If physicians overwhelming prefer the VA’s EHR, then why is adoption outside the VA so low? Dr. Edmund billings shares his insights.
Let’s start simply with the results. The questions will come later.
In their 2014 EHR Report—a survey of 18,575 physicians on their EHR preferences—Medscape concludes that doctors like using the VA’s Computerized Provider Record System (CPRS), the core electronic record in the broader VistA platform, more than any other solution.
Here’s what they said.
The highest-rated EHR, with a score of 3.9, is the Veterans Administration EHR: VA-CPRS. It’s regarded as one of the best overall by our physician respondents.
(Of course, Medscape said a great deal more than this about CPRS and EHRs in general. And their survey revealed much about how physicians view the use of EHRs and the vendors who provide them. I would encourage anyone who’s interested to look at the report in more detail.)
With regard to physician satisfaction, Epic finished in 8th place, Cerner was rated 15th best and Meditech 18th. Scattered among these enterprise solution providers are practice-based EHR vendors like Practice Fusion, Amazing Charts, Medent and eMD’s.
So, why is VistA CPRS the preferred choice? In a word, design. The VA built the system with two design goals: improved patient care and rapid adoptability. Physicians at the VA rotate through services and the system has to be adoptable with minimal (2 hours) training; they learn it as they take care of patients.
Other studies confirm that physicians find VistA CPRS “straightforward” to use. Because it was designed to take better care of patients, doctors can see how the system directly and positively impacts clinical care, which is not the default product of EHR use.
A summary of categories in which VistA CPRS was rated number 1 among enterprise solutions illustrates how well the VA did in meeting physician needs.
#1 – Ease of data entry
#1 – Physician satisfaction
#1 – Staff satisfaction
#1 – Overall usefulness
#1 – Usefulness as a clinical tool
#1 – Connectivity
#1 – Reliability
#1 – Practice Situation: Hospital Network
#1 – Practice Situation: Independent
Maybe you’re wondering how a government-derived software system could be more highly rated than private sector alternatives. As mentioned above, the VA’s goals are to develop a system that improves care for veterans and is easy to learn. Contrast that with the natural overarching goals of proprietary EHR providers, which is to automate the enterprise and make money.
Complex systems require extensive and expensive training, and certification courses. They create dependency on an omniscient vendor for support and development. And most enterprise systems started as administrative departmental applications and then morphed to incorporate the clinical side. Ease of use and patient outcomes were not primary concerns in their design.
Importantly, proprietary enterprise systems are also not easily interoperable, and even if they can be, proprietary vendors would often rather they not, thank you very much.
VistA CPRS was rated best for connectivity, “scoring 4.0 or better in all domains measured.” The Medscape report also comments on the growing importance of connecting physicians to improve care coordination.
Connectivity becomes increasingly more important as concepts of “care coordination” take hold, and also as hospitals and private practices work to make their operations more efficient … According to the Office of the National Coordinator for Health Information Technology (ONC), only a minority of physicians with EHRs from different vendors are exchanging clinical summaries of patient visits with other physicians.
So, if VistA is the preferred choice, why is adoption of VistA-derived systems outside the VA so low? One explanation is lack of awareness. How many hospitals and clinics know that VistA code is public domain and available without expensive license fees? That private companies are succeeding by offering development and support for VistA-based solutions?
Of course, the other explanation is that decision makers think the success of VA VistA is irrelevant—that it’s a nice story and good for veterans, but ultimately of little use in the non-federal healthcare sector.
This is simply untrue.
Well, for large academic medical centers and cash-rich nonprofit (cough, cough) healthcare systems, it may be true. I mean, who would ever stand in the way of a hospital’s right to overpay for Epic?
But most of American healthcare—independent and resource-challenged hospitals and clinics that dot the landscape and serve the most needy—does not live in that world. To increase efficiency and lower costs, America needs an affordable, customizable and robust solution that can interface with just about anything, including Epic.
As the Medscape report makes clear, there is really only one system that meets those requirements. Given the high level of dissatisfaction with EHRs, especially among physicians, and how difficult it is to realize health IT transformation in any organization, there is wisdom in adopting a system that minimizes opposition.