Having cloud-based mobile solutions for on-demand data with actionable insight into financial performance is one of the top reasons healthcare practices may be considering an EHR replacement option, a recent Black Book survey found.

Thirty percent of practices with more than 11 clinicians will likely replace their EHR system by 2021, according to the 2018 Black Book Integrated Ambulatory Systems report. Of organizations looking to make a change, 93 percent stated that cloud-based mobile solutions for on-demand data was their top priority.

Eighty-seven percent cited telehealth/virtual visit support as their key interest, while 82 percent said they wanted speech recognition solutions for hands-free data. 

Researchers interviewed approximately 19,000 EHR users, with groups and clinics varying in size and specialty.

"Traditionally, it’s been the smaller and solo practices with the highest dissatisfaction ratings for electronic health record applications but we confirmed also that the smaller the practice, the less likely they are to use advanced IT tools and that is where EHR frustration among small practices is generally focused," Black Book Managing Partner Doug Brown said in a statement.

Nearly nine out of 10 practices with six or less clinicians are not optimizing advanced EHR tools such as patient engagement, secure messaging, decision support and electronic data sharing, the report noted.

Solo physician practice systems in states of change tend to have a “wait and see” approach, the research showed. For example, both Practice Fusion and eClinicalWorks had over 93 percent customer loyalty positions in Q1 2018.

In January 2018, a Reaction Data survey showed that eClinicalWorks received an 82 percent approval rating from physician users. Fifty-three percent of respondents in that survey also said they would advocate for opting for eClinicalWorks.

The Black Book survey also found that single or solo practices reported lower numbers in either always using or frequently using electronic messaging (5 percent), clinical decision support (6 percent), interoperability/record sharing (13 percent), and patient engagement (8 percent).

Comparatively, 28 percent of small- to medium-sized practices said they always or frequently used electronic messaging, with 31 percent saying the same for clinical decision support. Twenty-nine percent always or frequently use interoperability/record sharing and 36 percent reported to regularly utilizing patient engagement.

Larger practices – with 15 or more clinicians – had the highest percentage of use for those EHR tools. Electronic messaging (82 percent), clinical decision support (84 percent), interoperability/record share (64 percent), and patient engagement (83 percent) were always or frequently used, the report found.

Epic Systems was ranked the top vendor in the Black Book report for all specialties in physician practices with 11 to 25 clinicians, while NextGen was ranked at the top for all specialties in physician practices with two to five clinicians and those with six to 10.

Allscripts and Epic Systems received top marks for physician practices (all specialties) for those with 26 to 99 clinicians and those with over 100, respectively.

Nearly all medical and surgical practices – 93 percent – of all sizes with an installed, functional system were using data repository, order entry and results review.

“When we look at apples-to-apples client satisfaction among small practices, it's about basic functionality experience," Brown explained. "While in large practices, the rating of customer satisfaction is based on that plus a much wider breadth of vendor offerings and client execution from claims management to population health bundled in."

An earlier Black Book report showed that physicians ranked specialty EHR product categories with higher satisfaction scores. Specifically, AdvancedMD, drchrono, Epic Systems, NextGen, NetSmart, Modernizing Medicine, and SIS Amkai received top ratings from Q3 2017 to Q1 2018.

Single-solution offerings, including ones that integrate EHRs, focus on revenue cycle management, and utilize coding and practice management tools will likely continue to lead the way for specialty practices in 2018, Brown stated in the earlier report.

“It’s clear that even in this tightening and increasingly complex ambulatory EHR market, specialist-centric vendors that innovate through integrated EHR, RCM, Coding and PM tools are continuing to lead the small specialist practice market,” Brown said.

“By providing a product that is a vital part of the users’ workflow, patient coordination and critical digital capabilities, independent and network-affiliated physicians can be successful in the value-based care environment through these systems.”