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Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

Integrating With EMR Vendors Remains Difficult, But This Must Change

Posted on October 4, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Eventually, big EMR vendors will be forced to provide a robust API that makes it easy to attach services on to their core platform. While they may see it as a dilution of their value right now, in time it will become clear that they can’t provide everything to everyone.

For example, is pretty unlikely that companies like Epic and Cerner will build genomics applications, so they’re going to need to connect using an API to add that functionality for their users. (Check out this video with John Lynn, Chris Bradley of Mana Health and Josh Siegel of CareCloud for more background on building a usable healthcare API.)

But as recent research points out, some of the vendors may be dragged kicking and screaming in that direction before they make it easy to connect to their systems. In fact, a new study by Health 2.0 concludes that smaller health IT vendors still face significant difficulties integrating with EMRs created by larger vendors.

“The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors,” wrote Health 2.0’s Matthew Holt on The Health Care Blog. “Most EMR vendors don’t make it easy.”

The study, which was supported by the California Health Care Foundation, surveyed more than 100 small health technology firms. The researchers found that only two EMR vendors (athenahealth and Allscripts) were viewed by smaller vendors as having a well-advertised, easy to access partner program. When it came to other large vendors, about half were happy with Epic, Cerner and GE’s efforts, while NextGen and eClinicalWorks got low marks for ease of integration, Holt reported.

To get the big vendors on board, it seems as though customer pressure is still critical at present, Holt says. Vendors reported that it helped a great deal if they had a customer who was seeking the integration. The degree to which this mattered varied, but it seemed to be most important in the case of Epic, with 70% of small vendors saying that they needed to have a client recommend them before Epic would get involved in integration project.

But that doesn’t mean it’s smooth sailing from there on out.  Even in the case where the big EMR vendors got involved with the integration project, smaller tech vendors weren’t fond of many of their APIs .

More than a quarter of those using Epic and Cerner APIs rated them poorly, followed by 30% for NextGen, GE and MEDITECH and a whopping 50% for eClinicalWorks. The smaller vendors’ favorite APIs seemed to be the ones offered by athenahealth, Allscripts and McKesson. According to Holt, athenahealth’s API got the best ratings overall.

All that being said, some of the smaller vendors weren’t that enthusiastic about pushing for integration with big EMR vendors at present. Of the roughly 30% who haven’t integrated with such vendors, half said it wasn’t worth the effort to try and integrate, for reasons that included the technical or financial cost would be too great. Also, some of the vendors surveyed by Health 2.0 reported they were more focused on other data-gathering efforts, such as accessing wearables data.

Still, EMR vendors large and small need to change their attitude about opening up the platform, and smaller vendors need to support them when they do so. Otherwise, the industry will remain trapped by a self-fulfilling prophecy that true integration can never happen.

Building a Usable Healthcare API

Posted on August 31, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long believed that a rock solid API is going to be required by healthcare IT software companies and EHR vendors in particular. If we want hospitals and doctors to be able to accomplish everything they need to accomplish, we need APIs to connect providers to services that will better serve the patients. EHR vendors aren’t going to do everything. With this in mind, we thought that it was time to start a discussion on how to build a usable healthcare API.

On Thursday, September 8th at 3:30 PM ET (12:30 PM PT), join us LIVE in our latest Healthcare Scene interview, as we discuss healthcare APIs with the following experts:

2016 September - Building a Usable Healthcare API-Headshots
There are a lot of people who talk generally about an API, but very few that have executed it well in healthcare. CareCloud and ManaHealth are two healthcare companies that are trying to implement a health care API in the right way, so we’re excited to sit down with them to talk about their experience building healthcare APIs.

If you’ve never watched one of our live video interviews, you can watch it live on this YouTube page (includes Live Chat room as well) or just visit this post on the day of the event and watch the video embedded below:

We look forward to shedding more light on what it takes to build a high quality, usable healthcare API.

Be sure to Subscribe to Healthcare Scene on YouTube to be updated on our future interviews or watch our archive of past Healthcare Scene Interviews.

$5 million for a PMS and Revenue Cycle Management

Posted on October 13, 2010 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’d been meaning to post this for a while. It’s the news that the company CareCloud got a $5 million round of financing after their initial $2.3 million round of financing. Here’s the description of Care Cloud from the Techcrunch post:

A cloud-based app suite, CareCloud attempts to modernize the process of being a healthcare provider; physicians can use CareCloud’s web-based apps to streamline the managing of their businesses as well as collaborate with other doctors in the CareCloud’s healthcare provider social network.

The interesting part of this to me is that when I visited the CareCloud website it seems that they are basically a PMS and Revenue Cycle Management company. That seems like a lot of funding for such a niche.

The website does mention the healthcare provider social network which kind of sounds like a health information exchange, but really doesn’t give any details of how CareCloud plans to connect all these doctors together. Plus, without an EHR software or connections to other EHR software, what information are they planning to share?

I guess I’m still trying to get the vision of what $2.3 million was spent on initially and where they plan on spending the next $5 million. That’s a lot of cash if they’re just going to be a PMS and Revenue Cycle Management company. Of course, maybe they just need to spend some of that $5 million and update their website to portray what they’re really trying to do.