Small Practices Pressured while Large Practices Seem to Like their EHRs More than Ever

Earlier this year, Black Book Research announced the results of its annual ambulatory EHR user satisfaction poll. While satisfaction with electronic health records has dipped, that trend is changing, the new report suggests. In 2013, much closer to the peak of the previous federal Meaningful Use incentive push, 92 percent of multispecialty groups said they were displeased with their EHR products and vendors, but that number reversed in 2015 and approval rates continue to rise.

Larger practice user of the technology seemed to fair better in this survey. Eighty-four percent of physicians practices with more than 25 practitioners polled this year believe that their vendor is “meeting or exceeding” their expectations for EHR optimization. Also, 88 percent of administrative staff believe that they have seen improvements in the operational or financial capabilities of their practice management and EHR software.

The increased satisfaction because of integrated practice management, revenue cycle management and EHR usability drove the rise in faith users have of their systems and vendors, but interoperability is still very much a problem, Black Book reports.

Lack of interoperability with payers and other providers impacts 33 percent of providers using systems with poor connectivity. "Vendor transparency and accountability concerns are challenging clinics and practices to re-evaluate their technology relationships again," said Doug Brown, managing partner of Black Book. “The nature of integrated EHR functionality and practice management is also changing, given that Medicare and commercial payers are endeavoring on the shift away from pay-per-procedure billing to paying for value incentives for providing better care efficiently.”

“For clients financially and contractually trapped in their EHR vendor relationship, middleware is gaining more attention and favor over regional and public HIEs as middleware offers trustworthy service delivery and innovative interoperability to support providers through reimbursement reforms,” Brown added. “Notably, leading-edge EHRs are supporting large group medical practices with multiple specialties and multiple locations with real-time insights and flexible technology to help drive successful accountable care organizations.”

However, issues persist in large group practices as 29 percent of users said their vendors have failed to make major efforts to improve complex implementation and training process. Ninety percent reported a negative opinion on the ability to receive adequate customer service from offshore call centers and EHR tech support, impacting client loyalty significantly.

Unfortunately, too, is that Black Book predicts that smaller practices are and will continue to be disadvantaged in terms of health IT resources, and are expected to merge or form joint ventures to meet the challenge of value-based care and acquiring the IT infrastructure needed to support it. Black Book reported that it expects most small- and medium-sized practices to eventually join larger organizations, such as independent practice associations (IPAs), accountable care organizations (ACOs), and bigger medical groups to be successful under the coming MACRA.

The leading firms now may not be those who are yet to come. Black Book says that EHR firms with a “wide offering” of products including health information exchange, population health tools, revenue cycle management services, patient portals, dashboards and analytics are emerging as the next wave of healthcare technology leaders.

“These leading vendors are assisting their clients in assessing current practice operations to meet the demands of ICD-10, payment reform, connectivity beyond closed networks, revenue cycle management gaps, and decision support tools, and recommending effective options within the same vendor suite,” Brown said in a statement.

Scott Rupp's picture

Scott Rupp


Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.

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