Acute Care EMR Usability 2013
Beyond Counting Clicks

¹ As of December 2012 from CMS website: https://www.cms.gov/

KEY FINDINGS
No EMR Vendors Have Usability Nailed Down. None of the EMR vendors scored above a 4 (on a 1–5 scale) for clinical usability, which suggests all can improve. Epic’s prescriptive implementation approach puts users furthest along the path of high usability, but has room to optimize. Cerner clients have done more on their own, but report Cerner is turning a corner with both technology and service improvements. Allscripts and Siemens offer high flexibility, but the systems require extensive effort from providers. McKesson Paragon and MEDITECH v.6 clients say their vendors are still trying to get the basics down.  
The Weight of Usability Is on the Providers’ Shoulders. Providers have assumed the bulk of the responsibility for making EMRs usable, with 86% reporting moderate to extensive effort required to configure their EMR vendor’s solution. The ability to modify Allscripts’, Cerner’s, and Siemens’ platforms is lauded, but overall, providers want more effort and direction on usability from vendors. Epic clients reported the least amount of effort needed and the best capability at the go live.  
The Stage 2 Microscope Will Magnify EMR Challenges. Stage 2 requires providers to increase usage in some of the least usable areas: physician documentation, medication reconciliation, and problem lists. While user behavior is a key factor, EMR user interfaces can either facilitate or discourage adoption. Cerner and Epic are best poised to support deep clinical usage, while clients from Allscripts, McKesson, MEDITECH, and Siemens noted more cause for concern.

 THE PROFICIENCY PARADOX
If an EMR has good usability, should it take less time for physicians to become proficient? The answer is, “Not necessarily.” Beyond mastering an EMR’s user interface, providers’ sense of proficiency often hinges on the depth of clinical functionality being used and how pivotal of a role an EMR plays in transforming care. This may be why both Epic and MEDITECH clients say it takes over a month for physicians to become proficient, but they are at opposite ends of the scale in usability ratings.
BOTTOM LINE ON VENDORS
Epic: Wins over physicians during demos. A prescriptive approach to implementation ensures go-live success. Overall deepest adoption of, and highest usability ratings for, MU functionality.
Cerner: The only vendor to improve Ease of Use scores in the last two years. Has often left usability up to providers, but with strong configuration tools from Cerner and some effort, customers are pleased with results. MPages a win. Moving toward mentoring role.
Siemens: Rollout of clinical functionality now on fast track. CPOE highly regarded. Soarian workflows provide flexibility. Customers await updates for physician documentation and problem lists.
Allscripts: Reputation as “the” physician’s EMR. Intuitive at its core, but power and flexibility sometimes overwhelming. Highly praised for ability to create custom decision support. CPOE and physician documentation among the best, but medication reconciliation deemed unworkable.
McKesson Paragon: Paragon a recent entrant for hospitals outside of the community space. Clinical functionality still maturing and basic data viewing is a challenge for some. Clients want better physician documentation and medication reconciliation. Some struggle for McKesson’s attention but see promise in pending updates.
MEDITECH v.6: Clients report good visual appeal and data viewing in v.6, but overall usability rated lowest. Many feel successful after much effort, but deep physician use (e.g., CPOE) is not yet a reality at many sites. Direct help from MEDITECH scarce, but product improvements seen on horizon.

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