With more electronic health record systems continuing to fall short of providers' expectations, a recent report by Black Book Rankings suggests that 2013 may indeed be the "year of the great EHR vendor switch." 

From the 17,000 active EHR adopters polled, report officials found that as many as 23 percent of medical practices were dissatisfied enough with their EHR systems to consider trading up in the near future. 

"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 press statement.

And in light of Stage 2, officials say provider demands are only increasing. EHR users polled cited numerous cases of software firms underperforming enough to lose crucial market share, with vendor solutions often struggling to keep pace.

Barry Blumenfeld, chief information officer at the eight-hospital MaineHealth, is among those switching EHRs. MaineHealth is in the process of transitioning from Allscripts and MEDITECH to Epic's EHR. When describing the Allscripts Sunrise Clinical Manager system it had previously, Blumenfeld said 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. 

In regards to MEDITECH, which is a little less expensive than other leading EHRs, Blumenfeld said most physicians at MaineHealth found it difficult to use, which was not the case with Epic. 

Moreover, survey findings also indicate that many EHR vendors have been more concerned with backlogged implementations and product sales that development issues have been neglected as a priority. Most concerning to current EHR users are unmet pleas for sophisticated interfaces with other practice programs, complex connectivity and networking schemes, pacing with accountable care progress and the rapid EHR adoption of mobile devices, the survey finds.

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

The survey also revealed that some popular "one size fits all" EHR products have failed to meet the needs of several medical specialties and cannot continue to satisfy their client base with a lack of customizable or bespoke tools. 

According to a November 2012 study in Pediatrics, 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. 

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 other medical specialties, nephrologists reported the highest rate of discontent, with 88 percent saying their EHR systems failed to meet their needs. Providers in urology, ophthalmology and gastroenterology also reported high rates of discontent. 

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

With a concerning numbers of providers indicating that EHR systems have failed to meet their needs, more are considering a system switch. Some 31 percent of survey respondents indicated they were "dissatisfied enough" with their EHR to consider making a switch. 

Out of those EHR users considering a system switch, 80 percent said the solution does not meet the practices' individual needs; 79 percent indicated 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. 

After conducting phone interviews with providers, Black Book officials also revealed three red flags current users see that would deter them from switching EHR vendors. The majority (32 percent) pointed to mergers and acquisitions; 26 percent cited senior management issues; and 22 percent said declining market share/value and internal staff system training issues were of concern. 

The vendors garnering the highest customer satisfaction reviews, according to a February Black Book report include CPSI for the under 100 beds inpatient EHR category; Cerner for the 100-249 bed inpatient EHR category; Epic Systems as the top ranked EHR for academic teaching hospitals, major medical centers; and Cerner for healthcare systems, hospital chains and integrated delivery networks. 

Added Brown, "An elite group of high performance vendors will be gaining considerable market share in the next two years while competitor EHRs will have difficulty surviving the customer upheaval as is."