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:
- Easy to learn
- Ease of data entry
- Overall ease of use
- Ease of EHR implementation
- Adequacy of vendor training program
- Vendor continuing customer care
- Interactivity with other office systems
- Value for the money
- Physician overall satisfaction
- Staff overall satisfaction
- 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).
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 …