Postmortem of the Hospital Electronic Health Record Replacement Frenzy

Four years after the rush to replace inpatient EHR systems, Black Book crowd-surveyed 1204 hospital executives and 2133 user-level IT staff that withstood at least one broad EHR system switch to grasp if providers got what they bargained for.

​Black Book reviews the inpatient EHR user survey results compiled since the replacement pace heated in 2013 aside the current 2016 feedback. As the fury subdues, present satisfaction outcomes reflect on mild successes balanced with higher than expected costs, layoffs, declining inpatient revenues, disenfranchised clinicians and doubts the benefits of switching systems.


The high total cost of ownership of EHR replacements was not a barrier for some struggling hospitals to buying a new system

87% of those financially threatened hospitals now regret the executive conclusion to change systems

14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR.

“It was a risky decision as hospitals were facing the fact that they would not be back to their pre-EHR implementation patient volumes, inpatient or ambulatory, for at least another five years,” said Doug Brown, managing partner of Black Book.  “No other industry spends so much per unit of IT on the part of the business that is shrinking the fastest and holds little growth as did inpatient revenues.”  


IT Leaders and Staff differ on the impact of the EHR replacement had on their community 

62% of IT non-managerial staff claim there was a significantly negative impact on healthcare delivery directly attributable to the EHR replacement initiative

90% of nurses reported the EHR process changes diminished their ability to deliver hands-on care at the same effectiveness. 96% of nurses in the last year’s Black Book usability survey claim they had no input or inclusion in hospital EHR replacement planning activities

In contrast, only 5% of the hospital leaders responded that the EHR replacement process impacted care in any negative way

“In our experience polling, most executives will not admit they were oversold or that their IT decisions had adverse bearing on patient care,” says Brown. “On the other hand, workflow changes and productivity issues may have added to the disappointment nurses felt after being left out of replacement EHR product evaluations.”

Hospital EHR replacements cost jobs, many left by choice

63% of executive level respondents stated they, or their peers, felt in employment jeopardy through the EHR replacement process

7% of respondents at the manager level or higher claimed they or their peers were actually fired or asked to resign directly because of EHR replacement cost or productivity impacts

19% said intermittent or permanent staff layoffs were directly caused by implementation delays, cost overruns, budgets under estimated, or trained personnel unavailable.

Levels of Interoperability decreased immediately upon initiating a replacement EHR

66% of system users responded that interoperability and patient data exchange functionality declined resulting in problematic connectivity in 2016

The automatic buy-in of physicians and other clinicians for certain replacement EHR brands was exaggerated

78% of non-physician executives admit the clinical buy-in they were oversold never materialized after a replacement launched

88% of hospitals with replacement EHRs could not report any competitive advantages to attract doctors based on their new system

80% of IT staff said they felt they had to coerce network physicians into adopting replacement EHRs via the hospital IT department

About Black Book ™

Black Book Market Research LLC, provides healthcare IT users, media, investors, analysts, quality minded vendors, and prospective software system buyers, pharmaceutical manufacturers, and other interested sectors of the clinical technology industry with comprehensive comparison data of the industry's top respected and competitively performing technology vendors. The largest user opinion poll of its kind in healthcare IT, Black Book™ collects over 450,000 viewpoints on information technology and outsourced services vendor performance annually. Black Book is internationally recognized for over 15 years of customer satisfaction polling, particularly in technology, services, outsourcing and offshoring industries.

Black Book™, its founders, management and/or staff do not own or hold any financial interest in any of the vendors covered and encompassed in this survey, and Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media prior to vendor notification of rating results. Follow Black Book on Twitter at

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Source: Black Book Market Research