With more electronic health record systems continuing to fall short of providers' expectations, a Black Book Rankings report released back in February posited that 2013 might indeed be the "year of the great EHR vendor switch." 

Thirty-one percent of the 17,000 active EHR adopters polled said they were dissatisfied enough with their systems to consider making a change, with 17 percent of them indicating they would be switching out their first choice EHR by the year’s end.

“The high performance vendors emerging as viable past 2015 are those dedicating responsive teams to address customers’ current demands,” said Black Book’s managing partner Doug Brown, in a news release announcing the report. 

And in light of the October 2014 Stage 2 go-live date, officials say provider demands are only increasing.

EHR users polled pointed to many cases of software firms underperforming badly enough to lose crucial market share as the industry evolves, with vendor solutions often struggling to keep up.

The eight-hospital MaineHealth system in Portland, Maine, is among those switching EHRs. They opted to trade out their Allscripts and MEDITECH systems for an Epic EHR. When describing the Allscripts system it had previously, former MaineHealth chief information officer Barry Blumenfeld, MD, told Healthcare IT News back in November that it was a "good product," but really lacked integration capabilities with ancillary and the departmentals. "I've been a fan of interoperability my whole life, but I have to say it hasn't gone quite as fast as we would like, and the thing that's very important about Epic," he explained, is that it integrates all workflows for seamless movement between different products. 

Providers opting to change out their systems are predominately switching to vendors like Practice Fusion, Care360 Quest, Cerner, Greenway Medical Technologies, ChartLogic, Vitera GE Healthcare and athenahealth, according to the report.

"Regularly, at least two of these eight vendors were on the short lists of 88 percent of the current replacement market buyers surveyed," said Brown, in a statement.

Report findings suggest that many EHR vendors have been preoccupied with both sales and backlogged implementations that development issues have been neglected as a priority. Most concerning to current EHR users are unmet needs for sophisticated interfaces with other practice programs, complex connectivity and networking schemes, pacing with accountable care progresses and the rapid EHR adoption of mobile devices, the report finds.

"Meaningful use incentives created an artificial market for dozens of immature EHR products," Brown said.

The Centers for Medicare and Medicaid Services have paid out more than $16.2 billion in EHR incentives as of August 2013. 

Findings also underscored the limitations of “one size fits all” EHRs, which have often failed to meet the needs of certain medical specialties.

According to a November 2012 study in Pediatrics, for instance, EHRs are especially ill suited for pediatricians, as only a paltry 3 percent of EHR systems were considered fully functional and pediatric appropriate. "Even if the pediatricians are adopting the systems, the systems they're adopting don't have the features that would really make the practice easier," said Michael Leu, MD, co-author of the study, to Healthcare IT News.

Leu cited weight-base dosing as an example. Most EHR systems don't have this capability, and in pediatrics, it's vital. "Without this capability, pediatricians would need to calculate the dosages on their own," he added. Leu's study found that pediatricians are typically one or two years behind other providers in terms of EHR adoption rates because the systems just don't accommodate many functionalities needed. 

As far as EHR systems meeting the expectations of various medical specialties, nephrologists reported the highest rate of discontent, with 88 percent saying their EHR systems were falling short. Providers in urology, ophthalmology and gastroenterology also reported high rates of discontent.

Contrastingly, a much lower number of small practice physicians (54 percent) reported that their system failed to meet their needs. 

Out of those EHR users considering a system switch, 80 percent said the solution does not meet the practices' individual needs; 79 percent indicated that the medical practice had not adequately assessed the group's needs before choosing the EHR; 77 percent of respondents cited solution design as ill-fitted for their medical practice or specialty; and 44 percent said vendors have been unresponsive to requests.