The 2011 EHR User Satisfaction Survey

One of the best sessions I attended at HIMSS 12 was the roundtable on EHR user satisfaction. The session was based on a survey of 2,719 family physicians published by the American Academy of Family Physicians in 2011.

The presentation stimulated a lot of audience interaction. I think this publication is a worthwhile reference for both those in the market for an EHR and for those who are already EHR users. Only a relatively small number of physicians participated in the survey so it doesn't represent a complete analysis of the EHR marketplace. Nevertheless, a substantial cross-section of the more popular products was evaluated. Some of the findings will be discussed below.


Practice size was an important determinant of the products being used. In other words, smaller practices tended to select vendor solutions that were distinct from those utilized in larger practices. Respondees from the smaller practices also tended to be more satisfied with their EHR products than users from larger practices. The survey did not provide a definitive answer as to why this was the case. Responses to individual questions where some of the elements of usability were broken out provide a strong clue. Some factors contributing to high EHR satisfaction included overall ease of use, ease of customization, vendor training and vendor support. Among other factors studied were documentation, ordering labs and x-rays, reviewing results, electronic prescribing, patient engagement, meaningful use tools, and communications capabilities both within and outside the practice. Some of the most popular products were unknown to me. I spent several hours visiting the websites of a number of the products discussed to garner some additional insight. The time was well-spent.


The sophistication of the website design and information available was variable. The best were transparent about pricing, offered product information and demonstrations in video format, were up-front about product certification, and provided interesting information about company history and management.


Surprisingly, one of the highest rated products is available free. Advertising is the revenue source although for a relatively small subscription fee the software is available sans advertisements. This is a web-based product that is very attractive because it requires very little local IT expertise. Also, access to the EHR is available anywhere there is Internet access.


Several of the products were distinct in having robust real-time meaningful use tools and easy-to-use reporting tools needed for attestation such as reporting core and menu requirements and clinical quality measures including numerators and denominators. Several of the companies have incorporated advanced neural network concepts in their designs to facilitate documentation and improve quality of care. This is an interesting alternative to templates or dictation for documentation and patient management. One of the companies excelled at ease of delivery of care summaries in the form of the CCD. Few vendors were upfront about how they meet this meaningful use requirement. All the vendors appeared to support electronic prescribing. Some of these modules appeared easier to use than were others. It was rare to find information about health information exchange capabilities, specifically whether the Direct Project specification and associated workflows had been incorporated natively into the EHR product. This will need to change because the use of Direct is headed for a new stage 2 Meaningful Use requirement.


The most alarming conclusions of the survey were that only about 50% of users were satisfied with the systems they were using. Frank dissatisfaction was nearly 30%. Finally, just 38% agreed or strongly agreed that they would purchase their system again. HIMSS has sponsored usability workshops at previous annual meetings. I attended two years ago and learned a lot. The Office of the National Coordinator supports a group looking at usability issues also.