Just a couple years ago, electronic health record business was booming, so much so that the federal incentive-based reimbursement plan became what might now be considered the second wave of the cash-for-clunkers program. But today is a tough time to be in the EHR business.

According the results of a highly insightful study by peer60, physicians are still "highly dissatisfied" with their electronic health records, but currently have few expectations that any of the systems will be much better in the near future. Thus, they think the benefits of switching might not be worth the time and investment.

So, they're stuck — or so they say.

The survey of 1,053 physicians at both acute and ambulatory care facilities suggested that as many as 85 percent of ambulatory facilities have an EHR, while those that did not were smaller, maybe even rural practice, which comes as no surprise. Additionally, of those practices that did not have an EHR, most did not believe they needed one or couldn't afford one.

But no matter the vendor — of those listed in the report, there were some major players, including Epic, Cerner, Allscripts and eClinicalWorks, among others — respondents were "almost universally unsatisfied" with their EHRs, mainly because of their poor usability and lack of desired functionality.

Despite their dissatisfaction, only 9 percent of physicians in acute facilities and 11 percent of ambulatory facilities said they are actively looking to replace their current EHR, citing, again, lack of benefit in the replacement.

"Physicians and other caregivers are the sleeping giants of healthcare," the report stated. "So all suppliers should be forewarned — you can only disappoint physicians and other caregivers for so long ... eventually, you will pay the piper."

What do physicians want in their technology? Simplicity, ease of use, quick and secure access to patient satisfaction data, accountable care, alternative payments models and patient portals.

"Given the amount of money involved in a single EHR deal, this still represents significant potential for new revenue; but the market is clearly settling down with few facilities interested in making a change in any given year," the report writers stated. "Finally, this data also makes clear that the change at acute facilities is not being driven by the smaller end of the market. Rather, the move to change appears to be driven by average and large acute systems with over 300 beds."

Finally, according to the report (and probably a little common sense), the market for supplying first-time users with systems does have a little upside — about 6 percent of the ambulatory participants who don't have an EHR say they are "seriously considering adoption." However, most of the physicians who say they will never implement a system cited cost as the obstacle and could not point to "demonstrable ROI," even with government incentives and penalties.

This sort of leads us back to where we started: Caregivers are almost universally unsatisfied with their EHR system — with few exceptions.