Thinking about switching to another EHR system? Think carefully about the type.

That’s what Black Book Market Research LLC is saying in a new study which found 68 percent of hospitals reevaluating the implementation of single source enterprise EHRs due to dissatisfaction among outsourced and contracted emergency physicians over their usability and functionality compared to best-of-breed emergency department information systems (EDIS).

"As hospitals and emergency room physicians grapple with intense pressure to optimize processes and with ED visits predicted to rise by double digits again in 2019, EDIS has emerged as a powerful solution to the challenges of the rapidly changing healthcare model and a key way to drive consumer engagement,” Doug Brown, founder of Black Book Research, said in a statement.

Corporate mandates for sole source EHRs have become common among EDs since 2012 with 16 percent of hospitals switching over to them.

Sole enterprise systems, however, are least preferred among emergency physicians, with 83 percent surveyed attributing dissatisfaction to lack of training, 77 percent blaming the number of screens and clicks needed to find data, and 92 percent specifying difficulty in retrieving patient information outside of regional EHR vendor silos.

Eighty percent who switched from best-of-breed or home-grown systems to single source systems report negative impacts on productivity, compared to 13 percent who saw improvement in operations, interoperability, and workflow.

Seventy-five percent saw slowdowns in patient processing workflows using enterprise EHRs, while nine of out of ten say deficits have increased tension, leading to greater medical staff burnouts in EDs and issues such as nurses or physicians blaming computer systems for delays or issues, a fact that created unsatisfactory experiences for 10 percent of consumers, according to the first quarter consumer survey of 2018.

"The increase is reportedly congesting facilities, overtaxing physicians, causing nursing shortages, and triggering descents in overall hospital patient satisfaction," said Brown.

ED managers and physicians attribute problems within the ED to the lack of EDIS usability and interoperability among providers outside the common EHR, such as retail pharmacies, primary care physicians, urgent care centers and pain management clinics.

In contrast, 86 percent of ED clinical managers see best-of-breed solutions as the best option, due to their functionality and efficiency, and improvements in customer care; while physicians rated them as better for decreasing the amount of time spent on charting patient data, with the average amount in visit time dropping from 44 percent in 2015 to 29 percent in 2018. In addition, physicians were able to see 3.4 patients per hour compared to 2.5 in 2015 due to improved workflows.

Among enterprise users, few changes were found, with charting taking up an average 42 percent of a physician’s time in 2018, compared to 46 percent in 2015. ED patient management remained the same, with physicians capable of managing 2.2 patient visits per hour on average regardless of any scored enterprise system used.

But 55 percent of the 114 CIOs interviewed say organizations favor enterprise single source solutions for their interoperability, and twenty-two percent believe that best-of-breed solutions will likely be phased out after 2022 as part of their long-term IT infrastructure strategies.

Scoring both types on the basis of 19 factors revolving around usability and functionality, the survey found best-of-breed systems to be superior in 12 of the categories. Enterprise systems scored higher only in connecting regional IDNs and network providers on the same EHR vendor system, while both held the same levels of efficiency and usability among the other six differentiators.

T-System users rated their experiences the highest in usability among ED nurses and order entries by ED physicians. Optum PICIS, Wellsoft, Cerner, MEDITECH and Allscripts also fared well.

Despite 16 percent of hospitals being moderately to highly dissatisfied with their current enterprise EDISs, 91 percent of managers and physicians report being stuck with hospitalwide, generic EHR systems due to the risk of losing funding for 2019 EDIS replacements.

By this time, hospitals hope that either will be equipped with additional features, including coding improvements, diagnosis enhancements, physicians productivity improvements, patient satisfaction, education and engagement, interoperability and connectivity for internal and external sources, and tablets, smartphone and mobile features.

"An obvious game-changer in the EDIS replacement environment is the continued development in EDIS interoperability and mobility," said Brown.

Brown did not respond for comment.