Arch Collaborative

Program Goals As part of the organization’s digital transformation strategy, continually improve the clinical user experience of the EHR. Organizational Outcomes Scored in the 91st percentile for Net EHR Experience Score in 2020 Increased Net EHR Experience Score by 14 points for physicians Is a top-performing Cerner organization in the Arch Collaborative Collaborative-Verified Best Practices Develop a comprehensive change management strategy so all stakeholders are engaged and informed throughout Have the governance and steering committees engage key champions to help drive deliverables, buy-in, and user satisfaction/experience What KFSH&RC Did

33% of Repeat Individuals Report Significant Improvement Changes in Net EHR Experience Score (NEES) † between a clinician’s first and second measurement have an almost perfect normal distribution, validating the accuracy of the survey in gauging EHR satisfaction. While the average clinician reports a 6.3-point improvement, approximately 33% of clinicians have seen highly significant improvement (i.e., an increase in NEES of at least 20 points). Analyzing the data from these “high-improvement” clinicians reveals the factors most commonly associated with improved EHR satisfaction (see below). † 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). The Individual Metrics Most Commonly Associated to High Overall Improvement Almost all clinicians in the high-improvement group report an increase in their personal accountability for mastering the EHR. This validates a key finding of the Collaborative, which is that—across metrics—users themselves can account for up to 40%–60% of the variation in their EHR satisfaction (see “Stakeholder” chart below). See the Intermountain Healthcare case study to learn how that organization’s focus on provider coaching led to improved perceptions of the EHR. Other common associated improvements include improved perceptions of the EHR vendor, increased satisfaction with the quality and frequency of ongoing training, and greater adoption of personalization. This validates the importance of two of the Arch Collaborative’s three pillars of EHR satisfaction: training (both initial and ongoing) is an important aspect of the user mastery pillar, while personalization is critical to the EHR “meeting unique user needs.” See full report for additional details on the three pillars. The Individual Metrics with Most Impactful Association to High Overall Improvement While personal accountability is the most common change, system integration is the core NEES metric associated with the largest increases in overall EHR satisfaction and represents a significant opportunity for organizations and vendors to completely shift their end users’ EHR perceptions. Regarding integration, respondents are asked to rate—on a five-point Likert scale—their level of agreement that the internal and external integration is sufficient. On average, respondents who increase by four levels of agreement (i.e., move from strongly disagree to strongly agree) see a corresponding NEES increase of 130.7 points. Even more modest shifts of one or two levels of agreement can still yield significant improvements. It is important to note that the core NEES metrics that are associated with the largest improvements in overall satisfaction—including integration as well as system speed and functionality—are actually the ones that individual clinicians have the least control over (see “Stakeholder” chart above). This highlights the fact that true EHR success does not depend on the user alone—it also requires collaboration from the vendor and organization to make meaningful changes that individuals cannot make themselves. Among the survey questions that don’t factor into a respondent’s NEES, the ones with the largest associated increases are the same metrics noted above as the most common—personal accountability, agreement that EHR vendor delivers well, and satisfaction with ongoing training. The strong association that exists between a respondent’s overall EHR satisfaction and their approval of the EHR vendor’s delivery again highlights the importance of provider organizations working closely with their vendors to hold them accountable for needed changes. Key Takeaways Changes across measurements show that a delicate balance must be achieved between three stakeholders: the individual, the provider organization, and the EHR vendor. When the three work together, it is possible to achieve significant improvement in EHR satisfaction. Individuals have the opportunity to improve their own satisfaction with the EHR by attending trainings, using tip sheets, and adopting more personalizations. Provider organizations and EHR vendors are responsible for making needed improvements to things such as integration, functionality, and system response time. Efforts in these areas can compound end-user efforts and transform EHR detractors into evangelists.

Program Goals Identify where problems exist within the EPR Provide each ward with access to the IT team Develop clinician EPR design expertise to help drive improvements Organizational Outcomes 15-point Net EPR Experience Score (NEES) improvement for doctors 20% increase in agreement that ongoing training is sufficient for doctors 14-point NEES improvement for nurses 16% increase in agreement that ongoing training is sufficient for nurses Collaborative-Verified Best Practices Round frequently to provide the IT team with key understanding of the needs of end users Collate up-to-date list of IT/hardware/Wi-Fi issues and promptly address and fix them to improve the experience for end users Focus on end-user mastery, both in providing easier access to help and placing some of the responsibility of success on groups of end users What University Hospitals of Morecambe Bay Did

Report

Arch Collaborative Nursing Summit White Paper 2021

28 May 21 | Connor Bice

Each healthcare organization that participated in the workshop experiences EHR delivery problems ranging from underdeveloped training programs to overwhelmed admission navigators to uncertainty regarding which clinical areas handle documentation. This paper highlights the organizations’ identified obstacles within the Arch Collaborative’s successful user framework (i.e., strong EHR mastery, shared ownership, and EHR meeting unique needs) and their solutions for overcoming those obstacles. KLAS wants to extend a special thanks to the following healthcare organizations and their faculty members for participating in the workshop. To watch a video of what sets these organizations apart, click the links below: Community Health Network Connecticut Children's Edward-Elmhurst Health Henry Ford Health System Spectrum Health Organization A (Shared Ownership) Identified Problem Organization A wants nurses from the floors and at the bedside to become engaged with EHR changes. The nurses’ involvement would shape the EHR development and improve its usability, resulting in increased EHR satisfaction. Proposed Solution Organization A intends to better involve care-giving nurses in the governance process by developing an EHR-champion network comprising nurses from the floors. With better engagement and wider representation, the organization hopes that more nurses will become enthusiastic about the EHR and choose to participate in the champion network as part of their career path. Ideal candidates for the network ask questions like “How can I impact and shape the EHR?” and “How can I engage educators in their units’ workflows and EHR usability?” Nurse champions will need to gather feedback, often from personal interactions in hallways and emails. The organization wants to broaden those personal interactions by assigning a nursing representative to each floor. Feedback that is acted upon will improve functionality and help floor nurses feel heard. Plan to Measure Organization A will use smaller KLAS surveys to measure the effectiveness of their implementation. They will also better leverage data from Epic’s Nursing Efficiency Assessment Tool (NEAT). The organization wants end users to rate their engagement with the EHR-champion network to know what is and is not working. Organization B (Shared Ownership) Identified Problem Organization B seeks to decrease burnout and the documentation burden among nurses. In the organization’s most recent KLAS survey, it was noted that nurses can spend up to 30–40 minutes completing the admission process. Proposed Solution To reduce burnout, Organization B will reduce redundant documentation. Each part of the documentation process will be examined to identify regulatory requirements and to determine whether the nurse is the right person to handle that documentation. The organization wants their system to retain information throughout the care continuum so if something is documented during one step of the process, it doesn’t have to be documented again during a later step. A governance process will be established to approve of new functionality and to determine whether older technology is still needed. The organization also wants to look at Epic’s Thrive class for nurses and Epic’s Foundation System to see how their tools and practices compare to other organizations’. Because Organization B has been using Epic for a while, they are considering removing some tools and updating others that Epic has improved over the years. Plan to Measure Organization B wants to monitor nurses’ use and acceptance of Rover, which was recently rolled out. Additionally, they will continue to participate in the Arch Collaborative and use pre- and post-surveys to measure implemented tools. To understand the valuable time that could be added back into the nurses’ workdays, Organization B will track the time that nurses are currently spending in the charts. Organization C (EHR Mastery) Identified Problem Organization C needs to improve their ongoing EHR training and education for nurses, who reported low satisfaction with their EHR education in their Arch Collaborative survey. Proposed Solution To address this problem, Organization C has identified several potential solutions, one of which is using Adobe Captivate or Microsoft Teams to record five-minute snippets of training content. The organization can currently access eLearning material, but using one of these programs would allow them to manage the material as well. The organization plans to save all learning materials in an accessible, but not editable, folder. This way, if a nurse has a question when trainers aren’t available, the relevant instructions or materials are readily available. Organization C also plans to have a more targeted approach to their communication. To better distribute information, the organization wants to create a biweekly newsletter to share tips and tricks, write information on whiteboards, and place flyers in staff rooms. The organization will put dates on the flyers so they know when the flyers have become outdated and need to be replaced—an idea that was shared at KLAS’ workshop. These ideas will increase awareness of changes to the EHR. Because some changes only impact certain user groups, the organization intends to communicate changes to the appropriate people by outlining the top changes for each service line. This way, nurses won’t have to read through several pages of content to find the information they need. Lastly, the organization will encourage two superusers from every service line to attend a monthly meeting. Ideally, at least one will be able to attend so that a superuser from each service line is present. Plan to Measure Organization C is considering doing a pre- and post-survey. At the time of the workshop, the organization had an EHR update scheduled for March, and they were considering doing another benchmark measurement about six weeks after the update went live. Organization D (Shared Ownership) Identified Problem Organization D has several teams operating in various areas: clinical informatics, applied informatics, nursing professional development, nursing education, and application training. Team members’ roles need to be better defined so that everyone knows each other’s responsibilities. Proposed Solution Organization D wants to start a series of meetings to align and engage different team members. The organization had an integrative training work group in the past and believes reimplementing this work group on a monthly or quarterly basis would help improve nurse EHR education and satisfaction. Additionally, Organization D is looking at cognitive learning platforms to design content and help provide a better EHR experience for nurses. A learning platform could help with ongoing education because the organization would be able to virtually publish micro-learnings using a very targeted approach. The platform would help Organization D avoid wasting time on unnecessary content and decrease the time nurses spend on education. To assist educators in distributing content among the staff, Organization D wants to establish a stronger feedback loop. This would allow team members to work more closely with the educators to improve trainings. Plan to Measure Organization D intends to use their Epic NEAT data to increase transparency. Epic provides a dashboard that highlights nursing impact, and the organization could further build this out for managers. With COVID-19, the distribution of NEAT data to people who needed it was paused, but now the organization would like their trainers to have access to that data and to the feedback loop to increase transparency. Organization E (EHR Meets Unique User Needs) Identified Problem Organization E wants to decrease the nursing documentation burden, specifically around best practice alerts (BPAs). Proposed Solution After examining their BPA usage, specifically during admission, Organization E determined they have an opportunity to remove some of the documentation they are doing. The organization will look at their data and use Slicer Dicer to better understand how BPAs are being used. This data will help identify solutions that are low-hanging fruit. Plan to Measure Organization E will use the data from their Arch Collaborative survey to inform them about their next steps and initiatives. They will also work with their KLAS representative to analyze measurements as they move further along their journey. Organization F (EHR Mastery) Identified Problem Organization F desires to improve nursing efficiency. Within the organization, there is a tendency among nurses to fill all blank spaces when documenting. Organization F wants to change this mind-set. Proposed Solution Organization F discussed how to offer better EHR education for nurses, provide more real-time alerts, and help nurses have more of a voice when changes are needed in the system. The organization is moving toward a Cerner-supported model called clinical datasets and is completing an assessment through which nurses can report documentation challenges. Previously, there was more feedback from bedside nurses, and the organization wants to encourage feedback by reimplementing a nursing informatics council within the next six months. This would allow bedside nurses to be involved in making changes and improvements to the system. For those staff members who have joined in the past year and a half, Organization F wants to distribute an assessment to evaluate the current training situation and improve both onboarding and ongoing EHR education. At the time of KLAS’ workshop, the organization wanted to achieve this within three months. Plan to Measure Organization F can use Cerner’s Advance data to see how long it takes nurses to do certain tasks in different areas. They will follow up on that data and use repeating surveys every three months to check their progress. Organization F wants to ensure that users aren’t overwhelmed and that all surveys and measurements are completed before moving on to future rounds of surveys and measurements. Organization G (EHR Mastery) Identified Problem Organization G wants to invest in improving their EHR training program for nurses. Proposed Solution Organization G’s training team will prepare consumable content (i.e., able to be internalized in 15 minutes or less) and deliver it to leaders, who can then disseminate the content during staff meetings. Organization G will also launch a video series that provides tips and tricks for specific topics and explains how to maximize use of the EHR. The organization will determine whether this video series should be mandatory to watch and will widely advertise it so it is accessible to staff. Plan to Measure Organization G wants to invest in a training program based on the perceptions of both new and seasoned nurses. Organization G’s team needs to demonstrate to executive leaders that increased training is worth investing in. To do this, the organization will measure training efficacy by asking staff members the following questions: “Was the training worth my time?” “Do I feel prepared or competent?” “Did I learn anything that was intended to be taught?” Afterward, Organization G plans to observe whether trainees can do what they were trained to do. The organization will focus on a training’s success from both the instructors’ and the attendees’ perspectives. The organization wants to compare what content is taught with how the content is used by staff members once they complete a course. Organization G will also use KLAS, the Net EHR Experience Score, and Press Ganey results to continually measure staff perception, changes in attitude toward training, and KPI trends. Organization H (EHR Mastery) Identified Problem Organization H has established an advanced training path for their providers but not their nurses. Ongoing education programs need to be defined and designed with a greater focus on user settings. Proposed Solution Organization H first wants to identify a pilot group, consisting of staff from either a specific service line or a specific facility. With a pilot group in place, the organization will examine which parts of the workflow can be personalized or modified for nurses. The resulting information will be presented to the organization’s CNO to create buy-in for the user-setting training. The plan is to roll out the changes to superusers first and then give superusers a list of nurses to teach. Organization H will also refocus on new nurses two to four weeks after they are hired to ensure they know how to navigate user settings. Plan to Measure Organization H will prove the value proposition, collect specific NEAT data, and use the Arch Collaborative to do a pre- and post-survey to look at the pilot group’s results. The organization will use the positive results as building blocks to build out their training path and offer more ongoing training for nurses. Organization I (EHR Mastery) Identified Problem After taking the KLAS survey, Organization I discovered their ED nurses—who use their own system—don’t feel supported and need more ongoing education. Proposed Solution Organization I has several proposed solutions, several of which involve training nurses and creating specialists. In each service line, the organization employs clinical development nurses. Organization I would like each nurse in this role to become a certified trainer with Epic. The nurses in each service line would then have superusers and certified trainers to support them. Organization I also seeks to identify subject matter experts to represent each of the organization’s EDs and take advantage of Epic’s Thrive training. To further expand their training, Organization I intends to have their principal trainers become more involved in change management to support ED nurses during changes. These trainers would be knowledgeable about the system and go-lives, and they would be responsible for creating reference sheets and videos for the nurses to quickly access. Organization I also wants to better use data and tools to support their nurses. They plan to measure success and opportunities for improvement, adopt efficiency-enhancing tool sets such as an admissions navigator, and provide ongoing change management. To tackle their current implementation process, Organization I has put together a clinically focused team that has experience working in departments and knows what pressures and concerns nurses face. The team will help the organization configure the system by being the nurses’ advocates. The organization seeks to be up front with nurses about how their work might slow down, simply because information won’t be documented on paper going forward. But the system will allow the organization’s staff to be more connected and better visualize data, ideally resulting in high initial adoption. After the go-live, Organization I will host an optimization sprint in the ED and ask users what their five most significant worries are regarding the system. The organization will put together a team to establish a plan addressing those concerns while simultaneously optimizing the system. Plan to Measure Organization I wants to define multiple metrics to measure the work they do. They will define and establish baselines and build dashboards so managers can access data and take action. Organization J (EHR Mastery) Identified Problem Organization J wants to promote user satisfaction and system efficiency by streamlining nurse education and introducing a personalization program. Proposed Solution Organization J seeks to optimize their current onboarding training and focus on user settings to facilitate ongoing efficiencies. The organization’s education team is already rewriting the inpatient onboarding training to make it more workflow based, which will decrease the total training time. Organization J also wants to check in with their round-back practice for new users to ensure these users see a bang for their buck when starting at the organization. Managers need additional training regarding efficiency, reporting, and personalization because they work in a different environment. The organization would also like to create an advanced training program for their preceptors. The preceptors need to use the same approach across all locations so that everyone has the same expectations and level of preparation. Plan to Measure [Measurement plans were not completed during the workshop.]

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