USE DATA TO UNLOCK THE POWER OF THE EHR

Physicians and advanced practice providers who are very satisfied with the EHR are almost five times more likely to report plans to stay at their organization, compared to peers who are very dissatisfied (see chart below); this illustrates how impactful technology can be on the clinician experience. One of the ways organizations can target improvements for those who are less satisfied is to look at EHR satisfaction by specialty—there is currently a gap of about 30 points between the most satisfied specialty (hospital medicine) and the least satisfied specialty (ophthalmology). The goal of this report is to help readers understand this variation and learn some ways the gaps between specialties might be addressed. Note: Arch Collaborative respondents are asked to rate the main EHR solution used at their organization. For ratings on the ancillary EHR solutions designed for specific departments, visit the KLAS website. † 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 Net EHR Experience Score (NEES), which represents a snapshot of the clinician’s overall satisfaction with the EHR environment at their organization. The NEES is calculated by subtracting the percent of negative user feedback from the percent of positive user feedback. An NEES can range from -100 (all negative feedback) to 100 (all positive feedback). EHR Satisfaction for Orthopedics & Cardiology Consistently Below Average across Vendors Examining how specialties score  compared to other users of their same EHR demonstrates that satisfaction can depend more on a user’s specialty than on which EHR is used and can help organizations pinpoint which specialties are most in need of extra focus. Vendor-specific specialty data is available only for Cerner and Epic users (other EHR vendors do not have large enough representation in the Collaborative to be broken out). In both customer groups, orthopedics and cardiology have some of the lowest scores compared to peers using the same EHR; regardless of the vendor’s average NEES, some common areas of frustration for these two specialties include functionality, ability to deliver quality care, and vendor delivery of a high-quality EHR. The specialty that scores the highest compared to each vendor’s average is also the same across Cerner and Epic—for both customer groups, hospital medicine providers report an NEES over 10 points higher than the average for their respective EHRs. These providers are particularly pleased with their workflow training, the EHR’s functionality, and how easy the EHR is to learn.   By implementing new EHR training, support, and governance programs, OrthoVirginia was able to improve their orthopedic providers’ NEES by 44 points. Some keys to success include: Creation of the Provider Support Specialist (PSS) program: Each provider has a touch point with a member of the PSS team every one or two weeks, resulting in greater EHR knowledge and efficiency. Implementation of an EHR governance structure: Modeled on Kaiser Permanente Northwest’s “Pyramid of Change,” OrthoVirginia’s governance creates structure and process for handling EHR change requests. Best Practices from Organizations That Buck the Satisfaction Trends A number of organizations that recently measured EHR satisfaction through the Arch Collaborative survey had abnormally high satisfaction in anesthesiology, cardiology, gynecology and obstetrics, and orthopedics. To understand the drivers of this unique success, KLAS conducted in-depth interviews with leaders from these organizations and also analyzed survey comments from their highly satisfied providers. Several common best practices emerged from this analysis. Additional details on what these organizations have done to improve satisfaction for their providers can be found in the full report. Individual involvement in EHR governance to better understand EHR changes and the reasoning behind them The ability for providers to ask the IT department, EHR analysts, or their peers for help with quick fixes and recommendations for being more efficient with the EHR Significant use of EHR personalization tools that enhance EHR use and make documentation easier Good EHR education, including required organization trainings and self-learning to increase EHR knowledge and understanding Specialty-Specific Workflow Training Tied to Higher Satisfaction with EHR Functionality Though it may take significant time and effort to build specialty-specific workflow training, providers who strongly agree their training was specialty-specific are almost 25 times more likely to agree that the EHR has the functionality they need. Both organizations and EHR vendors can help all providers find success with the EHR by ensuring that initial and ongoing education are tailored to the needs of different specialties. A case study from Kaiser Permanente Southern California outlines their efforts to improve both initial and ongoing EHR education programs by incorporating workflow-specific training. Clinicians attend education classes based on their specific work environment and receive training tailored to their unique needs. These education programs are then supported by rounding efforts. Infrastructure Improvements Could Help Specialties with Declining Satisfaction Several specialties—namely, endocrinology, pulmonology, ophthalmology, critical care, and anesthesiology—have seen notable declines in satisfaction (of 3–14 points) since the Arch Collaborative first began measuring satisfaction in 2017. The individual metrics that have seen the biggest decrease among these specialties are agreement that the EHR is reliable, agreement that the EHR has fast system response time, and agreement that the EHR enables patient safety. A recent Collaborative report on EHR response time and reliability demonstrated that industry-wide issues with system response time and reliability are creating significant barriers to clinician satisfaction and compromising patient safety. Addressing these issues by improving their broader IT infrastructure could be one way for organizations to turn the tide for specialties with declining satisfaction. 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 250 healthcare organizations have surveyed their end users and over 240,000 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. To participate in the Arch Collaborative, go to klasresearch.com/arch-collaborative .

Video Is Public

Program Goals Bridge the gap between IT, builders, clinical informatics, and end users to create a cohesive and effective governance structure Organizational Outcomes 97th percentile in agreement that EHR fixes are timely 95th percentile in agreement that the end user has a voice in EHR changes 89th percentile in agreement that IT is improving the EHR for clinicians Collaborative-Verified Best Practices Clinician Relationships & Communication Creating Shared Ownership: Governance What Dayton Children's Hospital Did

Program Goals Reduce unnecessary best practice alerts to improve alert effectiveness and create a smoother EHR workflow Organizational Outcomes 13-point percentage increase in agreement that EHR alerts prevent care-delivery mistakes from repeat respondents 99th percentile for agreement that alerts prevent care-delivery mistakes Collaborative-Verified Best Practices Shared Ownership and Governance What Dayton Children's Hospital Did

Video Is Public

Program Goals On their first day of clinical practice, nurses should be confident that they have successfully learned how to do all of the documentation that will be required of them. Organizational Outcomes 21-percentile jump between measurements for nurse onboarding training. Collaborative-Verified Best Practices Onboarding EHR Education A focus must be placed on creating effective simulation trainings. What Ohio State University Wexner Medical Center Did

Program Goals Reduce clutter in clinician inboxes. Reduce administrative burden on clinicians and allow them to focus on patient care. Reduce unnecessary notifications to allow emphasis on those notifications that are of higher importance. Organizational Outcomes 88th percentile in appropriate volume of inbox messages for all collaborative participants; 99th percentile for large health systems. Collaborative-Verified Best Practices Clinician Efficiency and Personalization What Advocate Aurora Health Did

Program Goals Increase nursing trust among IT End user satisfaction with EHR program Organizational Outcomes 84th percentile for nursing trust in IT Collaborative-Verified Best Practices Using EHR rounding to interact frequently with clinicians. EHR efforts are clinically, and IT supported. Clinician Relationships and Communication What University of Michigan Health West Did

Program Goals Provide a smooth transition to MEDITECH Expanse Organizational Outcomes 91st percentile for providers agreement on “Initial Training Was Sufficient” Collaborative-Verified Best Practices Onboarding EHR Education Clinician Relationships and Communication What Ozarks Healthcare Did

Program Goals Improve EHR optimization process so that providers will know where requests and approved projects are in the ticketing process. Optimize project management lifecycle to better manage end users’ expectations. Organizational Outcomes 91st percentile for provider agreement that they have a voice in improving the EHR 90th percentile for provider agreement that EHR fixes are made in a timely manner 87th percentile for provider agreement that they know how to request a fix for the EHR Collaborative-Verified Best Practices Shared Ownership and Governance What Southern Illinois Healthcare Did

Program Goals Help clinicians improve their EHR experience and documentation process. Improve response and resolution timelines to ticket requests. Organizational Outcomes 82nd percentile for nursing trust in IT. Collaborative-Verified Best Practices Shared Ownership and Governance Clinician Relationships and Communication Nursing EHR Success What Ochsner Health Did

† 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 Net EHR Experience Score (NEES), which represents a snapshot of the clinician’s overall satisfaction with the EHR environment at their organization. The NEES is calculated by subtracting the percent of negative user feedback from the percent of positive user feedback. An NEES can range from -100 (all negative feedback) to 100 (all positive feedback). Trust in Organization/IT Leadership Has a Big Effect on Overall Experience Since Arch Collaborative research began in 2017, participating organizations have seen improvements in some areas and declines in others. Despite an overall increase in the average NEES (by 16 points), clinician satisfaction with organizational EHR delivery has decreased by about 4 percentage points. The difference in clinicians’ NEES is dramatic depending on how they rate their organization/IT leadership. On average, there is a difference of 124.1 points in NEES between clinicians who strongly agree their organization/IT leaders deliver well and those who strongly disagree. (The same trend appeared in the Arch Collaborative’s last report on this topic.) This is especially important because clinician burnout is on the rise—fewer clinicians (by about 9 percentage points) report no burnout compared to four years ago. Organizations that have earned high trust from their clinicians are uniquely set up to address burnout. Targeted Organizational Initiatives Drive Significant Satisfaction Improvement Some Collaborative organizations have measured clinician satisfaction both before and after implementing an initiative targeting a specific department or goal. On average, these organizations see significant improvement in NEES. Typical areas of focus for these initiatives include training (e.g., training sprints for specific areas, a full EHR training overhaul) and implementation of new software (EHRs and other supporting technology). In these measurements, the NEES of repeat respondents increases an average of 22 points. In contrast, repeat respondents whose organizations have measured multiple times but not for a specific improvement initiative see an average NEES increase of about 7 points. In addition to seeing an increased NEES, repeat respondents for organizations that conduct pre/post surveys also report higher satisfaction with all three EHR stakeholders. EHR Training, Efficiency, and Ease of Use Most Impact Trust in Organization/IT Leadership A Boruta analysis (an algorithm used to determine what variables are most important to a particular metric) shows that the factors most important to clinicians’ perception of their organization/IT leadership are initial and ongoing EHR training, followed by agreement that the EHR enables efficiency, is easy to learn, and enables quality care. Organizations that focus on making strides in these areas will see higher satisfaction and trust from clinicians. Utilizing Superusers Yields Higher Trust in Organization/IT Leadership One common effort organizations make to improve satisfaction with ongoing training is using EHR superusers. Organizations that leverage superusers deeply embedded in their various departments also see higher ratings for trust in organization/IT leadership. In Arch Collaborative case studies, organizations with standout EHR satisfaction share their keys to success, and there are currently 17 published case studies that relate to superusers. Below are some common recommendations (additional details are included in the Expanded Insights section of the report): Give every department/specialty a superuser Prior technical expertise isn’t necessarily needed Protected or paid time for superusers can be helpful Superusers are best deployed as a peer-to-peer aid resource to teach best practices, support adoption of personalization tools, and more Superusers are key to developing effective EHR education materials Superusers are extremely effective members of EHR governance boards EHR Support of Patient-Centered Care Affects Organization Satisfaction The EHR is supposed to be a tool that helps clinicians deliver high-quality care to patients. When clinicians feel the EHR doesn’t support high-quality, patient-centered care, they are much less likely to be satisfied with their EHR and their organization. A little over 44% of all Collaborative respondents disagree or are indifferent that their EHR enables patient-centered care. The Collaborative organizations that rate highest for agreement that the EHR enables patient-centered care also see much higher agreement (by 20 percentage points) that the organization and IT leadership deliver well, compared to organizations who score lower on this metric. For additional insights on how to make the EHR more patient-centric, see case studies from CentraCare Health , Royal Children’s Hospital Melbourne , and UVA Health . 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 250 healthcare organizations have surveyed their end users and over 240,000 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. To participate in the Arch Collaborative, go to klasresearch.com/arch-collaborative .