Want to talk big-ticket purchases? Those behemoth electronic health record systems so many hospitals and medical practices have rolled out in recent years are easily near the top of the list.

According to data from the Office of the National Coordinator for Health IT, in fact, health organizations can expect to spend up to $70,000 per provider on EHRs.

The 24-hospital Sutter Health in California has paid out more than $1 billion for its EHR. The 38-hospital Kaiser Permanente has invested a whopping $4 billion for its system.

But while providers spend so many many millions – or billions – to purchase, implement and maintain these massive health IT products, reviews and rankings of how well they actually work can often be difficult to find.

How interoperable is the EHR with mobile devices? What about with billing systems? On the user end, how would you describe the user experience? Is it easy to navigate and use?

Then there's the support piece of it all. EHR rollouts not only require serious financial investment, but they also can present huge workflow and training issues, diverting time and attention away from the other IT projects. Healthcare organizations need their EHR vendors to be available for not only installation support but also ongoing platform support.

HIMSS Analytics tracks EMRAM progress, worksite installations and health IT RFPs. But there's very little data on user satisfaction.

So we took our questions to the people who know more than a little something about EHR platforms – our readers.

Specifically, we reached out to those in IT management, physicians and clinician end-users who are actively involved with EHRs. We wanted to hear strictly from individuals working in hospital, health system and ambulatory settings, so we eliminated consultants, payers, ancillary providers, students and vendors from our list. By using the HIMSS Enterprise Unified Database, which is verified through a variety of opt-in channels – newsletter signups, print subscriptions, event registrations, target list acquisitions – we sent this survey to those who could offer the most relevant and valued insight.
The 396 individuals we heard back from didn't hold anything back. We heard their biggest gripes with their EHR platforms, features they'd like to see improve. We also heard what makes them most satisfied about their EHR vendor. We asked our readers to rate their EHR vendor across nine different metrics, from one to 10, in addition to two open-ended responses on vendor limitations and positive features.

The nine metrics ranked in the survey include: EHR/visual appeal; user experience/ease of use; interoperability with medical devices; interoperability with other clinical systems; interoperability with billing systems; quality of installation support; quality of support for ongoing operations; downtime; and overall satisfaction with the product. For the first time around, we're focusing specifically on vendors, not individual products or versions.

All EHR vendors with a limited number of user reviews – 12 or fewer – were excluded from our list, which brought us to a total of nine EHR vendor companies included overall.

See what EHR Satisfaction Survey respondents had to say here

The big takeaways? Well, according to respondents, Epic is the all-around best – in every category our readers rated. Overall satisfaction with Epic averaged to 8.1 out of 10.0. The Verona, Wisconsin-based developer may have lost its bid for the Department of Defense's multi-billion-dollar EHR modernization project, but its customers are, for the most part, satisfied with the product – more so than customers of any of the other eight vendors we included on this list. Epic currently has just over 20 percent of the hospital EMR market share, according to data from HIMSS Analytics, edging out MEDITECH by fractions of a percent.

Infographic: EHR Satisfaction Survey overall results

Other overall high performers included eClinicalWorks, billed as the largest cloud-based EHR in the U.S., which earned the No. 2 spot. Both Allscripts and Cerner tied for No. 3 overall.

And the lowest rated? That designation went to Siemens, averaging an overall satisfaction score of 4.1. It's no surprise, really, and considering Cerner acquired the health IT business unit of Siemens last summer, in a deal valued at $1.3 billion in cash, there's some serious opportunity to improve customer satisfaction.

Now, we'll break it down by three categories to drill down even further into the numbers. Each of the three categories has multiple sub-categories that go into the overall number.

Interoperability
This is a big one. And our survey respondents had a lot to say about it.

For all the talk about Epic's lack of interoperability lately, its user ratings placed the vendor at the top of the list, with an average interoperability rating of 7.2.

Its highest marks under this category were for medical device interoperability at 7.4, followed by interoperability with billing systems at 7.2.

That's not to say there weren't some Epic users unhappy with the vendor's interoperability state – would be great to "increase support for interoperability, particularly with existing data warehouse/analytics capabilities external to Epic," said one user, for instance – but for the most part, they're positive.

The vendor coming in at No. 2 for interoperability? Considering DoD officials cited interoperability and data blocking as among the biggest reasons they chose Cerner for the $4.2 billion EHR modernization deal, one might anticipate it being Cerner. But it's not. Rather, NextGen earned the spot, with the score of 6.2 overall. Cerner, however, was a close third, coming in at 6.0.

The least interoperable vendor systems, according to our readers, were Siemens, rated a 4.8 out of 10; GE Healthcare, 4.9 out of 10; and McKesson, rated a 4.6 out of 10.

Features/Design
For this category, we asked survey participants to rate interface/visual appeal and user experience/ease of use. This one's important, too. It's not just how visually appealing the EHR interface looks, it's how well are clinicians and other users able to navigate it, access it. For instance, one survey respondent said their EHR needed to be more "user friendly for clinicians in the field. Too many clicks are required to get anything accomplished." Another user said their EHR interface was "too chaotic."

In this category, again, Epic snagged the No. 1 spot, earning an overall score of 7.5 across the two categories. Epic users rated the interface/visual appeal a bit higher (7.7) than the user experience/ease of use category (7.4).

eClinicalWorks took the No. 2 spot in this category, with its users giving it a 7.1 overall.

And the low performers on the list? Again Siemens earned the lowest score, at 5.0 in the category, followed by MEDITECH and McKesson who both saw scores of 5.5.  In the open-ended response "What would you change…" section of our survey, many customers of MEDITECH and McKesson said they wanted to see big improvements with ease-of-use and interface.

Support
No surprise: Epic took the No. 1 spot in this category too. But what made it more of an outlier is that this is the category where Epic essentially shattered the competition. They were rated nearly 20 percent better than all the other vendors rated here. MEDITECH and eClinicalWorks also fared well, earning the No. 2 and No. 3 spots, respectively, receiving scores of

Low performers in the support category were Siemens, at 4.1; McKesson, earning a 4.6 score; and NextGen at 5.3.
 

Learn what the readers have to say about their EHRs Slideshow: What users are saying See all vendor rankings here: Allscripts Cerner Epic eClinicalWorks GE Healthcare McKesson MEDITECH NextGen Siemens