The Adoption Revival of Best-of-Breed Emergency Department Information Systems, Black Book Survey

Black Book surveyed 902 emergency department administrative and nursing managers, and 611 physicians of which over half are members of ACEP.

The incongruent efficiency and functionality accounts in 2017 from hospital CIOs versus emergency medicine physicians showed that EDIS purchasing decisions were being driven by directives to adopt enterprise-wide systems for the sake of corporate interoperability, not user experience. However, when surveyed on their preferences for best-of-breed EDIS systems as compared to sole source EHR emergency department modules in 2018, Black Book reveals 68% of hospitals are reevaluating their election to implement enterprise models to achieve more urgent clinical workflow needs and consumer-centric innovations.

Outsourced and contracted emergency physicians least prefer single source Enterprise EHR modules primarily for gaps in training (83%), too many screens and clicks to find data (77%), and difficulty in receiving unique patient data outside of a regional EHR vendor silo (92%), particularly connectivity gaps with community mental health and pain management providers (89%).

"As hospitals and emergency room physicians grapple with intense pressure to optimize processes and 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," said Doug Brown, founder of Black Book Research.

Emergency medicine physicians that experienced a change in ED technologies since 2013 from a best-of-breed option or home-grown system to a single source EHR report the change in systems negatively impacted physician productivity (80%) as well as report impeded patient processing workflows (75%) and nine out of ten insist the deficits of single source EHR emergency department modules have added to tense state of  medical staff burnout in the emergency department.

13% of physicians polled using enterprise EHR modules in the ED found an improvement in operations, interoperability, and workflow after implementation and/or replacement.

Of the 114 CIOs responding, 22% say the best-of-breed solutions are not likely to be continued after 2022 as part of their long-term IT infrastructure strategies. Common corporate mandates to centralize on a sole source vendor hospital-wide are still trending to include emergency departments as 16% of hospitals since 2012 have made the replacement.

55% of CIOs surveyed state their organizations are strategically leaning toward an enterprise single source solution emphasizing overall healthcare system interoperability as the highest in priority.  In contrast, 86% of emergency department clinical managers see best-of-breed technology as the best solution for functionality, efficiency and improved customer care.

In 2018, physicians scored best-of-breed EDIS as superior at decreasing the amount of time spent they spent in charting patient data from 44% of visit time on average in 2015 to an improved 29% of visit time on average in 2018. An ED physician could reportedly manage approximately 2.5 patient visits per hour in 2015 but now report the ability to manage 3.4 patient visits per hour due to the improvements in best-of-breed system workflow improvements.

Users of enterprise EHRs with ED modules report relatively unchanged efficiency and workflow advancements of consequence over the 3 years period. 42% of physician time reported associated with patient charting in 2018 on average, has not shown much improvement as compared to 46% of physician time charting on average in 2015. ED patient management has remained the same at 2.2 patient visits per hour per clinician as manageable on average collectively of all scored enterprise EHRs.

80% of ED physicians claim the best-of-breed systems allow other advantages over Enterprise EHR modules in Q2 2018.

Best-of-breed systems receiving overall higher usability and functionality scores in 12 of 19 systems differentiators based on medical and nursing staff recommendations in Q3 2018:

Admitting and Discharge Diagnosis Support

Billing and Coding Support

Connectivity to Urgent Care Centers

Connectivity to Retail Clinics and Pharmacies

Connectivity to Telemedicine

Connectivity to EMS/Ambulance/First Responders

Ability to Shift Between Medical Conditions

Rapid Entry of Patient Data

Clicks to Complete Visit Tasks

Charting Speed

Access to Mental Health Records/Providers

Access to Pain Management Providers

Connectivity to regional IDN and network providers on the same EHR vendor system was the only feature scored higher by enterprise EHRs’ EDIS over best-of-breeds by ED physicians and nursing staff surveyed.

Physicians who stated they had used both enterprise EHR ED modules and stand-alone EDIS systems within the last 2 years also mentioned that both types of applications offer about the same level of usability and support for:

Test Ordering

Opioid Use Reporting/Closed Referral Loop Support

Risk Management and Patient Safety

Diagnosis and Symptom Support

Decreased Alert Fatigue

Result Reporting

In a Q1 2018 survey of healthcare consumers, Black Book reported an awareness of the emergency department as having a direct reflection on the entire health system’s community reputation, 10% of consumers surveyed recall having an unsatisfactory experience of the ED involving the physician or nurse blamed the computer system for delays or issues in their care. “The increase is reportedly congesting facilities, overtaxing physicians, causing nursing shortages, and triggering descents in overall hospital patient satisfaction,” said Brown.

Emergency department managers and physicians are also attributing ED complications to the lack of Emergency Department Information Systems (EDIS) usability and interoperability to providers outside the common EHR, particularly retail pharmacies, mental health providers, primary care physicians, urgent care centers and pain management clinics.

16% of hospitals with enterprise EHR emergency modules identify themselves as moderately to highly dissatisfied with their current EDIS, yet 91% of those managers and physicians claim they are stuck with making hospital-wide generic EHR systems work, and/or they have been denied budget funds for 2019 EDIS replacements.

Many of those EDIS purchases were made as part of EHR systems, some hospitals dedicated six months to two years in implementations, just to remove those systems for significant issues with patient satisfaction, physician productivity, even safety issues, according to Brown.

Hospitals employing the EDIS solutions from best of breed vendors T-System rated their experiences the highest including usability by ED nurses and order entry by ED physicians.  The survey is based on eighteen EDIS specific key performance indicators in which T-System ranked first in twelve categories. Optum PICIS and Wellsoft also scored among the top-rated vendors.

Cerner, MEDITECH and Allscripts enterprise EHR solutions fared well in the client experience poll, all surpassing several long-standing best-of-breed EDIS products in 2018. 72% of collective users of those EHR systems credit substantial enhancements in usability since 2015. 

Hospitals ranked their six (6) most desirable features in a 2019 replacement EDIS, either best-of-breed or enterprise EHR based:

Coding Improvements, 52%

Diagnosis Enhancements, 80%

Physician Productivity Improvements, 85%

Patient (Consumer) Satisfaction, Education, Engagement Tools 88%

Interoperability & Connectivity (Internal and External Sources) 93%

Tablets/Smart Phones/Mobile Features 94%

“An obvious game changer in the EDIS replacement environment are the continued developments in EDIS interoperability and mobility,” said Brown.

About Black Book

Black Book™, its founders, management, and staff do not own or hold any financial interest in any of the vendors covered and encompassed in the surveys it conducts. 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 and does not solicit vendor participation fees, review fees, inclusion or briefing charges, and/or vendor collaboration as Black Book polls vendors' clients.

Since 2003, Black Book™ has polled the vendor satisfaction across over thirty industries in the software and services sectors around the globe. In 2009, Black Book began polling the client experience of over 560,000 current healthcare software and managed services users. Black Book expanded its survey prowess and reputation of independent, unbiased crowd-sourced surveying to IT and health records professionals, physician practice administrators, nurses, financial leaders, executives and hospital information technology managers. Over 1000 users participated in the 2018 polls of EDIS client experience in a sweeping four-month set of studies. Additionally, 575 respondents that have not yet fully implemented or optimally using emergency department technology provided insight on budgeting, adoption plans, factors driving EDIS decisions and vendor awareness.

More information and survey methodology are available at

Source: Black Book Market Research LLC