The digital transformation of healthcare systems in Quebec is accelerating, with the adoption of Law 15 placing a strong emphasis on modernizing processes and technologies. Epic, who has won the RFP to provide a Digital Health Record solution to Quebec's health system, estimated at 1.5 Billions over 15 years, is a leader in the EHR market with 24% of the Canadian market share, just behind Meditech (30%). The performance of its solutions also stems from the integration of user experience (UX) optimization, a key factor that influences both user satisfaction and the sustainability of contractual engagements.
This article analyzes how market leaders leverage user experience to ensure their success, highlighting the risks associated with its neglect, with the most fatal being user churn.
Why This Study Is Important?
The Weight of Digital in Healthcare System Transformation: With Law 15 in Quebec, digital becomes an imperative vector of transformation, with significant investments in modern technological solutions.
The Rise of SaaS Solutions: SaaS models dominate the technological landscape, bringing rapid innovation and ease of integration. However, they pose unique challenges in terms of customization and configuration, particularly in complex healthcare environments where workflows must be adapted to clinical realities.
Standardization and Interoperability: As interoperability between systems becomes a norm to foster digital health ecosystem efficiency, exit barriers are diminishing. Providers must invest more and wisely to retain users in the face of increased competition and market fragmentation.
Scaling National E-Health: Best Practices from Around the World (McKinsey, June 2024)
A recent McKinsey study, titled "Scaling National E-Health: Best Practices from Around the World," highlights common challenges encountered in digital health solution adoption worldwide. (While the analysis is comprehensive, here's a summary of key elements around user experience specifically):
Unintuitive Experiences for Patients: Patients often report difficulties navigating e-health tool interfaces, which hinders their adoption and use.
Workflows Centered on Clinical Processes: E-health applications are generally designed around clinical processes, without considering end-users' needs or habits.
The practical value of e-health solutions may be unclear to patients (and HCPs).
To overcome these limitations, the study recommends placing users at the heart of digital solution design and development. This involves:
Active involvement of patients, healthcare professionals, and IT experts in co-constructing tools.
A clear objective of making solutions intuitive and user-friendly for all user types.
Build Trust
Build user habits
Implement compelling use cases
Such user-centered approach ensures not only better tool adoption but also alignment with the operational and personal needs of stakeholders, thus fostering a lasting impact on healthcare systems.
GROSS: A Model for Improving EHR Adoption
An exemplary initiative is that of Hawaii Pacific Health, which after 10 years of using their EHR platform, launched the "Get Rid Of Stupid Stuff (GROSS)" program in 2017 to address user frustrations related to EHR adoption.
1. Initial Observation: Medical users reported that EHRs added unnecessary workload, negatively affecting their efficiency and satisfaction.
2. Implemented Solution: The GROSS team created an electronic system allowing employees to report EHR-related issues and propose improvements. All employees were encouraged to identify unnecessary or poorly designed processes in their daily documentation.
3. Impact: By the end of 2020, out of the 450 submissions received, 10% were about elements that “should never have existed”, 75% were “necessary elements that could be made more efficient”, and 15% concerned elements that were “essential, but poorly understood”.
The success of the GROSS program underscores the importance of co-construction with end-users and establishing structured feedback mechanisms to maximize technological solution adoption and impact. GROSS has since been adopted by the American Medical Association and found several variants within health complexes of different sizes and complexities.
The Risks of Neglecting User Experience in Healthcare
In healthcare, poor user experience (UX) of EMR/EHR solutions, actually in all e-health systems, is not limited to adoption or user satisfaction issues; it has tangible repercussions on the overall effectiveness of healthcare systems:
Impact on Patient Care Quality
An unintuitive interface or poorly adapted workflows increase healthcare professionals' cognitive load, which can lead to documentation errors or delays in clinical decisions.
Poorly designed tools divert caregivers' attention from patients, thus limiting time spent on essential human interactions for quality care.
Compromised Operational Efficiency
Partial or inadequate digital solution adoption leads to underutilization of key features, reducing medical process efficiency.
Workflows that do not harmoniously integrate into user routines can cause task duplication or considerable time loss, slowing clinical operation flows.
Loss of User Confidence
Healthcare professionals, frustrated by tools that do not improve their practice or add complications, develop resistance to digital technologies. This mistrust hinders the digital transformation of establishments and complicates future implementations.
Patients, confronted with unintuitive digital experiences, may perceive systems as ineffective or useless, reducing their adherence to connected health programs.
Increased Financial Cost for Healthcare Systems
Ineffective implementations require additional resources for repeated training, technical adjustments, or even solution replacements.
Operational or clinical errors due to poor UX can generate indirect costs, such as litigation or unnecessary care extensions.
Fragile Digital Solution Sustainability
Low adoption provokes a lack of experience feedback to improve tools. This hinders innovation and limits providers' ability to respond to specific user needs in an ever-evolving medical environment.
In a context where exit barriers are diminishing due to standardization and interoperability, unsatisfied users can quickly migrate to competing solutions, jeopardizing healthcare establishment investments.
Leaders and Their Practices: Epic, Meditech and Cerner
The EMR/EHR canadian market is dominated by four players controlling approximately 70% of market share. In second position, Epic particularly distinguishes itself by its success in winning the tender for the Dossier Santé Numérique (Digital Health Record) in Quebec.
Net Promoter Scores (NPS): These actors actively measure user satisfaction through indicators like NPS, which varies from 30 (Epic) to -14 (Cerner).
Strategic Partnerships: They develop collaboration programs with healthcare establishments (hospitals, clinics) to capture end-user feedback and adjust their solutions.
Meditech: Medical Users Software Exchange
Epic: User Group Meeting
Cerner: Oracle Health Community
Followers Must Bet on User and Patient Experiences
However, market fragmentation persists beyond major platforms. The other providers are left with smaller market shares (below 5%) or are niche players. Although innovative in their adoption of recent technologies like SaaS or AI, they suffer from a lack of resources to structure user/client listening and involvment initiatives, thus compromising their ability to position themselves sustainably in a field highly sensitive to user adoption and increasingly standardized.
In the SaaS domain, the average Net Promoter Score (NPS) is 38, a respectable indicator but significantly lower than healthcare's 58. This difference illustrates the importance of user experience in a critical sector where expectations are higher due to human and operational stakes.
For the entire digital health solution ecosystem—EMR/EHR, Patient Relationship Management, Telemedicine, Radiology, Administrative Management, Billing, etc.—user experience is not simply a differentiating factor: it is an essential strategic lever for success in an increasingly competitive and interoperable technological ecosystem.
Investing in a refined and engaging UX allows for:
Successful Implementation: By placing users at the center of design and development, solutions integrate better into clinical workflows and gain operational efficiency.
Increased User Loyalty: Intuitive experiences foster long-term adherence of healthcare professionals and patients, thus increasing loyalty and reducing churn risks.
Increased Customer Lifetime Value (CLV): User satisfaction stimulates repeated interactions and contract renewals, reinforcing each client's overall value.
Maximized Return on Investment (ROI): Optimal adoption and rationalized processes contribute to fully exploiting solution potential, thus ensuring economic and strategic benefits for healthcare establishments and their technological partners.
In a field where innovation must constantly respond to caregivers' and patients' needs, user experience must be an absolute priority. It is the key to successful digital transformation, aligning technological progress with clinical objectives for sustainable and positive results.