American EHR: Where docs blast, praise EHR vendors

At American EHR, physicians register unfiltered, anonymous swipes and compliments at EHR vendors. Out the back door, the site sells leads to vendors.

AmericanEHR.com has established itself over the past few years as a popular ratings service for EHR systems big and small. Now the site has rolled out a forum that showcases hundreds of unfiltered and sometimes brutally frank, but anonymous, comments from its physician users that would appear to put American EHR at odds with some of the same companies it does business with.

Some of the docs' frequent targets of criticism -- companies that voluntarily participate with American EHR -- defend themselves vigorously in interviews with SearchHealthIT.

To be sure, the comments on vendors ranging from Cerner Corporation at the high end to smaller companies such as Arkansas' SOAPWare, Inc. can sometimes be complimentary. But more often, they are bitter expressions of frustration about the usability of the expensive software systems and vendor support, or perceived lack of it, that undergirds them.

Under cloak of anonymity, docs let it fly

Like other public-facing businesses, EHR vendors like ourselves have to address both positive and negative comments.

Michael Lovett,
executive vice president and general manager, NextGen Healthcare

One large company's EHR system absorbed this blast among dozens of other negative comments: "Terrible program. It is defective and the vendor is poorly responsive."

Another vendor's product drew similarly withering fire among the many opinion snippets directed at it: "I'd guess that about 40% of my dissatisfaction comes from the inadequate training, but much, much more is clearly from the 'creakiness' of the system," the physician wrote.

Many, but not all, of the companies that come under criticism are voluntarily submitting themselves to scrutiny in exchange for the ability to communicate with the disgruntled users and the opportunity to buy sales leads to the docs from American EHR.

Among the 27 vendors that participate with American EHR are major industry players such as Cerner, eClinicalWorks, NextGen Healthcare Information Systems Inc., athenahealth, Inc. and AmazingCharts.com, Inc. As participants, they have the ability to communicate directly with some users and get access to special surveys.

Canadian firm teams up with U.S. medical associations

More than 100 others, including market heavyweights Epic Systems Corp. and Allscripts Healthcare Solutions Inc., don't take part, but that doesn't insulate many of them from commentary by the 25,000 physicians who site founder, Canadian Thomas Stringham, said use American EHR.

Stringham, a marketing exec and non-physician who, perhaps also ironically (given the U.S. orientation of the site), is based in Vancouver. He owns Cientis Technologies, the Web marketing company that operates American EHR Partners as a joint venture with the American College of Physicians.

To verify the identities of the physicians whose IDs are later scrubbed for the site -- to, among other things, insulate them from retaliation, Stringham says -- site administrators tap into the American Medical Association's (AMA) physician master file by agreement with the AMA.

Stringham says he is agnostic about the vendors and strives to keep the forum and ranking systems the site was already known for as transparent and neutral as possible. He said he's never been presented with comparisons to Yelp or Angie's List, the popular consumer guidance Web services.

But "I have heard comparisons to Consumer Reports," Stringham said. "We're very much about collecting data and doing rankings. This information doesn't exist anywhere else."

EHR technology itself could be the real target

Stringham acknowledged that the attitudes of the physicians who register comments on the site -- who tend to work in solo and small practices -- about technology in general and meaningful use and attestation requirements in particular could be colored by resistance to government regulation and the challenge of adopting new technology.

"A lot of doctors feel like they've been turned into data entry clerks and a lot of the information is being used for insurance and billing rather than patient care," Stringham added. "There's definitely a growing number of practitioners who have decided it's not worth it."

But Stringham is convinced that his physicians' unmediated views are valuable to his vendor clients. The feedback, while often unpleasant, is useful, he says.

EHR vendors respond

While speaking up for themselves, vendors tend to agree.

In an interview with SearchHealthIT.com, Stephanie Keene, vice president of strategy and marketing for EHR vendor e-MDs, a popular object of the physicians' scorn, said she listens to what they have to say.

At the same time, Keene noted that e-MDs sells largely to ambulatory care providers that are often small operations without the capital to fund full-on training programs that could make using the technology easier. One way the company deals with this with programs such as free weekly training webinars.

Keene also pointed out that the e-MDs Solution Series platform ranks among the highest in the American EHR's attestation rankings.

"We take the voices of this feedback very seriously, both the rankings and the commentary," Keene said. "Physicians are struggling with meaningful use and struggling with pay for value as well.

"But looking at the comments, which are overwhelmingly negative, what it comes down to is that training is key and physicians can only absorb so much," she continued. "Our clients are not shy. We hear from them all the time."

In an emailed statement, Michael Lovett, executive vice president and general manager for NextGen Healthcare, said his company also values the feedback, whatever its tenor. He said NextGen also solicits commentary from its more than 3,500 clients through regular surveying.

"Like other public-facing businesses, EHR vendors like ourselves have to address both positive and negative comments made [in] online reviews or any other facets of communication. No matter how great a company's products or services are, there will be those individuals who are simply not happy with their purchase," Lovett said. "[As outlined in the RAND Health report], electronic health records are a source of both promise and frustration across the board and physicians' views of electronic health records are still mixed despite widespread adoption."

That sort of attitude is what Stringham says he expects from vendors who put themselves out before his hyper-critical audience. "My participating vendors on the site, they can respond to concerns about the product and they can reach out," he said. "We don't just want to be a bulletin board where users post and vent, but usability issues rise to the top.

"We're a conduit, and we're basically able to glean real user experiences and deliver them to an extensive level of EHR executives," Stringham added.

Let us know what you think about the story; email Shaun Sutner, news and features writer, or contact @SSutner on Twitter.

Next Steps

Patient review sites have physicians looking over their shoulders

Back to school? How physicians could benefit from analytics-derived report cards

Crowdsourcing medical opinions expands treatment options

This was first published in July 2014

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