EHR Optimization

Key Findings: Program Goals Keys to Success Organizational Outcomes What Mercy Did How Mercy Did It

Key Findings: Program Goals Keys to Success Organizational Outcomes What Children’s Hospital of Philadelphia Did How Children’s Hospital of Philadelphia Did It

Key Findings: Program Goals Keys to Success Organizational Outcomes What Legacy Health Did How Legacy Health Did It

Defining Virtual Training For the purposes of this report, virtual EHR education is defined as the combination of self-directed virtual education (asynchronous) and instructor-led virtual education (akin to an online classroom setting). This report focuses more on self-directed virtual education due to its scalability and high energy in the market. Self-Directed Virtual Education Is Revolutionizing Clinician EHR Training Benefits of Self-Directed Virtual Education For the organization Geographic barriers are removed Familiar methods and technologies are leveraged Training is constantly available Clinicians spend less time on training because it is focused to their specialty/role Variation between trainers is eliminated, which can reduce confusion for clinicians Clinician participation is higher Actionable analytics are generated Education can be broadly scaled with fewer resources (people and money) Content can be more quickly created For the clinician Geographic barriers are removed Familiar methods and technologies are leveraged Training is constantly available (including in clinicians’ moment of need) Clinicians spend less time on training because it is focused to their specialty/role Variation between trainers is eliminated, which can reduce confusion for clinicians Clinicians can self-pace progress based on familiarity with concepts Training can be reaccessed to strengthen understanding Both healthcare organizations and clinicians benefit from self-directed virtual training. Contrary to popular belief, physicians and nurses of all experience levels—from less than a year to over 10 years—agree that self-directed virtual training is useful. Several interviewed organizations report that their clinicians spend fewer hours on self-directed virtual training, enabling them to begin caring for patients more quickly, which is especially helpful in this time when staffing is stretched thin. Healthcare organizations also value self-directed virtual EHR education for the actionable analytics on clinicians’ content usage and progress; these analytics help leaders focus on individual learning needs and maximize the impact of education. Additionally, due to the scalable and resource-light nature of virtual education, EHR trainers no longer have to spend hours teaching in a classroom; rather, they can work with clinicians one-on-one and maintain touchpoints over time, providing an additional layer of education for clinicians who need more support. Virtual EHR Education Has Caught Up with & Now Rivals Traditional Education Methods for Physicians & Nurses In addition to being scalable and requiring fewer resources, both self-directed and instructor-led virtual EHR education have proven to be as effective as the traditional methods of classroom training and departmental meetings, with little to no difference in Net EHR Experience Score † (for either physicians or nurses). Further, self-directed and instructor-led virtual learning often correlate with higher EHR satisfaction than other traditional methods, such as scheduled one-on-one training and rounding. Clinicians often prefer self-directed virtual education in a microlearning format that is short and focused—enabling users to learn information in a manageable way that improves comprehension. eLearning Platforms Can Reduce Time It Takes Trainers to Create Content for Self-Directed Virtual Learning Some organizations report that commercially available eLearning platforms enable faster content creation, minimizing the time trainers spend developing content and allowing them to focus on other training needs. According to Derek Harley, EHR learning and development manager at M Health Fairview , the organization’s instructional designers have saved a significant amount of time by creating content in a commercially available training platform. “In the industry, the average time to develop super engaging simulated content is 66 hours per 17 minutes of eLearning time. At our organization, the instructional designer that developed the nurse efficiency course created 105 minutes of eLearning in 95.5 hours, equaling a time savings of approximately 76% over the industry.” —Derek Harley Read about M Health Fairview’s case study with their eLearning platform as well as other case studies below . Virtual Education Is a Game Changer & Self-Directed Virtual Education Maximizes Training Value Overall, clinicians at healthcare organizations that offer multiple types of EHR education—blending traditional and virtual methods together—report the highest satisfaction. Taking a blended approach to education helps organizations cater to a wider variety of learning preferences and enables organizations to benefit from the virtual options that are less resource intensive. When clinicians participate in only one training type, virtual instructor-led training is correlated with a slightly higher Net EHR Experience Score (NEES). Clinicians who participate in self-directed virtual education report very similar scores as compared to those who participate in other training types. Beyond that, self-directed virtual education is often less expensive, more scalable, and less resource intensive than other types of training. Organizations that blend self-directed virtual education with other approaches often use self-directed virtual education for onboarding and leverage more traditional methods for workflow-specific education. Still, there are many paths to success depending on an organization’s specific needs. Optimizing Virtual EHR Education: Best Practices for Enhanced Effectiveness As healthcare organizations continue to strengthen their virtual EHR education programs, a successful blueprint includes the following four steps: 1. Prioritize clinician convenience Store educational content in a centralized place and provide direct access via the EHR; include content on mobile and desktop platforms Ensure content is easy to find —include user-friendly filters and a powerful search tool, and configure the system to display only courses relevant to the clinician’s role/specialty Design a clear education path; ensure tip sheets, videos, and courses are well organized and include reliable, up-to-date information Create concise courses (15–60 minutes each) and microlearning modules (3–5 minutes each); for courses longer than 15 minutes, add a description of the learning goals 2. Build with clinicians in mind Create a video of a senior leader introducing the virtual EHR education program  and promoting its benefits (e.g., centralized resources, 24/7 access, etc.); use real examples of positive outcomes Design content that engages learners —maintain consistent branding and leverage multiple approaches (e.g., videos, tip sheets, community discussions, hands-on learning, gamification, etc.) Design courses specific to roles and specialties so that clinicians don’t have to sift through irrelevant content; emphasize this targeted content as an advantage Give clinicians protected time to participate in virtual EHR education Explain the “why” behind actions in the EHR Include some repetition over time to solidify concepts “High-quality training in our learning management system can be great as long as it is geared toward my specialty. For example, it is useful to have med-surg updates, but I do not want to be assigned to mother-baby or NICU training because those areas are not applicable to my job.” —Nurse 3. Create a strategy for clinician engagement Direct clinicians first to the centralized learning repository so that they can adapt to a self-service mentality Ensure learners have access to reliable equipment Have clinician peers promote the benefits of virtual EHR education Implement a teaching element for learning clinicians to promote better retention Establish a variety of ways for clinicians to ask questions and receive support and guidance Consider paying clinicians to engage in virtual EHR education (for more information, watch this presentation from Inova Health System) 4. Plan for long-term success Ensure leadership is aligned with virtual EHR education strategy and recognizes its value Build in additional help for struggling clinicians Test for learner competency via proficiency tests and EHR user-efficiency data Regularly evaluate and update virtual EHR education content Identify education gaps; review service-desk tickets to understand whether training-related requests have decreased and to uncover additional training opportunities Pair clinicians who have completed virtual EHR education with a peer/informaticist/ superuser to solidify concepts and provide on-the-job training Strengthen Your Virtual EHR Education Foundation for Future Success Measure clinicians’ education satisfaction: No matter where your organization is in your EHR education journey, measuring your current state is a crucial part of the process. Administer short internal surveys to clinicians who have completed their virtual EHR education to get feedback on what went well, where they needed additional help, and what improvement ideas they have. Persistently asking for and incorporating clinician feedback will show care for clinicians’ needs and help improve virtual EHR education. Learning from other organizations and making iterative changes will ensure continued success. Track trends in clinician EHR satisfaction: Measuring and remeasuring your clinicians’ EHR satisfaction via the Arch Collaborative EHR Experience Survey will help your organization identify year-over-year changes in EHR satisfaction, demonstrate the strengths of your virtual EHR education program, and reveal opportunities to further improve the program. Measure specific pieces of your virtual EHR education program via pulse surveys offered through the Arch Collaborative. Monitor the success of trainers and education programs: Leveraging the Arch Collaborative Trainer Quality Benchmark survey will quickly pinpoint key trainer competencies as well as areas for development. Need help getting started? Start with your EHR vendor’s training offering: Leveraging your EHR vendor’s virtual education can be an easy way to begin establishing a virtual EHR education program or to supplement an existing program. Explore third-party vendors and services firms: Find information about vendors and firms that can help you create or further develop a virtual education program in the 2023 EHR Education Vendor & Firms Capabilities report . Or read about how Ozarks Healthcare successfully partnered with Sedona Learning Services to reimagine their onboarding training with online and self-directed education modules. Additionally, the third-party vendors and services firms below are members of the Arch Collaborative and offer platforms and/or services for virtual EHR education. Validated outcomes for several of these vendors are included in the case studies in the next section. 314e Amplifire CSI Companies MedPower Nordic ReMedi Health Solutions Tegria uPerform Virtual EHR Education Success Stories: Best Practices from Leading Organizations Click on link to access full versions of the case studies summarized below A Transformative Training Experience through Adaptive & Role-Based EHR Education Aspirus Health partnered with uPerform to introduce a computer-based learning-on-demand training program. The organization has centralized a wide breadth of learning materials (nearly 600 tip sheets) and resources, and users can quickly and easily access these directly from the EHR. As Aspirus moved to computer-based training, they leveraged curriculum review boards, created and implemented role-based training, and incorporated the “why” behind specific actions in the EHR workflow. Role-specific tip sheets and live simulations reduced the need for live training sessions while enhancing the accessibility of training materials. Organizational Outcomes Fast Lane to Efficiency: How Emplify Health’s Virtual Training Strategy Accelerated Onboarding & Educator Effectiveness Emplify Health (formerly Gundersen Health System) leverages virtual EHR education to ensure training occurs at the right time, in the right place, and for the right person, as this helps decrease the time clinicians spend in training. Virtual EHR training has enabled Emplify Health to overcome geographic constraints, standardize education content, and more efficiently use their resources. The organization has upskilled their trainers by turning them into coaches. These coaches can answer questions, work with providers in a one-on-one setting, help with EHR personalization, and promote further learning through the EHR’s playground environment. Organizational Outcomes Improving EHR Training & Support Through Role-Based Training & a Structured but Flexible Support System Note: This case study has not yet been published and will be available in the near future. Frances Mahon Deaconess Hospital partnered with MedPower to create self-directed virtual education for both their clinical and nonclinical staff members. Realized benefits include accessibility for staff members to complete training at their own pace, scalability of EHR education that is now delivered efficiently in a standardized format, reduced costs for in-person training experiences (since neither learners nor instructors travel), enhanced learner engagement with the interactive microlearning content that caters to various learning preferences, real-time analytics to identify training gaps and provide targeted support, and reduced disruption since self-directed virtual learning enables learners to complete training in smaller increments, minimizing time away from patient care and administrative responsibilities. Organizational Outcomes Comprehensive Initial Training Sets Up Nurses for EHR Satisfaction Hamad Medical Corporation’s (HMC) comprehensive approach to nurse onboarding training helps them ensure that nurses leverage the EHR successfully from the beginning. HMC’s onboarding training pairs web-based training (eLearning modules tailored to specific roles and work locations) with classroom training, mentorship, and competency testing. This approach has resulted in a high percentage of nurses agreeing that the virtual training met their needs, the initial training prepared them to use the EHR, and the training was workflow specific. Organizational Outcomes Partnering to Improve EHR Education & Trust in IT by Enabling Learning & Efficiency M Health Fairview integrated their EHR with uPerform’s learning platform to centralize and simplify access to learning materials and resources. The organization also centralized the processes of contacting live support for real-time assistance and booking additional efficiency training sessions. M Health Fairview’s live support personnel can guide clinicians to existing resources in the learning library to reinforce the concept that these resources are constantly available to clinicians. New hires now engage in asynchronous eLearning before attending virtual instructor-led classes. Organizational Outcomes Optimizing Clinician Training by Leveraging Data & Expertise UTHealth Houston successfully pairs eLearning with other education methods (e.g., at-the-elbow support, department meetings, one-on-one training), relying on Epic Signal data to confirm where EHR tools may be underutilized and matching training to clinicians to fill knowledge gaps. UTHealth Houston utilizes gamification tools like Kahoot! to engage learners, and the organization ensures training is relevant to learners. Based on end-user feedback, the training team centralized more than 800 tip sheets on SharePoint to foster clinician learning with easy and quick access to learning materials. UTHealth Houston has provided growth paths for their training specialists, many of whom are now physician builders, EHR champions, and informaticists. Organizational Outcomes   Transforming Initial EHR Education UW Medicine partnered with Amplifire and implemented virtual EHR education in carefully planned phases. Tegria advised UW Medicine on curriculum mapping, performed a gap analysis, authored content, and helped facilitate user feedback. Additionally, Tegria helped to upskill the organization’s trainers by teaching them to author content in the Amplifire platform. UW Medicine feels that including subject matter experts from the beginning fostered the success of the Amplifire rollout. The organization consistently collects end-user feedback and leans into Amplifire’s analytics to identify improvement opportunities and further optimize their virtual EHR education. Leveraging eLearning for onboarding has reduced the time clinicians spend on onboarding courses, enabling clinicians to be on the floor more quickly. Overall, UW Medicine has reduced nurses’ training time by 75% and physicians’ training time by 50%. Organizational Outcomes Healthcare Organizations & Clinicians Weigh In on the Benefits of Virtual EHR Education Voice of the Organization “A barrier to classroom training is our large footprint. We span multiple states, and we are expanding. We are not going to have a provider drive for hours just to get in a classroom. That is illogical and doesn’t make good use of our resources or our time.” —Corporate IT trainer “As we move from classroom training to online training, we follow the experience in classrooms taught in high school and college. People are coming to us with more of an adaptable learning style and are able to get what they need from the content.” —Director of clinical informatics “The platform enables us to follow up with people who are struggling. We have so much more data that allows us to follow up with individual users, look for themes and trends, and check annual competencies. We can see the big things that people generally struggle with.” —Director of clinical informatics and education “With eLearning, we are moving toward educating clinicians up front and then having touchpoints over time. That was impossible and not scalable with instructor-led training.” —Director of clinical informatics and education “We don’t pull people into classrooms for new employee EHR training. I’m very specific when I say that because we have absolutely no problem whatsoever meeting with people one-on-one for efficiency training, and that gives us a bigger bang for our buck. We do not get a bang for our buck by bringing people into the classroom. The name of the game is efficiency—and speed. We need clinicians taking care of patients as soon as possible. We will remove as many barriers as we can.” —Corporate IT trainer Voice of the Clinician “Self-directed virtual training allowed me to find additional Epic features that were not being utilized, specifically the tap-and-go in the ED STAT narrator. With some work, our team was able to identify barriers to its use and submit tickets to improve access to promote its use for the intended functionality.” —Nurse “Hands-on self-directed virtual training was the best training for me because I was able to work through the steps that are applicable to my role.” —Nurse “I prefer to do virtual self-directed training. I can review whatever I might need to. While I like the direct contact with a person, I don’t remember all they say and then I need to repeat what they said. It is not as efficient as when I’m working with the computer on my own.” —Nurse “I find that the training available through the learning management platform is the most helpful because I can do it on my own schedule and review it if I need a refresher.” —Nurse “I like being able to participate in training on my own schedule and at my learning pace. Group courses are too painfully slow and teach to the lowest common denominator.” —Physician “Self-directed training enables me to learn at my own pace and experience level.” —Physician What Is the KLAS Arch Collaborative?  The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, almost 300 healthcare organizations have surveyed their end users and over 380,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR. The Arch Collaborative has been surveying clinicians about their EHR experience since 2018. To make sure we are reporting the most up-to-date trends, the data charted in this report includes responses only from 2022–2024. Report data comes from three sources: (1) clinician responses to the Arch Collaborative EHR Experience Survey, (2) in-depth interviews with organizations that heavily leverage virtual EHR education, and (3) case studies written in partnership with organizations that receive high marks from clinicians for the helpfulness and effectiveness of their virtual EHR education.

Key Findings: Program Goals Keys to Success Organizational Outcomes What Wooster Community Hospital Health System Did How Wooster Community Hospital Health System Did It

Key Findings: Program Goals Keys to Success Organizational Outcomes What Children’s Nebraska Did How Children’s Nebraska Did It

Establish Your Project Team & Measurement Objectives Create your project team: Include core team members and operational and executive partners who will lead improvement efforts in their respective areas. The human resources required for a successful project can vary by organization. We recommend that you involve individuals in the following roles: Project manager CMIO and/or CNIO Clinical Operations IT/informatics Executive-level sponsor Watch Putting Arch Collaborative Data into Action : Presented by Kay Burke (UCSF Health) and Alan Nebeker (KLAS Research) at the 2024 Arch Collaborative Learning Summit, this presentation details steps to a successful Arch Collaborative measurement, focusing on operationalizing the data. However, knowing the objectives from the beginning will guide your efforts. Download the associated Excel workbook from the encore presentation given during the Collaborative’s October 2024 quarterly networking session. Build your measurement objectives: With your project team, determine your objectives and success criteria (e.g., baseline measurement, remeasure to gauge initiative impact, remeasure after moving to a new EHR). Tie your objectives to the organization’s broader strategic objectives (e.g., improved clinician satisfaction, lower burnout, reduced turnover, enhanced EHR education) Discuss hurdles to improving EHR satisfaction and how to overcome them Discuss resource needs (e.g., executive sponsor, project manager, sprint team) Build Your Survey Timeline & Communication Plan Determine your survey timing: Review your EHR upgrade schedule and other surveys across the organization to determine the optimal time to administer the Arch Collaborative EHR Experience Survey. Determine which clinicians to include in the measurement: Options include advanced practice providers, allied health professionals, nurses, physicians, physician residents, and fellows. Determine your kickoff date: We recommend kicking off your survey on a Tuesday. Most clinicians complete the Arch Collaborative survey on Wednesday, Thursday, or Friday, with many participants completing the survey one or two days after the survey kickoff. Complete the KLAS scoping survey: Your responses will help KLAS understand your measurement objectives, project sponsors, desired survey timing, clinician population, hurdles to improving EHR satisfaction, and recent EHR improvement initiatives. Provide counts of your clinical population: Aiming for a distributed data sample, KLAS will use this information to calculate minimum target response rates by clinical background. Create your survey communication plan: Ensure your plan is clear and consistent and includes an impactful message about why you want to capture the voice of your clinicians. Your KLAS client success manager will send you communication best practices. Engage your internal project and marketing teams to help develop your survey communication plan. Successful communication plans include why you are surveying your clinicians, why their candid opinions are crucial, how you will track your progress, how you will communicate with survey participants, who will send communication messages, when you will deploy your messages, message content, a plan to communicate findings to the organization, and how you will take action on the survey results. If this is not your first Arch Collaborative measurement, be sure to include what you have worked on since your last measurement. Determine how you will communicate with survey participants. Plan to leverage multiple communication formats, including email, screen savers, electronic messages (e.g., videos), newsletters, flyers, posters distributed across your campuses, and messages in team huddles and other meetings. For an example, view Emplify Health’s survey announcement video here . Include a personal invitation from C-level sponsors across surveyed clinical areas and make sure it includes why the survey is important and how you plan to turn the data into action. Determine when you will send the initial invite to survey participants. Include the survey dates and the cadence for follow-up reminders. As soon as your survey is finalized with KLAS, your KLAS client success manager will send you a QR code to include in your communication. Begin communicating about the survey a few weeks before the survey kickoff. The longer you market the survey, the more successful you will be. Determine the cadence for updating your project team, senior leaders, and clinicians about the survey progress. Create a landing page with an update on survey progress that includes a link to the survey. Leave a placeholder for a “We Heard You” section to be added once you have received your survey results. Include how you will collaborate with various stakeholders to act on the results. Build Your Survey & Begin Surveying Clinicians Work with your KLAS representatives to create your EHR Experience Survey: KLAS will schedule a survey-preparation call with you to review the core questions (included in every survey for benchmarking purposes) and any additional questions you wish to add. You may include up to ten additional questions in your survey. These questions can come from KLAS’ existing bank of additional questions, or your organization can create your own custom questions. Shorter survey lengths encourage higher clinician participation, prevent clinician frustration, and set you up for success with subsequent measurements. If you have measured previously, note any questions that are not part of the core question set that you wish to include in the follow-up measurement. Finalize survey questions: KLAS will send a Word document as well as a survey preview link for you to use to test the survey. After you test the survey, send any changes to your KLAS representatives. Once the survey questions are finalized, KLAS will send the survey link for your clinicians to use, a finalized Word document with the survey questions, and a QR code that you can incorporate into your communication plan. Begin surveying: Continue to implement your communication plan. KLAS will provide a live Qualtrics link that will allow you to monitor data-collection progress. Bookmark this page and check it regularly to understand who is participating in the survey, inform your communication plan, and enable you to follow up in areas that are light. Send updates to your senior leadership, project team, and clinicians. Review progress with your KLAS representative to determine when to close your survey. Close the Survey & Prepare to Act on Your Results Sign vendor/firm data-sharing agreement(s): These agreements authorize KLAS to share your survey results with your vendor and/or firm partners. This step is highly recommended because these partners can help as you implement action plans based on the survey results. Invite your vendor/firm partners to the action plan call with KLAS: This ensures you are aware of their upgrades, recommendations, and available resources. Close your survey Attend a 30-minute expectations call with KLAS: This call will help your organization prepare for the deep dive. Ensure the appropriate individuals (e.g., project executive sponsor, individuals responsible for EHR education/training and EHR support, IT leadership, well-being leads) are scheduled to attend the deep dive, review next steps, and review areas you wish to focus on. During the expectations call, the KLAS team (insights director and KLAS client success manager) usually meets with 5-6 members of the organization’s project team. During the expectations call, please designate someone from your organization to introduce the survey process during the deep dive, convey why the organization participated, and provide an overview of what you plan to accomplish. KLAS has found that keeping cameras on during this call fosters collaboration and a better discussion of the data. Participate in 90-minute deep dive with KLAS: During the deep dive, KLAS will provide three to four high-level, actionable findings and feedback (i.e., charts and clinician comments) from the main benchmarked areas. The aim of the deep dive is to discuss areas that are going well and opportunities for improvement with key stakeholders of your project team. This discussion furthers KLAS’ understanding of your objectives, resources, and obstacles. KLAS has found that keeping cameras on during the deep dive facilitates collaboration and a robust discussion. Plan to have a small group (no larger than 5-10 people from your organization) at the initial deep dive to foster an engaging conversation as we review the high-level findings. KLAS is happy to schedule additional deep dives with a broader audience after your project team has participated in the first. KLAS records the deep dive and will provide the recording and deck to you so others may review the information at your discretion. At the beginning of the deep dive, KLAS will provide time for you to introduce the survey process, remind participants of the measurement objectives, and set the stage for your next steps, including the action plan call with KLAS. Participate in a 60-minute action plan call with KLAS: A few weeks after the deep dive, you will meet with KLAS for an action plan call to begin formulating your project improvement plan and share your priorities and next steps. During this call, we will invite you and your team to share plans for improving one or two key action areas reviewed during the deep dive. KLAS will provide feedback on your plan and recommend relevant case studies, reports, and webinars from other organizations who have tackled issues similar to the ones you are working to solve. We recommend that you invite your EHR vendor and third-party firms who are invested in your clinicians’ EHR success to the call to support and strengthen your efforts and inform you of their available resources. Leverage the KLAS report Operationalizing Arch Collaborative Data as you prepare for the call and develop your long-term action plan. The report includes guidance on sharing results with your leadership team and clinicians and outlines steps to identify action items and pilot initiatives. Plan to leverage pulse surveys to gauge progress from pilot programs and full-scale initiatives. Continue to meet with your KLAS client success manager regularly: We recommend quarterly meetings to collaborate and share additional information (e.g., reports, case studies, webinars) that will be helpful in fine-tuning your action plan. Determine when you will next complete a full measurement to check your results: KLAS recommends surveying your clinicians annually.

Data Methodology This report uses data from the Arch Collaborative EHR Experience Survey, which consists of two parts: (1) the standardized questions (including ones about message burden) that all participating organizations ask their end users and (2) an optional set of additional questions that allow organizations to collect deeper insights into key topics—in this case, message burden. KLAS added the set of additional message burden questions in April 2024 and has surveyed six organizations so far; thus, insights are still early (and are marked as such throughout the report). KLAS will continue to collect data specific to message burden and share insights via future reports. Do Acute Care Physicians Also Experience Message Burden?  While message burden is primarily a problem among ambulatory care physicians, one-fourth of acute care physicians also feel overburdened by messages—most of their messages either are from other clinicians within their organization or require no action. Message Volume & Backlog Exacerbate Ambulatory Care Physician Burnout  High message volume combined with pressure to promptly respond to messages is a recipe for physician burnout. Ambulatory care physicians report inconsistent or ambiguous response-time expectations across their organizations; thus, they are setting their own expectations, often holding themselves to a higher standard for response times than what their organization deems necessary. These self-imposed expectations worsen the feeling of falling behind on message management and lead to physician burnout being most severe. In contrast, ambulatory care physicians who feel they are effectively managing their messages and can respond in a timely manner are less likely to report burnout. Message Burden Negatively Affects Ambulatory Care Physicians’ Perception of EHR Enabling Patient Care It is natural to assume that patients’ increased access to care teams would result in improved patient outcomes. However, ambulatory care physicians experiencing message burden are less likely to agree that their EHR enables patient-centered care. Although the cause of their disagreement could appear to be the patients depending too much on messages instead of scheduled appointments, the disagreement stems from physicians feeling too overwhelmed and burdened to provide adequate care. As messaging use increases, it will be critical to balance its convenience with the facilitation of high-quality care. When effective message management is in place, more physicians agree that their EHR enables patient-centered care. To Reduce Message Burden, Organizations Should Work to Filter Inappropriate Content & Focus on Certain Specialties Challenges with Message Content 60% of messages that ambulatory care physicians receive are from patients (n=642; early insight) Receive messages at least weekly from patients demanding care deemed inappropriate or that requires additional clinical assessments Receive messages at least weekly from patients frustrated with system-related issues , which are out of ambulatory care physicians’ direct control Specialties Encountering Message Burden Ambulatory Care Physicians Want to Better Support Patients via Messaging but Need Help from Staff, Technology & Patients to Do So Hundreds of ambulatory care physicians were asked how they would like to see their EHR message burden be reduced. The following section outlines their suggestions. Note: KLAS began asking this message burden question in April 2024; thus, insights are still early. Look to Staffing Solutions Triage Have staff triage and handle messages. Get messages to the right people the first time. Improve the triage system so that only clinical decision-making messages reach the providers. Train staff to handle messages Increase the number of staff (e.g., RNs, MAs, NPs) helping with messages. Ensure they have sufficient access/permissions and are well trained so they can work at the top of their license and handle patient messages without having to unnecessarily loop physicians back in. Provide protected time Carve out standard administrative time for clinicians so they can catch up on charting and messages. “I have enjoyed having a trusted RN handle my messages and escalate anything appropriate to me—this approach would be a benefit to many physicians.”  —Ambulatory care OB/GYN physician (large health system) Ambulatory care physicians have confidence in their team members’ ability to respond to messages, yet nurses feel ill-equipped to address certain content. By upskilling nurses (and other staff) and providing opportunities for them to become more familiar with message content, organizations can not only improve the overall nurse experience but also help both physicians and nurses feel more satisfied with their handling of patient messages. Improve Message Management Limit message length and frequency  Restrict message length and the number of messages a patient can send within a certain time frame. Prioritize current patients and encourage regular patient visits  Restrict the ability to send messages if the patient hasn’t had an appointment in over a year. Remove clutter  Reduce duplicate messages. Automatically delete old messages after a certain amount of time. “Send fewer copies of the same note. Stop sending drafts, pending information, duplicate notes, or cover letters and notes.”  —Ambulatory care pediatrics physician (children’s hospital) Improve Technology Simplify message workflows Streamline the process of handling messages and reduce the number of steps required to complete a message. Improve message system integration Improve the integration between messaging systems and other workflows. Use a single platform for all types of messages. Improve remote access to the chart (e.g., use a mobile app). Make the message center easier to navigate Make the secure chat searchable with filters. “Streamline the number of inboxes in our message center. For example, I have 33 inboxes; it is ridiculous to expect me to check 33 inboxes throughout the day.”  —Ambulatory care physician (academic health system) Leverage AI Solutions  Filter Use AI to filter out unimportant or duplicate messages. Triage Implement an AI solution to route patient requests to the correct person. Automate responses Use AI-generated responses for FAQs or basic patient questions. Indicate message receipt Use automated messages to indicate message receipt and expected response times. Use AI to notify patients of when they should make an appointment Have AI identify key words in messages that will alert patients to the need for an in-person visit rather than a messaging interaction. “AI should send new problem questions directly to an appointment line.”  —Ambulatory care internal medicine physician (large health system) Provide Patient Education Share guidelines for appropriate messaging  Inform patients about what types of questions are appropriate to include in messages. Explain that physicians will never use messages to diagnose or treat conditions without an office visit. Communicate response times  Set clear expectations with patients for how long it will take to receive a response from their provider. Notify patients of potential charges  Inform patients that there may be a charge for responses if their message meets certain criteria. “I see a trend where patients are not coming to appointments and are instead messaging the provider. This does not allow for optimal care. Patient education may help address this challenge.”  —Ambulatory care internal medicine physician (large health system) Organizations That Are Successfully Reducing Message Burden     Keys to Success: Children’s Nebraska has message reduction strategies that focus on using the four rights of decision support (i.e., information, person, time, method), being intentional about routing and recipients, using the appropriate alerting method, anticipating needs, automating responses, and engaging providers. The strategies include using nurse inbox pools for shared access and efficient message screening, implementing evidence-based treatment protocols and orders that can be initiated without immediate provider involvement, using message documentation templates to gather necessary information up front, and suppressing courtesy message alerts to reduce unnecessary notifications. These approaches aim to streamline communication, improve efficiency, and ensure that providers receive only essential messages. For more details, watch this webinar . Keys to Success: Confluence Health did several things to improve messaging at their organization. They made process improvements by using tools to analyze and improve message handling, empower staff, and embed helpful links in messages. The tools also helped reorder messages based on priority, close out message threads after 14 days, and filter out “thank you” messages. Additionally, the organization increased patient engagement and portal usage, and they batched patient test results and limited premature access to reduce patient confusion regarding results. They also offered on-demand virtual visits and explored using AI to draft messages. The organization regularly reviews these data and process improvements to measure effectiveness. Confluence Health also wanted to shift patients’ expectations toward team-based care. For example, the organization changed their messaging option from “Message your doctor” to “Message your provider’s office,” implying that messaging is not intended for emergencies. Confluence Health also encouraged patients to review past appointment notes before messaging. Confluence Health supported their providers and staff by regularly communicating updates and providing training around messages. They also helped foster good message etiquette by forming a superuser community that shared best practices with providers. For more details, watch this webinar . Partner with KLAS: Share Your Organization’s Experience with Message Burden KLAS is looking to partner with 10-15 more healthcare organizations to further understand the impact that messages are having on clinicians’ overall EHR experience. Comparative results of these questions will be released to each organization that participates once the threshold of 15 participating organizations is met. If you are interested in participating, please contact your KLAS Provider Success Manager or visit the KLAS website . Get Involved with the KLAS Patient Voice Collaborative The KLAS Patient Voice Collaborative is a growing group of healthcare organizations and healthcare IT vendors committed to using patient perspectives to improve the overall patient experience with technology. For more information, see this webinar . Reach out to KLAS to get involved and learn more: patientvoice@klasresearch.com . What Is the KLAS Arch Collaborative?  The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, over 300 healthcare organizations have surveyed their end users and over 500,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR. This report acknowledges an organization that has won KLAS Arch Collaborative Awards . The Arch Collaborative EHR Experience Pinnacle Award honors members of the Arch Collaborative who have demonstrated that success is possible with the EHR. Qualifying organizations must have a NEES of at least 75.0 for nurses or a NEES of at least 60.0 for physicians. To put this in context, the average nurse NEES is 47.3 (n=113,045), and the average physician NEES is 23.4 (n=53,037). The Arch Collaborative EHR Experience Breakthrough Recognition honors any participating organization whose NEES has increased by at least 15 points between measurements. This can be earned for physician or nurse scores.

Key Findings: Program Goals Keys to Success Organizational Outcomes What SUNY Upstate Medical University Did How SUNY Upstate Did It

Key Findings: Program Goals Keys to Success Organizational Outcomes How Advocate Aurora Health Increased AHP EHR Satisfaction

Healthcare Delivery Organizations Identify Improvement Opportunities Leverage all the help you can : Share your KLAS Arch Collaborative EHR Experience survey results with your EHR vendor and other key vendor and firm partners that support your clinician EHR satisfaction initiatives (KLAS will share this data on your behalf once you sign a data-sharing agreement). Invite these partners to the action planning call with KLAS. Focus your efforts : With your project team, identify the areas of improvement you will address. Review KLAS Deep Dive findings and commentary analysis. Read clinician comments (Dr. Heidi Twedt from UW Health presented her strategy for leveraging clinician comments at the 2024 Arch Collaborative Learning Summit). Identify differences between your current state and evidence-based practices in the Arch Collaborative’s provider and nurse guidebooks. Work with your Arch Collaborative representative to identify applicable case studies , reports , and webinars . With your Arch Collaborative representative, determine which organizations to connect with to understand deeply how and what they implemented to successfully overcome similar challenges. Identify quick wins (e.g., store all current education materials in a central, easy-to-access location, promote broader personalization tool adoption, participate in vendor-led EHR education). Leverage the KLAS report Easy Lifts for Quickly Improving EHR Satisfaction . If this is a repeat measurement, use trending data to highlight the impact of the work you have already completed . Use comments, raw scores, benchmarking, charts, and scorecards to prove your work. Position your organization to be a leader in EHR satisfaction to raise the bar for all of healthcare . If your organization benchmarks high on the EHR Experience Survey, and there are few or no obvious needs, review raw scores. Even if your organization benchmarks higher than others, raw scores may be low and need improvement. Clinician comments underscore additional improvement opportunities. Secure Leadership Support & Resources; Socialize Your Results Secure your leadership team’s buy-in : Socialize the Arch Collaborative EHR Experience Survey results with organization leadership (e.g., clinical, operational, financial, regulatory, quality). Highlight scores and benchmarking, what is going well, what needs to be improved, and what areas you plan to focus on. Lean on the KLAS Deep Dive deck and Executive Scorecard as a foundation to share this information. Include direct clinician quotes from the survey results to highlight successes and improvement opportunities. Ensure the deck aligns with organizational goals and objectives. Tie improvement efforts to existing strategic objectives and initiatives (e.g., lower clinician burnout and turnover, higher clinician EHR satisfaction, improved clinician efficiency, faster patient care, improved patient throughput). Secure support and resources for the identified improvement efforts by sharing the costs at stake (e.g., clinician burnout and turnover ) using your Executive Scorecard data, assigning a dollar amount to the money that your intended improvement efforts could save the organization. Identify leadership champions for selected improvement initiatives . Throughout the improvement process, determine when and how to leverage these individuals. Socialize the Arch Collaborative EHR Experience Survey results with clinicians : Thank them for participating. Use the deck created above to broadly share results. Include clinician quotes so they see their voices were heard. Use multiple communication methods to disseminate the information , including posters, emails, flyers, and videos, like this example from The University of Kansas Health System . Highlight scores and comments to show what is going well and what needs to be improved. Include one or two improvement areas you plan to focus on. Leverage resources like the “We Heard You” document (your KLAS representative is happy to share this with you). Organize Your Process-Improvement Teams Identify a process-improvement team for each opportunity : These teams will assist in the design of changes, identify pilot groups for testing, communicate and champion changes to leadership and end users, etc. Team members should be passionate and persistent (i.e., unlikely to give up under pressure). Lean in to your shared ownership structure to identify clinical champions via informaticists, superusers, and other engaged clinicians. Ask for volunteers. Help clinicians tie their participation to meaningful EHR improvements. Ensure the improvement team includes clinicians at all levels , from end users to clinical and operational leaders. Establish a regular meeting cadence for your process-improvement team : Ask team members to commit to and adhere to the schedule. Ensure they have dedicated time to participate. As an improvement team, watch the 2024 Arch Collaborative Learning Summit presentation Putting Arch Collaborative Data into Action by Kay Burke (UCSF Health) and Alan Nebeker (KLAS Research). Download the associated PowerPoint presentation to gain complimentary access to UCSF Health’s Action Planning Resource. Incorporate ideas from these resources. Begin formulating your next steps and a project timeline. Determine how often to communicate your improvement efforts with leadership and clinicians : Employ a multimodal communication approach (e.g., email, posters, videos, meeting announcements). Explain why you are making changes and use data that will resonate with the organization. Schedule regular meetings with your leadership team to discuss changes, progress, setbacks, and wins. At a minimum, update progress via monthly or quarterly update emails. Deeply Understand the Issues Leverage your process-improvement team to understand the depth and breadth of each identified improvement opportunity : Perform a comprehensive root-cause analysis to deeply understand the challenges and what departments and specialties are impacted. Brainstorm potential solutions. For example, if the opportunity is to improve ongoing EHR education, identify the groups most in need of an improved experience and the changes that could be made. Round on-site with end users, especially with the most dissatisfied group(s) and the survey participants who agreed to share their names , to observe and ask questions to ensure you focus on the correct issues (i.e., are EHR education scores low because content is not specialty specific, because clinicians don’t understand what EHR education is available and how to access it, or because clinicians don’t have dedicated time to participate?). While focus groups and governance councils are valuable sources of feedback, using them as the only source of end-user feedback limits your perspective. While rounding, deliberately speak with clinicians you do not know to expand your understanding of the challenges . Understand what is working and what is not working (i.e., What are the barriers? What have you already done to address them? What has worked and what hasn’t?). Work in close partnership with your EHR vendor to seek feedback, diagnose challenges, and drive improvements (e.g., ensure you are on the latest EHR version, leverage vendor-led EHR education, use the vendor’s diagnostic tools to address configuration challenges). Review these vendor and firm resources to understand how other organizations have leveraged their vendor and firm partners for improvement. Create & Execute Your Plan Create your process-improvement plan : Include the changes you will implement and which locations, units, departments, and specialty areas will be part of the pilot group. In addition to your improvement team members, determine who else should be included in this effort (e.g., the organization’s IT team, leadership champions, regulatory specialists). Utilize the communication plan created in step three as needed. Leverage information from the Arch Collaborative report on successful improvement efforts/sprints . Use the Arch Collaborative’s Success Pathways to guide your efforts . Share your plan with the KLAS team and ask for feedback . If you would like deeper help and guidance, consider engaging KLAS in a consulting project , such as Expert Guidance . Execute your plan : Use relevant data (e.g., fewer clicks, higher percentage of same-day chart-closure rates, higher patient satisfaction) to show why change is necessary, communicate wins, and show progress. Determine how to measure your success (e.g., Arch Collaborative survey, decreased turnover, increased patient throughput). Leverage KLAS pulse surveys, pre/post surveys, and the Education Quality Benchmark to check progress, validate efforts, and point to needed adjustments. Partner with your Arch Collaborative representative to successfully use these resources. Identify and communicate a few early wins (i.e., easier lifts) to clinicians and leadership to build momentum. Look for low-hanging fruit (e.g., clarification for clinicians on submitting fix tickets, increasing clinician awareness of existing resources). Regroup with your process improvement team(s): Discuss adjustments. Iterate with test groups until you are ready to broadly roll out changes. Share successes broadly with clinicians and leadership: Continue to tie initiatives to the organization’s strategic objectives. Remeasure via the Arch Collaborative EHR Experience Survey Self-Examination Questions—Operationalizing Arch Collaborative Data On a scale of 1–5, rate your agreement with the following statements (5 means “strongly agree” and 1 means “strongly disagree”): We are passionate about elevating the clinician EHR experience because we understand that successful EHR use lowers clinician burnout, decreases clinician turnover, improves clinician efficiency, and improves patient care. We persistently help our leadership team connect our KLAS Arch Collaborative survey results and clinician EHR satisfaction to our broader strategic objectives to engage the leadership team and obtain resources for EHR-improvement efforts. We carefully select our leadership and clinical champions based on their skills, capabilities, reach, and desire. We build multidisciplinary process improvement teams to best understand how changes impact all areas by choosing clinicians who understand multiple perspectives, are passionate about the EHR, and deeply understand clinical workflows and how the EHR functions. We then pair them with team members from other areas of the organization who are familiar with quality metrics, regulations, and nonclinical workflows. Our EHR communication strategy prominently includes why we are making a change, is cohesive (e.g., consistent look and feel, is sent from a trusted source), and is distributed in various ways (e.g., emails, newsletters, meetings, intranet, posters around the building, videos). We use our communication strategy to build trust with our clinicians and our leadership team members as we celebrate wins, vulnerably share improvement opportunities, and actively engage clinicians and leadership team members in our change management processes. We leverage our superusers/EHR ambassadors/informaticists/IT analysts to reinforce communication. When we communicate with our clinicians and leadership team about EHR process-improvement opportunities, we bring relevant data (e.g., EHR data, feedback from surveys, cost information) in an easily digestible format. We are willing to fail fast and learn from feedback and test pilot initiatives to build a better EHR that meets clinicians’ needs. We have invited our Arch Collaborative representative to be part of our process improvement and to share related reports and case studies as well as connect us with organizations that have successfully tackled some of the same issues we are working on. We leverage our Arch Collaborative membership for pre/post and pulse surveys to measure and verify our improvement efforts. We maximize our Arch Collaborative membership and send six attendees each year to the annual Arch Collaborative Learning Summit held in Salt Lake City to learn from peers and KLAS. We leverage the Arch Collaborative Learning Center and stay abreast of reports , case studies , and webinars as we continue to optimize our EHR success strategy. We share identified improvement opportunities with our EHR vendor and other vendor/firm partners who support our EHR initiatives and ask for feedback, guidance, and best practices. We leverage their resources and support as we plan and execute on our improvement opportunities. We have accessed our vendor’s available resources via the Arch Collaborative (located on the left-hand side of your My Files page on the Learning Center). As needed and applicable, we review the KLAS framework reports— EHR Education Software and Services , Clinician EHR Efficiency Software and Services , and EHR Governance Software and Services —to identify potential partners to assist in our improvement initiatives. We actively encourage peer-to-peer promotion of our EHR education program and shared ownership structure to bolster our change management success similar to the University of Virginia Health System , MetroHealth , and Kaiser Permanente Southern California . We prepare specialty-specific communication for our clinicians so each understands how they will be uniquely impacted by decisions and changes. When we create tip sheets and other materials about changes, we celebrate incorporating clinicians’ voices by including on the materials who requested the change (e.g., directly by name, by department, by unit). When we run a pilot within a unit, group, location, or specialty, we recognize that clinicians may need to work under a reduced schedule to accommodate the changes and feedback necessary for the success of the program. Total Scoring Total score Maturity level Next steps 75+ Mature Your improvement plan likely needs only fine-tuning. Your current efforts are extensive and align with Arch Collaborative best practices. 50–74 Established Your answers indicate you have created an improvement plan and have some areas to shore up. To improve clinicians’ EHR experience, focus on enhancing communication and covering gaps to align your plan with the organization’s strategic objectives, available resources, and clinician needs. <50 Nascent Continue to work on your process-improvement plan to create value for clinicians as you work to improve their EHR experience. HIT Software Vendors Self-Examination Questions—Operationalizing Arch Collaborative Data We are passionate about elevating the clinician EHR experience because we understand that successful EHR utilization lowers clinician burnout, decreases clinician turnover, and improves patient care and safety. We actively encourage our customers to participate in the KLAS Arch Collaborative. We persistently help our customers, including their leadership team, connect Arch Collaborative survey results and clinician EHR satisfaction to their broader strategic initiatives to engage the leadership team and obtain resources for EHR-improvement efforts. We actively and regularly provide information to our customers from the EHR, such as user-efficiency data, in easily digestible and actionable formats and suggest opportunities for EHR education and optimal EHR configuration. We proactively work with our customers after their Arch Collaborative measurement to align with their identified improvement areas and position ourselves to assist them based on user-efficiency data, their unique survey results, and our experience with other organizations’ positive changes. We consistently ensure our customers have an optimal EHR configuration. We make regular suggestions for changes to improve EHR speed and reliability, provide means for them to enhance external interoperability, and aid them in improving user efficiency. We regularly meet on-site with our customers and round with their clinicians to better understand how we can improve clinicians’ EHR satisfaction. We are willing to fail fast and learn from our customers’ feedback to build a better EHR to best meet clinicians’ needs. We offer clinician specialty- and role-specific EHR education at no additional cost to our customers. We leverage our Arch Collaborative membership to attend the annual learning summit to connect with our customers and understand their needs. We utilize the information from the Arch Collaborative Learning Center, including reports , case studies , and webinars . Our EHR communication strategy prominently includes the reason we are making a change, is cohesive (e.g., consistent look and feel, is sent from a trusted source), and is distributed in various ways (e.g., emails, newsletters, meetings, intranet, posters around the building, videos). Our communication materials are easily adaptable by our customers for their own internal use. We prepare specialty-specific communication for our customers so each clinician will understand how they will be uniquely impacted by decisions and EHR changes. We regularly review our customers’ usage of our complimentary resources to ensure they take full advantage of the resources to enhance clinician EHR satisfaction.

Key Findings: Program Goals Keys to Success Organizational Outcomes What Intermountain Health & Solventum Did How Intermountain Health & Solventum Did It