Most EHRs Disappoint Specialists

The vast majority of EHRs are outright failing the specialists. Is this news? Surely not to those physicians suffering EHR implementation disasters, but thanks to KLAS, we now have hard data to confirm the anecdotal evidence. It is provided in the recent KLAS report, and eloquently described by Ken Terry in his recent article in Information Week. His title, however, “EHR’s Aren’t Specialist-Friendly Enough,” underestimates the seriousness of the problem. And the problem will only get worse as more specialists rush to purchase EHRs under the pressure of impending meaningful use deadlines.

In an industry where the EHR satisfaction scores by specialty range from a paltry high of only 7.6 (on a scale of 10) for internal medicine and family practice to an embarrassing low of 5.8 for oncologists and ophthalmologists, most specialists rate their EHRs in the barely passing range between 6.2 and 6.8.

Source: KLAS as reprinted in HIStalk

Let’s look at these scores as grades—the best EHRs are only earning a C (76%); orthopedists are trying to make a go of EHRs that are squeaking by with a D (65%); and some specialists are saddled with EHRs that are simply flunking out (58%).

And these scores are averages. Assuming a normal distribution of responses (see example of bell curve for ophthalmology, below), there are many physicians who rate their EHRs considerably lower than the average—giving scores of 48%, 38%, or even lower. (Readers who are physicians know what happens to students who get a 38% on an organic chemistry final exam: dreams of medical school quickly disappear as these students are weeded out of the candidate pool!)

Of course, just as there are some specialists who rate their EHRs below the average, there are also some who score theirs at the high end of the bell curve (in the orange section). Oh, and guess where a vendor is going to take a prospective customer for a site visit?

So, what’s a specialist to do to increase the chance of EHR success? Play it safe and go with a name brand, generic EHR? Clearly not! That strategy is anything but safe. The legacy EHRs are all built to support the needs of primary-care physicians—it is no surprise that internists and family practitioners are less dissatisfied with their EHRs than their specialist colleagues are.

Here are some tips:

  • Start with the KLAS report, “Ambulatory EMR by Specialty Study 2012: Finding the Fit”, and identify those EHRs that have high ratings in your specialty.
  • Make sure that these vendors have a large network of providers in your specialty.
  • Perform comprehensive due diligence, calling physicians that you select.
  • Beware of vendor-selected site visits—these physicians should not be expected to be representative of the majority experience.

You can’t cheat when it comes to selecting an EHR. After all, it may be the EHR that gets the bad grade, but it’s you who is going to have to pay.

3 thoughts on “Most EHRs Disappoint Specialists

  1. I am a neurologist. I am now, also, a primary care physician according to the requirements of Phase 1 and, even more so, Phase 2. I can’t get the labs to interface with me (unless I start threatening) due to my specialist status. As an example, why does a neurosurgeon need to document and transmit immunization status as a requirement?

    Awaiting the Supreme Court upcoming but not betting either way.

    Additionally, 65% medication electronic prescriptions are unlikely given Medco, Perscription Solutions, Express Scripts that, at this point, use a mail order for long term perscriptions, thus subtracting from my stats.
    Sorry about the rambling.

    [from Evan Steele:]

    Meaningful use was clearly designed with a focus on primary care program, but there are features built into it to try to accommodate specialists. Some of the measures allow specialists to attest to an exclusion if the measure is not relevant to their practice. For example, since you do not provide immunizations, you do not have to document and transmit them to a registry. The same is true of syndromic surveillance, vital signs, and several other measures. Regarding ePrescribing, mail order prescriptions can be ePrescribed, so they are counted towards the required threshold (40% in Stage 1).

    That said, your concerns are valid, and now is the time to make them known to CMS as they finalize the requirements for Stage 2. They are inviting comments from all stakeholders. You can submit comments on the proposed rule at

  2. Have Apple design an EMR app. Even though Steve Jobs is no longer with us, his design philosophy is still embedded in Apple’s DNA.

  3. The success of EHR seems to be a debatable topic with many specialists holding different opinions. All in all the general performance is very poor and below average and therefore something must be done to improve this.

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