent) of buyers request a claim support application. This allows practices to submit and manage claims electronically and ensure all medical services have been properly coded to maximize insurance reimbursements.
Patient scheduling is the third-most requested application, requested by 23 percent of buyers.
Prospective Buyers’ Billing Practices
It’s not surprising to see billing and claim support applications top this list. That’s because starting Oct. 1, 2015, the U.S. health care system will require providers to employ a new set of codes used in the billing process to classify patient diagnoses, diseases, symptoms and more.
These codes, known as ICD-10, come from the World Health Organization (WHO), and are already in place in more than a dozen countries, from Canada to Korea.
ICD-10 is significantly more complicated than ICD-9—the set of codes currently in place. Whereas ICD-9 features 17,000 codes, ICD-10 has more than eight times that amount. It is expected to be a difficult and costly transition, estimated to come out to $3,430 per physician in manuals, training, software upgrades and testing.
Indeed, the need for software with billing and coding applications that can help with ICD-10 preparation is specifically mentioned as a primary purchase driver by several of the buyers in our sample. This is in line with market trends, as a recent athenahealth study found 83 percent of practices are worried about ICD-10.
And with good reason: There can be significant consequences to being underprepared. When Canada implemented the new codes, for example, its medical coders saw a 23 to 50 percent drop in productivity due to the added complexity. Fortunately, EHRs can ease the switch through ICD-related functionality, such as clinical documentation templates.
Patient Tracking, Customizable Templates Are Most-Requested
Speaking of functionality, 28 percent of our sample are looking for software with patient tracking capabilities, which includes monitoring assessments, treatment plans, progress notes and initial evaluations. Its popularity is likely a result of two primary factors: the desire to leverage patient data, and the need to prepare for value-based reimbursement models.
“Simply moving patient records from paper to digital formats is not enough,” says Sarasohn-Kahn. “Clinicians need to manage and mash up the data in new ways to get to population health management.”
While there is debate over the actual meaning of the term “population health management,” it is often described as a study of health determinants that describe the quality of care individuals in a group of patients receive.
According to the Institute for Health Technology Transformation, population health management’s goal is to keep patients as healthy as possible by minimizing the need for expensive interventions, such as emergency room visits, hospitalizations, imaging tests and procedures.
EHRs can assist with this through functionality that helps track patient progress, prevent health issues and treat problems.
Indeed, Sarasohn-Kahn says a practice’s bottom line will increasingly depend on meeting population health management objectives. The Department of Health and Human Services is currently “testing and expanding” new health care payment models that reward “value over volume”—meaning the focus will increasingly be on quality of care, as opposed to current models, where most physicians are paid per service.
EHR experts say that the functionalities that contribute to population health management correspond with those buyers request: Patient tracking functionality can automatically message patients when they are overdue for preventive or chronic care visits.
And reporting functionality (requested by 20 percent) allows clinicians to run queries on patient data to determine which are at risk for chronic illnesses, or run reports on hospital readmission rates over time.
Another top request, cited by 25 percent of buyers, is for customizable templates: pre-filled forms and information sheets that providers can tailor to particular patients, procedures and conditions. The importance of these cannot be overstated: A UC Davis study found that EHR-related productivity losses could be mitigated by choosing a system with specialty-specific templates.
A further 25 percent of buyers seek functionality that enables regulatory compliance. This can refer to mandates, such as the government’s “meaningful use” requirements (what eligible providers must attest to in order to receive the HITECH Act funds for EHR adoption), as well as federal privacy and security laws.
Such compliance-enabling functionality includes EHR access logs, which can help clinicians comply with privacy laws by tracking unauthorized access to patient records.
Dislike of Current System Is Top Driver for Shopping Around
Drilling down into buyers’ motivations for seeking new software, nearly one-quarter (24 percent) say it’s because their current system is too cumbersome or faulty. Meanwhile, 20 percent say they need an EHR for opening a new practice.
Top Reasons for Purchasing Software
We hear a lot of feedback from unsatisfied EHR users, whose pain points include that their current system “takes tons of clicks to get through,” “is not intuitive” or “keeps crashing.” Sarasohn-Kahn says this is partially because clinicians are becoming more discerning shoppers as their experience with EHRs grows.
“We’re in the beginning of this trend toward lighter, better-designed EHRs with frameworks that facilitate patient engagement,” she says. “Systems will have to be more nimble, patient-focused and interoperable.”
Indeed, government-funded researchers are attempting to simplify EHR systems by developing a health IT platform with substitutable applications constructed around core services, Sarasohn-Kahn says.
While this is not expected to hit the commercial EHR market any time soon, due to the amount of “challenges and questions” researchers must address, this model is spurring further innovation in the industry. In 10 years, she says, EHR systems may look completely different.
In another notable result, 13 percent of buyers seek a system that is compliant with government regulations: a leading purchase driver in Software Advice’s 2014 EHR BuyerView.
Clearly, many practices want a piece of the more than $30 billion in incentives the Centers for Medicaid and Medicare Services (CMS) has already paid eligible practitioners for going paperless.
But before making a purchase, buyers are advised to check product offerings against the CMS’ current list of “core and menu measures” to ensure their new system is compliant.
One practice manager we spoke with summed up the significance of regulatory compliance: “The doctor is worried because our current vendor doesn’t have meaningful use certification, and he’s frantic that he’s not going to qualify for any [incentives payments].”
With EHR replacements on the rise due to system shortcomings or company closures, buyers are becoming more savvy and selective in their purchase decisions, seeking user-friendly, easily customizable alternatives. Nevertheless, there are four key elements clinicians must consider if they are to make the best choice for their organization:
⇒ Functionality. Buyers want features that allow them to make the most of patient data and practice population health management. Patient tracking and robust reporting tools make an EHR more than just a means for digitizing paper records. Thanks to the upcoming ICD-10 transition, practices are also paying special attention to billing applications that will help office staff collect the proper reimbursements.
⇒ Ease of use. While an intuitive interface is a must for any buyer, usability is especially important to dissatisfied EHR users who have been struggling with a “cumbersome” system. Buyers should ensure their product’s design is suited to their specialty, and that it will minimize workflow disruptions and help maximize care quality.
⇒ Regulatory compliance. Since 2009’s HITECH Act, we’ve been tracking the influence of incentive payments on EHR adoption. Based on this year’s data, that influence remains strong. Buyers should always ensure a vendor is ready, willing and able to comply with the latest stages of Meaningful Use by ensuring products meet the CMS’ criteria.
⇒ Outside opinions. Whether it’s reading EHR user reviews on our website or joining a physician social network (e.g., Doximity or Sermo), it’s very important for buyers to seek the opinions of their peers when evaluating a product. With so many EHRs out there, doctors are eager to share their experiences so others can avoid making the wrong choice.
The largest percentage of buyers in our sample represent doctors or practitioners (34 percent), managers or directors (25 percent) and owners or co-owners (21 percent). More than half of buyers are in a solo practice.
The greatest percentage of our buyers’ time frames for implementation are between one and three months (51 percent).
By Job Title: Prospective Buyer Size
By Number of Employees: Prospective Buyer Size
Our advisors regularly speak with buyers who contact Software Advice seeking new EHR management software. The data used to create this report was collected by our advisors during those interactions for business purposes, rather than for market research. We randomly selected 385 interactions (unless otherwise noted) from U.S. buyers during Q1 2015 to analyze this report.
These findings exclusively represent those buyers who contacted Software Advice for guidance on software selection and may not be indicative of the market as a whole. Expert commentary solely represents the views of the individual. Chart values are rounded to the nearest whole number.
If you have comments or would like to obtain access to any of the charts above, please contact firstname.lastname@example.org.