SURVEY SAYS MU ISN T USABILITY Health IT Meaningful Usability Summit Washington DC September 11, 2012

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1 SURVEY SAYS MU ISN T USABILITY Health IT Meaningful Usability Summit Washington DC September 11, 2012 Thomas Stringham President &

2 MISSION // Cientis facilitates the adoption and use of health information technology to reduce the cost of care and improve healthcare delivery. Our online communities provide the largest and most comprehensive HIT satisfaction rating data available in North America. KEY FEATURES Verified Physician Ratings Readiness Assessment Tool Request a Proposal Research & Reports enewsletters Blogs Webinars Podcasts AmericanEHR.com was co-founded by the American College of Physicians and Cientis Technologies

3 PROVEN TRACK HISTORY // Cientis has partnerships with 21 Medical Societies representing over 720,000 licensed physicians (over 75% of the market) in the United States. American Medical Association (AMA): 225,000 Members American College of Physicians (ACP): 132,000 Members American Academy of Family Physicians (AAFP): 105,900 Members American College of Surgeons (ACS): 77,000 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

4 COMMUNITY GROWTH 15,332 14,550 15,000 13,066 13,858 12,500 10,000 8,957 10,646 >80,000 clinicians surveyed to date (ACP, ACS, AAAI, IDSA, RPA, ACR, ASCO, AOAMI, AAPA) Number of Members 7,500 5,000 7, AMA & AAFP surveys will be conducted in Q ,700+ responses from users of EHRs 15,300+ registered community members 2,500 0 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Satisfaction Rating Source: AmericanEHR.com, September 11, 2012.

5 EHR SATISFACTION SURVEY METHODOLOGY 139-question online survey conducted with members of participating professional societies 3,590 Real-time satisfaction rating data collected from physicians, physician assistants, and nurse practitioners All nationally certified ambulatory EHR products (>300) 3,500 3,000 2,500 Number of Ratings 2,000 1,500 1, GRAPH AmericanEHR.com EHR Ratings Apr May Jun Jul Aug Sep Satisfaction Rating Source: AmericanEHR.com, September 11, 2012.

6 Sample EHR Product Rating

7 EHR Top 10 Ratings

8 EHR Product Comparison

9 EHR Advanced Search

10 AVERAGE SATISFACTION RATINGS PER CATEGORY Benchmark N= Verified clinician ratings Rating Prescribing N= 2, Purchase Experience N= Order Management N= 2, Overall Usability N= 2, Implementation Experience N= 1, Satisfaction N= 2, Training N= 1, Support Experience N= 2, Billing N= 1, Interfaces N= 1, Population Management N= 1, Workflow Management N= 1,814 Satisfaction Rating Source: AmericanEHR.com, September 11, 2012.

11 TOP 10 EHR PRODUCTS BY MEANINGFUL USE ATTESTATION 1. EpicCare Ambulatory - Core EMR 16, eclinicalworks 6, Centricity EMR (Incl. Practice Solution) 4, NextGen Ambulatory EMR 4, Allscripts Professional EHR 4, PrimeSuite (Greenway) 2, atehnaclinicals 2, Practice Fusion 2, Vitera EMR (Previously Sage) 1, 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 ( September 11, 2012.

12 CORRELATION BETWEEN MU ATTESTATION AND EHR SATISFACTION (AMBULATORY EHRS) 5.0 Rating benchmark 4.5 N= Verified clinician ratings Rating N= N= N= N= N= N= N= N= N= N= 69 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 % of Top 10 Attested EHR Products are below the Satisfaction Benchmark Score of Satisfaction Rating Source: AmericanEHR.com, September 11, EpicCare Ambulatory - Core EMR eclinicalworks Centricity EMR (Incl. Practice Solution) NextGen Ambulatory EHR Allscripts Prefessional EHR PrimeSuite (Greenway) athenaclinicals Practice Fusion Vitera EMR (Previously Sage) e-mds Solution Series Attestation Records Source: Data.gov - CMS Medicare and Medicaid EHR Incentive Program, electronic health record products used for attestation ( September 11, # of Attestations: 16,697 6,580 4,759 4,584 4,298 4,298 2,174 2,007 1,782 1,712

13 TOP 10 SATISFACTION RATINGS VS. ATTESTATION SHARE , N= ,000 N= N= N= N= N= 36 N= N= 16 N= 22 8,000 N= 258 Average Rating Number of Attestations N= Verified clinician ratings 3.5 6,580 7,000 Average Satisfaction Rating 3.0 6, , ,000 Number of Attestations Praxis, Spring Charts, Meditab & Acumen aren t even in the top 18 most MU attested products 1.5 3,000 2,243 2,007 1,712 1, ,000 Satisfaction Rating Source: AmericanEHR.com, September 11, , Praxis EMR 890 Amazing Charts e-mds Solution Series MEDENT Spring Charts EHR PrimeSuite (Greenway) Meditabs IMS Clinical Acumen EHR Practice Fusion eclinicalworks Attestation Records Source: Data.gov - CMS Medicare and Medicaid EHR Incentive Program, electronic health record products used for attestation ( September 11, 2012.

14 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.

15 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

16 FROM THE FRONT LINE - PREVIOUSLY UNPUBLISHED QUALITATIVE FEEDBACK A great deal of confusion and difficulty with implementation. There were so many problems I spent a fortune on IT to help fix the problems; took about 6 months. Failure of implementation of product. 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.

17 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.

18 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. Had to manually enter a vast amount of data that did not transfer. 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. Comments from AmericanEHR satisfaction surveys.

19 WOULD YOU RECOMMEND YOUR EHR PRODUCT TO A COLLEAGUE? Yes 47% No 30% Undecided 23% Source: AmericanEHR.com, September 11, 2012.

20 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 certified products Vendors can leverage feedback by making product and support improvements