Whether an electronic health record works well or not depends who you are: The opinions of clinicians and IT staff can vary widely. But a new EHR satisfaction survey from Black Book suggests that perspective gap may be narrowing.

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Black Book Market Research's hospital EHR user poll ranks inpatient systems based on its own "crowdsourced opinion mining process." The latest report spotlights those vendors with high satisfaction scores in certification-required EHR functionalities; administrative and documentation functionalities; clinical workflow functionalities; add-on modules; accountable care data requirements and connectivity capabilities.

Those are all very different functionalities, of course, and open to very subjective experiences, depending who's using the EHR and how. But Black Book Managing Partner Doug Brown said this year's poll shows "substantial improvement in reducing the gap between hospital nursing, physician, administrative, financial and technology stakeholder satisfaction."

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For rural, critical access and hospitals under 100 beds, CPSI scored the top ranking for the fifth consecutive year, according to Black Book earning top scores for both nurse and clinician satisfaction at 90.2 percent and "technology & financial administrative satisfaction" at 95.4 percent.

For community hospitals, 101 to 250 beds, Cerner took the top spot, with 91 percent nurse/clinical satisfaction and a 94.1 percent IT/financial/administrative rating.

Allscripts was tops for the second consecutive year at hospitals with more than 250 beds, according to Black Book – besting Epic, which had scored best the previous three. Clinical users reported a 83.2 percent satisfaction rate, with 92 percent among IT and financial staff.

In the category of top vendor for health systems and IDNs – which is voted on only by CIOs and IT managers – Cerner is ranked as the best EHR for multi-hospital systems, with a 94.6 percent satisfaction rating.

Other vendors scoring well in the 2015 survey included Epic, GE Healthcare, McKesson, Meditech, Healthland, HMS, Quadramed, NextGen, Razorinsights (recently acquired by athenahealth), Prognosis and Siemens, according to Black Book.

Still, a substantial percentage of respondents are unhappy with their EHR, with one in five hospitals saying they feel "stuck" with suboptimal technology – "trapped with an EHR system that does not and/or will not meet their foreseeable organizational needs," according to Brown.

The top reasons for this, according to Black Book, include vendors overselling system capabilities or mismatching functionalities to the hospital situation (reported by 65 percent of those feeling "trapped"), vendors' inability or unwillingness meet hospitals' interoperability goals at 81 percent, and implementation costs higher than anticipated, with unexpected overruns and required add-ons to systems at 90 percent.

One bright spot, according to the report, is that nurses and IT leaders seem to be collaborating a bit more when it comes to making decisions on EHR replacements – even if the two camps have different opinions about just how much.

Some 75 percent of technology leaders and CIOs say they believe their EHR systems were selected with "significant nursing input," according to Black Book. Nevertheless, just 14 percent of nurses said clinicians’ opinions were a major consideration in the technology decisions. (In 2014, however, those numbers were 60 percent and 6 percent, respectively.)

CIOs recognize that good EHR workflow is key to happy nurses, though: 69 percent of IT leaders report an uptick in satisfaction thanks to internal, post-implementation EHR modifications in response to clinician complaints; 20 percent attribute the increased satisfaction to the updates and improved functionality of EHRs, and 10 percent to better training and comfort levels.