And the survey says … physicians prefer VistA

Posted on: October 31st, 2012 by Edmund Billings, MD 4 Comments
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Two recent surveys clearly show that, when it comes to enterprise EHRs, physicians prefer VistA.

In a 2012 survey by Medscape, 21,000 physicians in 25 specialties were asked to evaluate enterprise EHRs in hospital-based health delivery networks based on the following characteristics:

  1. Easy to learn
  2. Ease of data entry
  3. Overall ease of use
  4. Ease of EHR implementation
  5. Reliability
  6. Adequacy of vendor training program
  7. Vendor continuing customer care
  8. Interactivity with other office systems
  9. Value for the money
  10. Physician overall satisfaction
  11. Staff overall satisfaction
  12. Appearance/overall usefulness of the end product.

According to the results of the Medscape survey, the VA’s Computerized Patient Record System (VistA CPRS, the clinical application in the VistA EHR system) is the third most preferred enterprise health IT solution in American medicine, ahead of Epic (6), Cerner(11), Meditech(14) and McKesson(15).

http:/www.medscape.com/viewarticle/768899
http:/www.medscape.com/features/slideshow/EHR20Vista12

Similarly, a 2011 survey by the American Academy of Family Physicians (AAFP) asked physicians to compare 30 EHRs on 15 criteria. Of the enterprise EHRs included in the survey, Epic was 5th, VistA 6th,McKesson 19th and Cerner 25th. The top four were all physician practice management systems.

                  Family Practice Management May/June 2012   www.aafp.org/fpm/2012/0500/p19.html

 

But, if we dive more deeply into the AAFP survey, we see that specific questions focused on physician adoption, acceptance and quality care yielded results consistent with those in the Medscape survey. VistA is consistently preferred by physicians over other enterprise EHRs when the focus in on particular performance and adoption issues.

On overall ease of use and intuitive design, for example, VistA was 8th, Epic 11th and Cerner 29th.

Appropriately, responses to the AAFP survey’s most relevant question make the most compelling argument for VistA. When asked which available system best supports higher quality care, physicians chose VistA over all other options. Epic came in 10th and Cerner 23rd.  This result specifically reflects the VA’s primary design goal of improving care for veterans, which is now critical to Meaningful Use and real clinical transformation.

On overall satisfaction, physicians ranked VistA 4th, Epic 10th and Cerner 24th. To refresh your memory, the AAFP surveyed doctors in physician practices, and the only solutions ranked above VistA for overall satisfaction were physician practice management systems.

The results of both surveys reflect dramatic differences in EHR design goals and priorities. At the VA, VistA has evolved to improve care for veterans through ease of adoption and use. This latter point bears repeating. Because the VA is staffed by resident physicians and fellows rotating through on a monthly basis, VistA must be easily adoptable. New clinicians are given one hour of training before they hit the floors and clinics to take care of patients. They learn as they use. This is how great products are adopted.

The other leading enterprise EHRs evolved from financial / administrative systems for which design goals evolved over time.  Physician ease of use and adoption was not primary. (Some would argue it wasn’t secondary, either.)  Clinical documentation suffered from efforts to “optimize” E&M coding and charge capture.  CPOE was burdened by administrative and bureaucratic requirements.  Early adopter physicians and market competition drove feature function wars focused on covering every potential need and desire. In this unnecessarily complex, burdensome scenario, physicians often feel like clerks, pointing and clicking after hours to get their work done; many feel like EHRs make for more work, not less, and someone else’s work at that.

In contrast with enterprise solutions, EHRs for physician practices are designed to make physicians more productive by serving physician practice workflow. Products like Amazing Charts have nailed it.  VistA is the best enterprise EHR because it takes a similar approach to automating patient care and physician workflows. Having evolved VistA over the last 15 years, the VA has progressively refined a straightforward design that helps physicians get their work done.

It may run counter to conventional wisdom and industry misinformation, but according to physicians, VistA is the best enterprise EHR on the market.

Postscript:  The AAFP’s 2012 Survey is scheduled for release in Q4 2012.  Stay tuned …

4 Responses

  1. David Morf says:

    I’m glad to see your statement that “EHRs for physician practices are designed to make physicians more productive by serving physician practice workflow. Products like Amazing Charts have nailed it.” That opens the way for large-scale installations, where “VistA is the best enterprise EHR because it[is]["designed to make physicians more productive by serving physician practice workflow"][and]patient care.” The modular design behind Amazing Charts begs the question, is there an interface to link VistA with Amazing Charts to connect independent community and urgent care sites with VistA as a regional backbone?

  2. David Morf says:

    I’m thinking you, Mike Morotti, and I should talk. There may be a real window in Western Mass for access to a new high-end computing center now completing construction on top of the major N-S and E-W Internet backbone for the Northeast. Nice place to house a cloud node version of Medsphere’s solution. The aim: provide regional RHC/UCC/FQHC/Hospital pt-level connectivity (start local region, expand to state, and/or New England region, e.g., looking straight north at VT’s single-payor initiative, itself abutting NH’s Cheshire Med Cntr’s regional outreach at Keene 2020 which includes local business involvement in the medical center steering committee, but omits regional personal nudge tools from Hannaford and collaborative regional care & med mgt practices from Asheville. As a result, Keene succeeded in its community and profile outreach, but didn’t drive regional employer and medical actions for region-wide health——the keys to lifting a regional economy. Also have hospital counterparts in ME & CT. I’m building a sketch set of US FQHC & UCC franchises that may mark a path toward medical & business scale that opens two-way access between the new community walk-in world and area hospitals. Allies would be employers who could see regional population health boosting regional productivity via reductions in absenteeism, presenteeism, and labor overhead, as well as increased regional work team reliability, resilience, trainability, and output. Regional economic planners also can see daylight here — on that score, I’m in touch with the head of the largest professional assn of econ development planners employed by regional planning orgs across the US. Interested?

  3. David Morf says:

    Terse mode… envision a Medsphere cloud backbone with Amazing Charts at user sites for pt-level workflow from walk-in to primary to specialist to tertiary for regional RHC/UCC/FQHC/Hospital connectivity, care, and analytics. (Start local region, expand to state, then to corridors). FQHC & UCC/RHC franchises & primary care practices mark a path to practical, hands-on medical & business connection and scale. Self-insured employers become working allies linking community and on-site walk-in clinics with area hospitals. Why? Employers could see regional population health boosting regional productivity via reductions in absenteeism, presenteeism, and labor overhead, driving higher work team reliability, resilience, trainability, and output. Regional economic planners can see daylight here.

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