EHR Optimization

Key Findings: Program Goals Keys to Success Organizational Outcomes What Henry County Hospital Did How Henry County Hospital Did It

Key Findings: Healthcare Delivery Organizations: Optimization Journey Self-Examination Questions HIT Software Vendors: Self-Examination Questions

Celebrating an Arch Collaborative Milestone At the beginning of the summit, Adam Gale—KLAS co-founder and CEO—announced that more than 500,000 respondents have taken the Arch Collaborative survey since the Collaborative’s establishment in 2017, with a record number of 108,000 clinicians participating in 2023. Arch Collaborative Awards To recognize and celebrate the hard work of healthcare organizations who have significantly enhanced their clinicians’ EHR experiences, KLAS presented the first-ever Arch Collaborative EHR Experience awards—the Pinnacle Award and the Breakthrough Recognition . Organizations who received these awards demonstrate that achieving EHR success and clinician satisfaction is possible. The Arch Collaborative EHR Experience Pinnacle Award honors participating healthcare organizations who have a Net EHR Experience Score † of at least 75.0 for nurses and at least 60.0 for physicians (on a -100 to 100 point scale). Of the over 300 organizations who have participated in the Arch Collaborative, only 12 have received the Pinnacle Award for nurse satisfaction and only 10 for physician satisfaction. The Arch Collaborative EHR Experience Breakthrough Recognition honors any participating healthcare organization whose Net EHR Experience Score for nurses or physicians increased by at least 15 points (on a -100 to 100 point scale) between measurements. The 2024 awards were given to healthcare organizations who have measured with the Arch Collaborative at any time since 2017. In the future, organizations will only qualify for a Pinnacle Award or Breakthrough Recognition if they measure with the Arch Collaborative within the given year. See here for a full list of the 2024 winners. † The Arch Collaborative measures satisfaction with the EHR via the Net EHR Experience Score (NEES). Each individual clinician’s responses to the Arch Collaborative EHR Experience Survey regarding core factors such as the EHR’s efficiency, functionality, impact on care, and so on are aggregated into an overall NEES, which represents a snapshot of the clinician’s overall satisfaction with the EHR environment at their organization. A NEES can range from -100 (all negative feedback) to 100 (all positive feedback). Main Stage Summit Presentations Click on the headers to access recordings of the presentations and panels. Welcome: Arch Collaborative Growth & a Look into the Future Presenters Summary Healthcare organizations are proving that clinician EHR satisfaction is achievable: The Arch Collaborative has always affirmed that high clinician EHR satisfaction is possible, and participating organizations across the world—from the US to Canada to the Middle East—are proving that clinicians can have positive EHR interactions. Moreover, healthcare organizations are not alone in their efforts; many HIT vendors and services firms have collaborated with client organizations to improve the clinician EHR experience. The Arch Collaborative is continually enhancing resources for organizations:  One recent development is the Executive Scorecard , which provides a snapshot of how well an organization supports their clinicians’ EHR use as well as the financial risk if the organization doesn’t improve the EHR experience. KLAS has also published Success Pathways for ongoing EHR education and EHR personalization tools that detail next steps for organizations; more Success Pathways will be released in the future. Other upcoming offerings from the Collaborative include: Updated format for case studies (including a promotional toolkit for involved organizations) Support in setting goals for EHR improvement Measurement of third-party technologies’ impact on clinician experience Measurement of ROI Prediction of nurse/physician turnover and financial risk Improved training quality benchmark Improved Learning Center user experience Improving the EHR Experience with Data Presenter Summary Make changes based on Arch Collaborative data: Data from the Arch Collaborative’s measurement of Ozarks Healthcare laid a foundation for the organization, enabling them to improve their EHR implementation and the physician EHR experience through evidence-based best practices. Acting on user feedback was pivotal in the organization’s journey toward better EHR practices. Push through challenges: In their efforts to improve the EHR experience, Ozarks Healthcare faced numerous challenges, including limited resources and hesitance from senior leadership. Dr. Frase encouraged participation in the Arch Collaborative and used the Collaborative’s Provider Guidebook to enhance EHR implementation and training. Clinician feedback from Arch Collaborative surveys showed improved EHR satisfaction, and Dr. Frase used this data to validate her IT team’s efforts and gain support from senior leadership and vendors. Learn from all organization types: Ozarks Healthcare is a smaller health system, but by connecting with and learning from Arch Collaborative members of all sizes, Ozarks was able to implement strategies that had far-reaching benefits. Enhancing Interoperability to Elevate the Clinician Experience Moderator Panelists Summary Healthcare organizations still face challenges with achieving true interoperability: While data sharing has progressed, interoperability continues to be a struggle, especially for smaller community hospitals or among hospitals that don’t share a common EHR. Additionally, when data is shared, it is often outside of the clinician workflow. External data needs to be presented in the EHR in an actionable, digestible format that enables clinicians to drive improved patient care. EHR vendors should play a role in improving interoperability: True interoperability comes at a high cost to healthcare organizations, who must work to identify and connect with core sharing partners. According to the panelists, this burden could be lightened if EHR vendors helped facilitate easier communication across platforms and implemented common documentation standards. Vendors should listen to clinicians’ needs and establish cross-vendor committees to ensure data is useful and relevant to clinicians at the point of care. Improved interoperability will revolutionize healthcare: With the rise of AI and machine learning, and with increasing partnerships between EHR vendors and other entities (e.g., Google) to better summarize integrated data, the utility of shared data will continue to improve. This improvement will reduce waste by minimizing duplicate tests and enhance patient outcomes and experiences. Leveraging Ambient Speech Technology to Improve Provider Well-Being & the Patient Experience Moderator Panelists Summary Ambient speech technology leads to high physician and patient satisfaction: Physicians appreciate the technology’s ease of use and how it lessens the documentation burden; in particular, ambient speech technology decreases the amount of time physicians document at home because they can complete their notes in real time. Patients appreciate the improved connection with their physicians during consultations. Ambient speech technology isn’t a cure-all, but when used in conjunction with other documentation best practices, it can reduce physicians’ cognitive burden. Ambient speech technology requires proper education: Informaticists need to be trained to support the tools, and end users need to be trained on the workflows and the technology’s limitations. Improved integration and standardization are needed: Not all ambient speech tools can integrate with EHRs, requiring physicians to go to an external site to access notes. Improved integration is needed so that physicians can access notes inside the EHR and quickly glean relevant insights. Additionally, without proper note standardization, incorrect formatting can occur. Healthcare organizations and vendors need to partner together to continually enhance the accuracy of ambient speech tools. Summit Sessions When working to improve the clinician EHR experience, healthcare organizations don’t need to reinvent the wheel. The goal of the Arch Collaborative is to bring healthcare leaders together so that they can learn from each other and achieve improvements faster. Click on the following topics to learn about best practices shared via summit sessions by healthcare organizations, healthcare associations, HIT vendors and services firms, and KLAS Research. Operationalizing Arch Collaborative Data  Supporting Clinician Well-Being  Creating Documentation Efficiencies  Providing EHR Education & Training  Establishing EHR Governance  Learning from KLAS Research EHR Vendor Sessions Several EHR vendors actively participate in the Arch Collaborative. At the Learning Summit, Epic, MEDITECH, and Oracle Health gave presentations on how they use Arch Collaborative learnings to help customers improve the clinician experience. To access recordings of these sessions, please reach out to your KLAS Provider Success Manager. Operationalizing Arch Collaborative Data Click on the headers to access recordings of the presentations and panels. Putting Arch Collaborative Data into Action UCSF Health & KLAS Research UCSF Health used the results of their Arch Collaborative measurement to identify key improvement opportunities with their clinicians’ EHR experience. This presentation shared the following best practices used by UCSF Health to achieve improved clinician satisfaction: (1) utilize lean management and continuous improvement, (2) establish effective communication and engagement, (3) adapt resources, and (4) measure impact and ensure sustainability. Using Physician Survey Data to Determine System Optimization Strategy UW Health To determine an optimization strategy to drive physician satisfaction with the EHR, UW Health asked physicians to share the top three things they want fixed in the EHR. In this session, the organization shared the processes they used for survey analysis, optimization ideation, and project prioritization. Supporting Clinician Well-Being Click on the headers to access recordings of the presentations and panels. Joy in Medicine: Organizational Well-Being as a Leadership Imperative American Medical Association (AMA) The AMA presented on its efforts to improve organizational well-being. The AMA collaborates with more than 150 healthcare systems committed to decreasing burnout for physicians and care team members as well as helping staff regain joy, purpose, and meaning in the work of delivering patient care. Keeping Patients Engaged and Clinicians Empowered—Maximizing Portal Value while Minimizing Burnout Confluence Health Providers can often feel overwhelmed by the volume of MyChart messages from patients. Confluence Health was struggling to balance increasing patient engagement through MyChart while avoiding provider burnout from constant advice requests. In this webinar, Confluence shared their journey to “bend the curve” on patient message volume without compromising care quality or access. Despite steadily increasing their MyChart user base, Confluence has been able to successfully flatten message growth through a multi-pronged approach. How to Burn Down Provider Burnout Piedmont Healthcare Through many programs, EHR optimizations, and new technologies, Piedmont Healthcare has improved their scores for Arch Collaborative metrics related to provider burnout and likelihood to leave. This session shared these strategies as well as next steps for Piedmont related to AI to keep the momentum going with improving the lives of providers. Empowering Healing Hands: Physician Wellness Program Yuma Regional Medical Center This session covered the growth and structure of a medical group and the role of a chief wellness officer. Additionally, it highlighted Yuma Regional Medical Center’s physician builder program, well-being index, self-assessment, support services, and DYAD leadership model. Creating Documentation Efficiencies Click on the headers to access recordings of the presentations and panels. Optimizing Your Time & Driving Documentation Excellence with Collaborative Solutions Intermountain Health & Solventum Intermountain and Solventum leaders discussed their journey to clinical documentation excellence by utilizing AI supported by a robust physician advisor organization. This session examined how the EHR’s integrated technology extends into patient care by identifying opportunities to transition patients to the right level of care at the right time. Empowering Nurse Voices & Redesigning EHR Workflows for Enhanced Efficiency Mercy Health This presentation focused on harnessing nurses’ insights and expertise to improve workflow design. By involving nurses in the decision-making process, organizations can create more efficient systems that enhance both patient care and operational effectiveness. Additionally, this presentation demonstrated the value of combining clinical evidence with nurse-led insights to drive workflow improvements. Increase EHR Satisfaction & Efficiency through Personalization Training UCSF Health Education is one of the pillars of success for clinician EHR satisfaction. In 2022, UCSF Health’s advanced practice providers (APPs) ranked in the seventh percentile of Epic organizations for ongoing training sufficiency and the fifth percentile for adequate workflow training. The organization’s APPs underutilized personalized templates, order lists, and shortcuts in the care setting, with 44% needing to perform after-hours EHR work. Guided by insights from their Arch Collaborative results, the organization’s informatics team developed a provider-led ongoing training program that improved workflows through EHR personalization. Using a hybrid model of asynchronous training tailored to individual participants through baseline EHR performance data and small group learning integration, UCSF Health has seen measured improvements in Epic proficiency, after-hours work time, and overall EHR experience scores. UW Health & Virtual Scribes, Then & Now UW Health & IKS Health In this presentation, UW Health and IKS Health reviewed current UW Health metrics and surveys and discussed the future state and technology advancements for virtual scribes. Providing EHR Education & Training Click on the headers to access recordings of the presentations and panels. Nursing Achievements through Innovative E-Learning, Data Utilization & Focused Rounding CommonSpirit Health This presentation dove into innovative EHR learning methods employed by CommonSpirit Health—the largest nonprofit healthcare system in the US—to enhance nurse satisfaction and adoption. By aligning with Arch Collaborative data insights, the organization fostered efficient processes and ensured end-user needs were met. The presentation also explored methods for validating competencies and emphasized continual improvement and user-centric approaches. Fast Lane to Efficiency: How Gundersen’s Virtual Training Strategy Accelerated Onboarding & Educator Effectiveness Gundersen Health System & uPerform Faced with rapid growth, a dispersed workforce, and limited training staff, Gundersen Health System needed to scale their Epic training and ongoing support. They realized the old classroom approach wasn’t enough and chose a digital approach. In this session, Gundersen and uPerform discussed their self-directed virtual training strategy that accelerates onboarding and delivers a more effective ongoing training experience for caregivers. Onboarding & Continuing Education for the Provider Inova Health System Inova Health System has developed a highly effective, multistep onboarding process that incorporates virtual training modalities and at-the-elbow support to ensure new providers are seamlessly integrated into the healthcare team. This structured approach facilitates a smooth transition and empowers providers with the needed tools and knowledge to excel in their roles from day one. In 2024, Inova has implemented an advanced EHR training program, supported by an incentive structure, to provide ongoing EHR education and cultivate a community of SmartUsers. Through these virtual training programs, Inova is enhancing both provider engagement and patient care. Ochsner’s Training Transformation with Amplifire for Onboarding, Go-Lives & Beyond Ochsner Health & Amplifire This webinar shared how Ochsner Health moved to web-based onboarding and ongoing training in the midst of a large implementation by leveraging Amplifire’s adaptive learning platform. The presentation also discussed how the healthcare organization dispelled the perception of adaptive learning as a test rather than a learning platform and how they are leveraging Amplifire for ongoing learning needs. Nursing Informatics: How to Implement a Successful Training Program UCI Health In this webinar, UCI Health shared how they have used Arch Collaborative insights to improve their clinical end users’ experience. Establishing EHR Governance Click on the headers to access recordings of the presentations and panels. EMR Satisfaction: A Holistic Partnering Model Children’s Healthcare of Atlanta Children’s Healthcare of Atlanta’s 2023 Arch Collaborative measurement showed a Net EHR Experience Score in the 95th percentile—a significant increase from their 2019 measurement in the 60th percentile. In this session, the organization shared how they achieved higher satisfaction through a holistic partnering model. Key strategies include clarifying ownership, understanding satisfaction, evaluating quality, integrating learning, and planning collaboratively. Go to the Head of the KLAS: How a Small Children’s Hospital’s EHR Governance Program Helps Set the Bar for EHR Satisfaction Children’s Nebraska In 2023, Children’s Nebraska measured with the Arch Collaborative for the third time, achieving a Net EHR Experience Score in the 90th percentile or higher across all clinical roles when compared to all health systems, all health systems that use Epic, and all pediatric health systems in the Arch Collaborative. The organization shared the governance strategies and philosophies that led to their end users’ high satisfaction, focusing specifically on agile decision-making, use of data to identify problem areas, and strategic use of the phrase “no, but . . .” Enhancing Provider EHR Satisfaction: A CEO’s Perspective Henry County Hospital In 2019, Henry County Hospital went through a total EHR conversion. By utilizing change management theories and focusing on provider needs, the EHR implementation and optimization have resulted in high provider satisfaction with both the EHR and the organization’s IT department. The presentation reviewed the organization’s processes for EHR selection, orientation, and optimization as well as future steps to ensure continued satisfaction. Clinical Optimization & Workflow Enhancement: The Value of Gemba Rounding During an Informatics Program Restructuring UCI Health & Chartis Chartis helped restructure the clinical informatics program and enhance clinical optimization at UCI Health by introducing Gemba rounds for workflow efficiency, aiding with orthopedic workflows and facilitating the onboarding of a new CMIO. This session examined how these organizations’ collaborative efforts resulted in a substantially improved EHR experience score and improved the alignment between IT and end users. Learning from KLAS Research Click on the headers to access recordings of the presentations and panels. Improving EHR Upgrades KLAS Research EHR upgrades introduce new functionalities, improve technology, and incorporate new regulatory requirements. However, clinicians often struggle to adequately understand and leverage EHR upgrades. This session shared best practices to maximize the clinician upgrade experience and prevent frustration. Using the Arch Collaborative to Achieve Your Goals KLAS Research This session summarized findings from recent Arch Collaborative reports, including Empowering Nurses to Focus on Patient Care , Easy Lifts for Quickly Improving EHR Satisfaction , Understanding & Addressing Trends in Physician & Nurse Burnout , and Self-Directed eLearning . Nursing Guidebook 2024: EHR Best Practices for Nurses KLAS Research The 2024 Nursing Guidebook is a great resource for learning data-backed best practices directly from the voices of nurses. This session shared some of those best practices that can improve the nurse EHR experience. Patient Voice Collaborative: Recent KLAS Insights from the Patient Perspective KLAS Research At the heart of EHR improvement strategies is a desire to improve the quality of patient care. This session examined patients’ needs and expectations regarding technology and how it impacts their loyalty to healthcare organizations. Save the Date: Arch Collaborative Learning Summit 2025  KLAS is excited to announce that the next Arch Collaborative Learning Summit will be July 22–24, 2025, in Salt Lake City, Utah. Please reach out to your KLAS Provider Success Manager for more information on the summit and how to register for the event. Summit Attendees Healthcare Organizations Advocate Aurora Health Aliados Health Atlantic Health System Avera Health Baylor Scott & White Health Brevard Health Alliance Children’s Health Children’s Healthcare of Atlanta (CHOA) Children’s Hospital Los Angeles Children’s Hospital of Orange County (CHOC) Children’s Hospital of Philadelphia (CHOP) Children’s National Hospital Children’s Nebraska Cleveland Clinic CommonSpirit Health (Dignity Health) Community Health Care Association of New York State (CHCANYS) CommUnityCare Health Centers Confluence Health Dayton Children’s Hospita Department of Veterans Affairs Enloe Medical Center Essentia Health Franciscan Health Frederick Health The Froedtert & the Medical College of Wisconsin Gillette Children’s Hospitals and Clinics Gundersen Health System (now part of Emplify Health) Health Choice Network HealthLinc Henry County Hospital HonorHealth Hospital Sírio-Libanês Houston Methodist Inova Health System Intermountain Health Jefferson Healthcare Kettering Health Legacy Health LifeBridge Health Loma Linda University Health Mackenzie Health Mayo Foundation Memorial Hermann Health System Mercy Health Michigan Medicine Military Health System/Department of Defense Northfield Hospital OCHIN Ochsner Health Olmsted Medical Center Ozarks Healthcare Piedmont Healthcare Providence Reid Health Saint Luke’s Health System Southern Illinois Healthcare St. Jude Children’s Research Hospital SUNY Upstate Medical University UC San Diego Health UCI Health UCSF Health University of Illinois Hospital & Health Sciences System University of Kansas Health System University of Texas MD Anderson Cancer Center University of Utah Health University of Vermont Health Network UTHealth Houston UVA Health UW Health VCU Health System Wellstar Health System Yuma Regional Medical Center Vendors/Services Firms Abridge Ambience Healthcare Amplifire Canary Speech Chartis CSI Companies DeepScribe Epic Goliath Technologies Greenway Health IKS Health MEDITECH Nordic Microsoft Nuance OnPoint Healthcare Partners Oracle Health ReMedi Solventum Tegria uPerform Healthcare Associations American College of Health Data Management (ACHDM) American Medical Association (AMA) College of Healthcare Information Management Executives (CHIME) 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.

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

Key Findings: Program Goals Keys to Success Organizational Outcomes What Ozarks Healthcare Did

Key Findings: Program Goals Keys to Success Organizational Outcomes What Ozarks Healthcare Did

In 2004, EHR interoperability became a government mandate to make patients’ health data—regardless of where it originated—complete and accessible at the point of care. While most EHR vendors have progressed in their ability to connect to national record exchanges and HIEs, healthcare organizations report that government data-sharing standards are still inadequate and unenforced and that EHR vendors often do not consistently facilitate needed data sharing. Additionally, healthcare organizations often feel unempowered to improve interoperability for their clinicians and patients. This lack of progress from industry stakeholders has left clinicians’ needs unmet. Based on feedback from over 500,000 clinicians, this KLAS Arch Collaborative report shares, for the first time, clinician perspectives on EHR interoperability—examining end-user satisfaction with external integration, needed improvements to how clinicians receive external patient data, and best practices from high-performing healthcare organizations. External Integration Is Worst Part of Clinicians’ EHR Experience, Most-Requested Physician Fix Regardless of EHR vendor, interoperability is a major pain point for clinicians amid an already painful EHR experience. Among the 11 metrics used to calculate the Net EHR Experience Survey (NEES), clinicians are least satisfied with external integration— only 44% of respondents agree their EHR provides expected integration with outside organizations. In particular, physicians most frequently cite interoperability as a challenge and report that it is their top fix request, noting that external patient data often isn’t readily available in their EHR and, if found, is difficult to leverage (see next section). Of all clinical backgrounds measured by the Arch Collaborative, physicians have the lowest average NEES—22 points lower (on a -100 to 100 point scale) than the average NEES of other clinician types. Clinicians’ External Data Needs Are Not Being Met; Lack of Accuracy, Relevance & Accessibility a Major Pain Point The Arch Collaborative asked over 33,000 clinicians about their experience with using outside patient data, and many emphasize that data from outside sources is too often inaccurate, irrelevant, or difficult to find. 47% of respondents report they can’t quickly find important patient information from outside organizations, and another 47% say they have to sift through duplicated data. Voice of the Clinician “The EHR allows us to pull in information for some patients, but there are times when the information is not accurate. EHRs can interpret information for things like immunizations differently, so if we are not careful, we can incorrectly document that a patient has received a vaccine.” —Nurse “There are too many places for outside records to be found. I spend a lot of time looking for records.” —Physician “CCDs can range between 5 and 30 pages. I don’t have the time to sift through that amount of data.” —Physician Few Healthcare Organizations Achieve Successful Interoperability for Clinicians—What Best Practices Do Top Performers Suggest? Most healthcare organizations are struggling to meet their clinicians’ interoperability needs, with most users feeling external integration doesn’t function as it should. However, improved interoperability is possible—the Arch Collaborative has validated 17 organizations where 70% of clinicians or more agree that external integration meets their needs (see chart to the right). To understand these organizations’ keys to success, KLAS spoke to executive leaders from these top-performing organizations. The following best practices are based on these strategies and detail ways that others can better improve interoperability for their end users. Best Practices from Top-Performing Organizations Executive Perspectives from Top-Performing Organizations Commit to sharing data:  “We are not all [sharing data]. . . . [Vendors should have] data sharing settings turned on by default.” —CMIO Coordinate with core sharing partners:  “[Organizations should] identify their network. It can be overwhelming to share data with the entire country, but in a region, there are usually 10–20 health systems that are responsible for over 90% of shared patient data. Sharing data with those health systems is doable.” —CMIO Focus on key health measures:  “We prioritized the mapping of key preventive health measures. We basically said we want to be targeted and strategic, so we looked at things like A1c, colorectal screenings, hepatitis C screenings, and CT/NG screenings. We chose a subset of procedures and imaging tests to squeeze as much usable data as possible from our trading partners, and we put that data in the physician workflows. If we have A1c data from another system, it can’t be buried in a big document. It has to be in normal workflows.” —CMIO Educate end users:  “I was with a physician rounding recently, and they asked me how to connect to our outside data source. They had been at our health system for 18 months. I felt terrible that it took that physician so long to reach out and ask that question. I added the connection, and when I revisited the physician a week later, they said it had already saved them countless clicks and logins.”  —CMIO Involve EHR vendors as much as possible:  “The entire industry relies on standards, but the standards are too broad. The standards need to be baked into technology vendors’ offerings. Far too much responsibility is placed on healthcare organizations to wrangle what is a hugely complicated problem of data mapping. Vendors want to give people flexibility, but they have shot themselves in the foot. I wish my job could be made irrelevant by all EHR vendors. I think they could solve a lot.”  —CMIO Next Steps: Measuring Your Clinicians’ Experiences with Interoperability Healthcare organizations striving to improve EHR interoperability need to know their current position with interoperability. The Arch Collaborative measures clinician satisfaction with EHR interoperability as well as with other factors important to EHR success. To participate in the Arch Collaborative, go to klasresearch.com/arch-collaborative . Additionally, organizations who want help establishing regular touch points with core sharing partners can reach out to their KLAS provider success manager for assistance. Other KLAS Interoperability Research Panel discussion:  Arch Collaborative Learning Summit 2024 panel on EHR interoperability Vendor performance report:  Ambulatory and Enterprise EMR Interoperability 2023 Summit overview:  Interoperability Summit 2022

What Is the Arch Collaborative Nursing Guidebook? The 2024 Arch Collaborative Nursing Guidebook is based on the feedback of around 75,000 nurses who have measured their EHR satisfaction via the KLAS Arch Collaborative over the last three years; in this time, nurses’ satisfaction with their EHR experience has gradually increased. This data has enabled the Arch Collaborative to identify universal best practices that any healthcare organization—regardless of their size, region, or EHR vendor—can use to further improve their nurses’ EHR satisfaction. The best practices shared in this guidebook are organized according to the Arch Collaborative’s EHR House of Success, starting with the foundation (EHR infrastructure) and also including three pillars of success (EHR education, governance, and personalization). Arch Collaborative analysis has shown that these key areas explain a significant portion of the variation in a clinician’s EHR satisfaction and that focusing on these variables can greatly improve the EHR experience. This guidebook also includes a section on nurse burnout and wellness, which are important factors in EHR satisfaction. When organizations address the foundation and pillars, they can improve both nurse wellness and EHR satisfaction. The Cost of Nurse Burnout The average cost of turnover for a bedside RN is $52,350 † —leading the average organization to lose $6.6–$10.5 million per year due to nurse burnout † This calculation is based on data from a 2024 study by NSI Nursing Solutions Inc. EHR Infrastructure: Building a Foundation for Success through System Reliability & Response Time Poor EHR reliability and response time create significant barriers to nurse EHR satisfaction, and these barriers must be addressed in order to create a foundation for nurse EHR success. 40% of nurses feel their EHR doesn’t have the expected response time, and 23% feel it isn’t reliable. EHR Education: Establishing & Sustaining User Mastery & Efficiency Onboarding EHR Education Onboarding EHR education most commonly refers to the EHR training offered to newly hired clinicians during their first 90 days at an organization. Nurses who are satisfied with their initial training report a 135% higher agreement rate that their EHR is easy to learn. However, 42% of nurses feel their initial training was insufficient, and 32% report their training wasn’t specific to their workflow. Ongoing EHR Education Ongoing EHR education is an essential component of user mastery and efficiency. Nurses who are satisfied with ongoing training report a 115% higher agreement rate that the EHR enables efficiency. Unfortunately, 38% of nurse respondents don’t agree that their ongoing training is sufficient. Organizations with the most-highly satisfied nurses typically use three methods of ongoing training. EHR Governance: Supporting Nurse Success through Shared Ownership Although nurse EHR satisfaction has increased in recent years, many nurses still feel they don’t have shared ownership over EHR governance—which is the strategic and operational framework established within a healthcare organization to oversee system management, use, and optimization. Organizations’ governance strategies should involve four elements: (1) decision-making , (2) training/education oversight , (3) accountability , and (4) continuous improvement . 46% of surveyed nurses do not agree that their organization implemented, trains on, and supports the EHR well. Additionally, 56% of nurses report they don’t have an EHR liaison assigned to their area. Having a liaison who provides status updates, collects and shares nurse feedback, and communicates about changes can help address challenges related to governance. EHR Personalization: Increasing Efficiency by Meeting Individual User Needs Personalization allows healthcare organizations to meet the needs of individual end users without making significant changes to the EHR. On average, nurses who have personalized their EHR have a Net EHR Experience Score that is 45 points higher (on a -100 to 100 point scale) than those who have not employed personalization. Nurse Wellness: Reducing Burnout through Well-Being Burned-out nurses are 192% more likely to leave their organization within the next two years compared to those who don’t report experiencing burnout. Nurse satisfaction with EHR infrastructure, education, governance, and personalization can be strong indications of nurses’ burnout risk. About This Report KLAS surveys clinicians about their EHR experience and satisfaction using our Arch Collaborative EHR Experience Survey. This survey captures clinician feedback on various metrics, including 11 metrics (see the accompanying chart) that are aggregated into an overall Net EHR Experience Score (NEES). The NEES represents a snapshot of the clinician’s overall satisfaction with the EHR environment at their organization and can range from -100 (all negative feedback) to 100 (all positive feedback). The data in this report was collected from 171 healthcare organizations between 2021 and 2023—historical data (prior to 2021) is not included. If an organization has surveyed their clinicians multiple times, only the most recent full measurement is included. Additionally, the insights in this guidebook draw from the following sources: The Arch Collaborative Executive Survey , which asks healthcare leadership teams about their organizational EHR practices and processes. The Executive Survey data in this report was collected from 81 executives between 2021 and 2023. Arch Collaborative member case studies , which highlight top-performing members of the Arch Collaborative that have worked with their EHR vendor or third-party vendor to improve different aspects of the EHR experience for nurses. 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 350 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.

Key Findings: Healthcare Delivery Organizations: Optimization Journey Self-Examination Questions HIT Software Vendors: Self-Examination Questions

Key Findings: Healthcare Delivery Organizations: Optimization Journey Self-Examination Questions HIT Software Vendors: Self-Examination Questions

Key Findings: Program Goals Keys to Success Organizational Outcomes What M Health Fairview & uPerform Did How M Health Fairview & uPerform Did It

Unproductive Charting Detrimental to Nurse Productivity & Well-Being  Arch Collaborative data shows that unproductive charting is a significant time waste. Specifically, 35% of nurses report spending three or more hours per week on unproductive charting. † The data also identifies a connection between poor nursing efficiency and higher rates of burnout—nurses who report more than three hours of unproductive charting in a week report higher levels of burnout than those who do not. Given this added stress, it is unsurprising that these nurses also report a higher likelihood of leaving their organization. † The Arch Collaborative survey defines unproductive charting as charting that is duplicative or adds no value. The Nurse Perspective Comments come from nurse respondents to the Arch Collaborative EHR Experience Survey “Nursing charting takes up so much time that it decreases patient care significantly.”  “[Charting] takes time away from our patients. For example, for patients with CRRT, a recent update (about two years ago) added an additional three clicks every hour to care for this very sick patient population. Three clicks means less time with patients, which means less care, which means poorer outcomes.“ “Things requiring charting are verging on ridiculous and make it difficult to provide patient care due to the immense amount of charting required.”   While not all nurses follow through with their intentions to leave, preliminary Arch Collaborative data indicates that nurses who report an intention to leave their organization are 5x more likely to actually leave within two years. Given the expense of staff turnover, helping nurses become more efficient and satisfied can lead to significant cost savings for organizations. With staffing shortages cited as one of the top three contributors to nursing burnout, nursing turnover can further exacerbate the current state of burnout, leading to more financial loss and an increased burden on existing nurses. Steps for Reducing Unnecessary Charting Efforts to reduce unnecessary charting should focus on helping nurses feel that the EHR enhances, rather than hinders, their delivery of patient care. Arch Collaborative data indicates that nurses who report less time on unproductive charting have higher general satisfaction with the EHR ‡ than nurses who report more unproductive charting. This higher satisfaction is evident across all aspects of the EHR measured by the Arch Collaborative survey, though the biggest divergence is seen in nurse agreement that the EHR enables efficiency, patient-centered care, quality care, and patient safety (for more information about the NEES metrics, see this report on drivers of clinician EHR satisfaction). So what can organizations do to improve the nurse outlook? The next sections highlight three steps based on analysis of Arch Collaborative data. ‡ The Arch Collaborative measures satisfaction with the EHR via the Net EHR Experience Score (NEES). Each individual nurse’s responses to the Arch Collaborative EHR Experience Survey regarding core factors such as the EHR’s efficiency, functionality, impact on care, and so on are aggregated into an overall NEES, which represents a snapshot of the nurse’s overall satisfaction with the EHR environment at their organization. A NEES can range from -100 (all negative feedback) to 100 (all positive feedback). Step 1: Assess Current State of Charting through Surveys and Usage Data The first step in reducing unproductive charting is to complete a comprehensive assessment of the nurse experience across your organization. This can be accomplished in multiple ways, but using industry-wide data about inefficient charting in addition to organization-specific data and feedback from individual nurses can help generate buy-in to improve nurse efficiency: Internal perception surveys  can be used to ask nurses to self-report their experience and satisfaction. Additional benchmarking information —such as KLAS’ Arch Collaborative survey—can be used in lieu of or to supplement an internal survey. Additionally, some EHR vendors provide EHR usage tools —such as Epic’s NEAT or Oracle Health’s LightsOn—that can provide details on which users spend a disproportionate amount time on certain tasks. Key Groups to Focus On Each organization’s individual circumstances vary, so organizations will want to assess their own nurses to ensure they direct their efforts to the groups most in need at their own organization. However, the Arch Collaborative’s collective data reveals some general trends: The nursing groups most impacted by unproductive charting are full-time RNs and those practicing in inpatient settings . The specialties in the Arch Collaborative who report the highest frequency of unproductive charting are critical care , perinatal (mother/baby) , med/surg , and acute care . Learn from Your Peers Houston Methodist uses Epic Signal and NEAT data to identify and address EHR issues. They also foster collaboration through shared ownership councils and committees that include nursing and support personnel, and they focus on improving workflows and end-user/clinician efficiency based on user feedback. The organization also uses virtual nursing to alleviate the nursing documentation burden and enhance the patient experience. Step 2: Optimize Nursing Flow Sheets in Problem Areas Using Nurse/Informatics Input After completing the assessment, it is time to identify problem areas and make an improvement plan. Some areas may need substantial flow sheet changes; in other areas, improvement might be achieved simply through additional training. In these latter instances, you can move directly to step 3. For areas that need to be revamped, create a multidisciplinary team to prioritize which flow sheets need optimization, ensure charting matches nurse workflows, and remove unnecessary clicks and duplicative fields. Additionally, this team should establish standard procedures and criteria for making future charting changes. The team should include the following: Frontline nurses and nursing leadership: Frontline nurses can explain how the documentation is used, identify redundancies, and speak to the effects of unnecessary charting on patient care and burnout. Nursing leadership can provide a broader perspective to ensure continuity across focus areas. Informaticists: Informaticists will be able to highlight the technology’s capabilities and limitations and identify ways to create flow sheets that are streamlined but still in sync with the nurse workflow. EHR vendor resources: Organizations should also partner with their EHR vendor to include the right kind of expertise where it is needed. Stakeholders with regulatory expertise: These resources add value to the process by ensuring that regulations are met and that unnecessary tasks are removed when regulations change. Nurses who report having a more active role in optimizing the EHR generally report fewer hours spent on unproductive charting. They also have higher satisfaction with the EHR. Many nurses view this collaboration as an active partnership between all key stakeholders—end users, IT resources, and the EHR vendor. One way to involve nurses in EHR governance is to create a standard process (such as a ticketing system) for the submission, review, and implementation of EHR optimization requests from nurses. Keeping nurses apprised of the status of their requests throughout the process will help manage expectations. Nurses should also receive regular updates about any changes to flow sheets and be given additional training as needed. The Nurse Perspective Comment comes from a nurse respondent to the Arch Collaborative EHR Experience Survey “The redundancy is overwhelming at times. The documentation is considerably more cumbersome than the documentation at my previous, Magnet-designated hospital. At my previous hospital, the nurses contributed to the reduction of excessive documentation by having a representative nurse on the domain team with [the EHR]. The domain team met bimonthly to go over documentation and review policies and procedures together. It saved the hospital money and incidental overtime by having simplified and precise documentation.” Learn from Your Peers Sutter Health’s multidisciplinary team dramatically improved the efficiency and satisfaction of their perioperative nurses by fostering collaboration between nurses and the IT support team to streamline the nursing workflow and documentation requirements. CentraCare Health uses nurse optimizers to connect nursing with the organization’s information systems group. This collaboration helps nurses stay engaged and provides the information systems group with EHR-improvement ideas. TidalHealth Peninsula Regional has reduced their nurses’ documentation burden by fixing existing issues through strong clinical engagement and IT support and also preventing additional burden by adhering to defined change management protocols for nursing documentation requirements. Step 3: Provide Consistent, Workflow-Specific Training The third crucial step in the process is to provide consistent training. Nurses who get better training generally report fewer hours of unproductive charting. Receiving initial training that is specific to their workflow can help newly hired nurses start off on the right foot with efficient charting practices. Ideally, nurses’ initial EHR training teaches them the best way to perform a function for their role rather than showing them a variety of ways to complete the same task. Learn more about providing workflow-specific training in the Arch Collaborative’s Clinician Training 2023 report . Ongoing training is just as vital to efficient charting. Educating nurses about flow-sheet changes is an essential part of the optimization process. Additionally, organizations can always look for ways to help nurses chart more efficiently, regardless of whether a flow sheet has been changed. Nurses who are newer to the profession generally report fewer hours of unproductive charting (see chart). Those who have been in the field for five or more years could benefit the most from additional training to master the most up-to-date and efficient charting methods. The Nurse Perspective Comment comes from a nurse respondent to the Arch Collaborative EHR Experience Survey “Not everyone is trained the same, and if we all chart differently, it can make it harder to find medical information than in a paper chart.” Another strategy that can improve charting efficiency is to standardize organizational charting practices and include charting by exception as the model. Training nurses to chart only patient data that is outside of expected norms can help reduce charting time and make documentation quicker to review—all without requiring any actual changes to the EHR. The Nurse Perspective Comments come from nurse respondents to the Arch Collaborative EHR Experience Survey “Charting should be simple and not take away from patient care. I see a lot of repetitive motions, such as daily safety care, every hour. We should chart by exception and note changes.” “All the charting impedes patient care. I don’t waste time with care plans or notes unless there is something critical that happens. Unless there is a change with my patient that needs to be communicated or elaborated on, there is no reason to duplicate information that is in the flow sheets into a note. Your flow sheets can tell the patient’s story on their own. I chart by exception also.” Learn from Your Peers To prevent a backlog of EHR-optimization requests and increase nurse satisfaction with informatics, Amsterdam UMC developed an ongoing training program with the understanding that many nurse EHR requests and inefficiencies could be addressed with better training. In addition, their ticket triage and ambassador program ensure two-way communication between nurses and support resources. At Valley Children’s Hospital , nurse and IT teams focused on optimizing the most frequently used nurse flow sheets and ensured nurses on the task force received recognition from leadership. They also adapted and streamlined existing training and implemented lunch-and-learns led by nurses who are highly efficient at charting to help shift the culture to documentation by exception, dispelling the common sentiment that if it wasn’t documented, it didn’t happen. 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 440,000 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.