arXiv:2610.04762v2 Announce Type: replace Abstract: Objective: To assess trends in family physicians' (FPs) electronic health record (EHR) satisfaction and their experience of interoperability across organizations. Materials and Methods: Serial cross-sectional analysis of five waves of the American Board of Family Medicine's Continuous Certification Questionnaire (2022-26). Adjusted logistic regression compared odds of being very satisfied across 11 EHRs; Cochran-Armitage tests assessed vendor trends. Ease of using outside information was analyzed separately for same- and different-vendor sources. Results: Across 36,785 FPs, adjusted odds of being very satisfied relative to Epic ranged from 0.91 (95% CI, 0.74-1.11) for Elation Health to 0.17 (95% CI, 0.15-0.20) for Oracle Health/Cerner. Only Epic's users became significantly more satisfied (Benjamini-Hochberg adjusted P < .001), widening the vendor satisfaction gap. Within comparable periods, ease of using different-vendor information did not improve; fewer than 13% rated it very easy. Epic's interoperability advantage reversed by exchange type: non-Epic users had less than half the odds of Epic users of rating same-vendor interoperability very easy (adjusted OR, 0.41; 95% CI, 0.38-0.44) but 1.54 times the odds for different-vendor interoperability (95% CI, 1.35-1.75). Discussion: Rising national exchange volume has not yielded easier use of outside information. Epic's advantage is confined to its own network, so market concentration may shift, rather than solve, the different-vendor problem. Conclusion: The ABFM data are already informing EHR policy but also have utility for the EHR marketplace. While EHR satisfaction has known implications for burden and burnout, poor interoperability is a quality and safety threat that may be compounded by artificial intelligence.