SURVEY SAYS… MU ISN’T USABILITYHealth IT Meaningful Usability Summit – Washington DC

September 11, 2012

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Thomas StringhamPresident & CTO@thomasstringham

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MISSION // Cientis facilitates the adoption and use of health information technology to reduce the cost of care and improve healthcare delivery.

KEY FEATURES

• Verified Physician Ratings

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Our online communities provide the largest and most comprehensive HIT satisfaction rating data available in North America.

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American Medical Association (AMA): 225,000 Members

American College of Physicians (ACP): 132,000 Members

American College of Surgeons (ACS): 77,000 Members

American Academy of Family Physicians (AAFP): 105,900 Members

American Academy of Physician Assistants (AAPA): 73,000 Members

American Osteopathic Association of Medical Informatics (AOAMI) via its parent company, American Osteopathic Association (AOA): 42,000 Members

American Psychiatric Association (APA): 38,000 Members

American Society of Clinical Oncology (ASCO): 30,000 Members

American Academy of Neurology (AAN): 24,000 Members

American Academy of Dermatology (AAD): 17,500 Members

Infectious Disease Society of America (IDSA): 8,600 Members

American College of Rheumatology (ACR): 7,000 Members

American Academy of Allergy, Asthma & Immunology (AAAAI): 6,500 Members

Renal Physicians Association (RPA): 4,000 Members

Society of General Internal Medicine (SGIM): 3,000 Members

Total Society Members: 720,500 Members

PROVENTRACK HISTORY

Cientis has partnerships with 21 Medical Societies representing over 720,000 licensed physicians (over 75% of the market) in the United States.//

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7,500

5,000

2,500

0

Jan FebMar MarApr AprMay MayJun JunJul JulSep SepAug AugOct Nov Dec

15,000

12,500

10,000

2011 2012

Num

ber

of M

embe

rs

7,673

8,957

10,646

13,066

13,858

14,550

15,332

• >80,000 clinicians surveyed to date (ACP, ACS, AAAI, IDSA, RPA, ACR, ASCO, AOAMI, AAPA)

• AMA & AAFP surveys will be conducted in Q4 2012

• 3,700+ responses from users of EHRs

• 15,300+ registered community members

COMMUNITY GROWTH

Satisfaction Rating Source: AmericanEHR.com, September 11, 2012.

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• 139-question online survey conducted with members of par ticipating professional societies

• Real-time satisfaction rating data collected from physicians, physician assistants, and nurse practitioners

• All nationally cer tified ambulatory EHR products (>300)

AmericanEHR.com EHR Ratings

GRAPH

3,590

SepApr May Jun Jul Aug

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Num

ber

of R

atin

gs 2012

EHR SATISFACTION SURVEY METHODOLOGY

3,590

Satisfaction Rating Source: AmericanEHR.com, September 11, 2012.

cientis.comSample EHR Product Rating

cientis.comEHR Top 10 Ratings

cientis.comEHR Product Comparison

cientis.comEHR Advanced Search

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AVERAGE SATISFACTION RATINGS PER CATEGORY

4.5

1. PrescribingN= 2,177

5. Implementation Experience N= 1,017

9. Billing N= 1,630

2. Purchase Experience

N= 995

6. Satisfaction N= 2,173

10. Interfaces N= 1,802

3. Order Management

N= 2,078

7. Training N= 1,240

11. Population Management

N= 1,399

4. Overall Usability N= 2,166

8. Support Experience N= 2,023

12. Workflow Management

N= 1,814

0

1.0

2.0

3.0

2.5

1.5

0.5

3.5

4.0

5.0

Ratin

g

3.813.66 3.56 3.55 3.5 3.48 3.44 3.39 3.363.36

2.92 2.83

Benchmark N= Verified clinician ratings

Satisfaction Rating Source: AmericanEHR.com, September 11, 2012.

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TOP 10 EHR PRODUCTS BY MEANINGFUL USE ATTESTATION

1. EpicCare Ambulatory - Core EMR 16,697

2. eClinicalWorks 6,580

4. NextGen Ambulatory EMR 4,584

3. Centricity EMR (Incl. Practice Solution) 4,759

5. Allscripts Professional EHR 4,298

6. PrimeSuite (Greenway) 2,243

7. atehnaClinicals 2,174

8. Practice Fusion 2,007

9. Vitera EMR (Previously Sage) 1,782

10. e-MDs Solution Series 1,712

Attestation Records Source: Data.gov - CMS Medicare and Medicaid EHR Incentive Program, electronic health record products used for attestation (http://1.usa.gov/RjVp4l). September 11, 2012.

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CORRELATION BETWEEN MU ATTESTATION AND EHR SATISFACTION (AMBULATORY EHRS)

• Satisfaction Benchmark – Average Cumulative Score for all Ratings Across all Products

• Most Frequently Attested EHR Products are Not Highest Performers in terms of User Satisfaction

• 50% of Top 10 Attested EHR Products are below the Satisfaction Benchmark Score of 3.48

Satisfaction Rating Source: AmericanEHR.com, September 11, 2012. Attestation Records Source: Data.gov - CMS Medicare and Medicaid EHR Incentive Program, electronic health record products used for attestation (http://1.usa.gov/RjVp4l). September 11, 2012.0

EpicCare Ambulatory -

Core EMR

16,697

4.0

4.5

5.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

eClinicalWorks

6,580

Centricity EMR (Incl. Practice

Solution)

4,759

NextGen Ambulatory

EHR

4,584

Allscripts Prefessional

EHR

4,298

PrimeSuite (Greenway)

4,298

athenaClinicals

2,174

Practice Fusion

2,007

Vitera EMR (Previously

Sage)

1,782

e-MDs Solution Series

1,712

3.59 N= 398

3.65 N= 258

2.76 N= 130

Ratin

g

Rating benchmark

N= Verified clinician ratings

3.39 N= 178

3.81 N= 36

3.89 N= 693.75

N= 223.41

N= 673.19 N= 171

3.19 N= 22

# of Attestations:

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TOP 10 SATISFACTION RATINGS VS. ATTESTATION SHARE

Praxis, Spring Charts, Meditab & Acumen aren’t even in the top 18 most MU attested products

0 0

Praxis EMR

4.0 8,000

4.5 9,000

5.0 10,000

3.5 7,000

3.0 6,000

2.5 5,000

2.0 4,000

1.5 3,000

1.0 2,000

0.5 1,000

Amazing Charts

e-MDs Solution Series

MEDENT Spring Charts EHR

PrimeSuite (Greenway)

Meditabs IMS Clinical

Acumen EHR Practice Fusion eClinicalWorks

Average Rating

Number of Attestations

Aver

age

Satis

fact

ion

Ratin

g

Num

ber

of A

ttest

atio

ns

4.47 N= 32

4.11 N= 55 3.89

N= 693.88

N= 433.82

N= 133.80

N= 363.75

N= 203.73

N= 163.71

N= 223.65

N= 258

6,580

2,0072,243

1,6881,712

890

24 76286224

Satisfaction Rating Source: AmericanEHR.com, September 11, 2012. Attestation Records Source: Data.gov - CMS Medicare and Medicaid EHR Incentive Program, electronic health record products used for attestation (http://1.usa.gov/RjVp4l), September 11, 2012.

N= Verified clinician ratings

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TRANSPARENCY DRIVES ORGANIZATIONAL IMPROVEMENT & INNOVATION

Social Media has changed the consumer landscape forever.

Social networks and online communities enable everyday people to publicly address organizations and brands.

Companies that are passive or reactive with social media can suffer severe backlash — they need to listen to consumers, and respond accordingly.

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REMEMBER THE IMPORTANCE OF FREE SPEECH

• The presence of a “gag clause” included by many EHR vendors in their contracts (designed to prohibit users of EHRs from sharing information about software problems outside of their organizations) currently affects the response rate for EHR satisfaction data

• Providers are fearful of litigation when asked to share their challenges with a product

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FROM THE FRONT LINE - PREVIOUSLY UNPUBLISHED QUALITATIVE FEEDBACK

“A great deal of confusion and difficulty with implementation.”

“Failure of implementation of product.”

“There were so many problems I spent a fortune on IT to help fix the problems; took about 6 months.”

“Poorly designed, not well implemented and we abandoned it.”

“Did not live up to specs that sales told us. Functionality was grossly overstated.”

Comments from AmericanEHR rating surveys.

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HALF OF EHRS SOLD ARE NOW REPLACEMENTS

• Use of electronic health records is snowballing, and so is the number of unhappy users. Half of EHR systems sold to physician practices are now replacements, up from 30% last year, according to a recent study by research firm KLAS.

• The leading reason for switching systems, cited by 44% of practices, is product issues.

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EHR MIGRATION - THE GRASS ISN’T ALWAYS GREENER

“Cost of migration from old system was significant. All support is from overseas. Language barrier is problematic . Our sales person mislead us on many issues.”

“The transfer of our old data was very poor. Staff were forced to re-enter demographic data on all patients - labs and images not transferred over for 4 months.”

“ICD-9 coding issues, E-prescribe error, Lab integration issues, migration issue, 7,000 chart duplications, EKG and PFT application failures, data migration on the wrong date.”

“Had to manually enter a vast amount of data that did not transfer.”

Comments from AmericanEHR satisfaction surveys.

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WOULD YOU RECOMMEND YOUR EHR PRODUCT TO A COLLEAGUE?

Yes 47%

No 30%

Undecided 23%

Source: AmericanEHR.com, September 11, 2012.

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5 KEYS TO ADDRESSING EHR USABILITY ISSUES AND WORKFLOWS

Providers need to share experiences openly

Tie incentive funding to mandatory product ratings

Certification should incorporate benchmarks for satisfaction

Facilitate transparency by disallowing “gag orders” for cer tified products

Vendors can leverage feedback by making product and support improvements