EHR Optimization

Assess Your Organization Want to know more about how to mitigate the impact of EHR dissatisfaction on providers’ likelihood to leave? Contact your KLAS representative or send an email to arch.collaborative@klasresearch.com . Physician-Reported Plans to Leave Bear Out in Actual Turnover Rates Based on an odds ratio calculation of Arch Collaborative data, physicians who indicate they are very likely to leave their organization are 15 times more likely to actually leave compared to those who report being very unlikely to leave. With this high, statistically significant correlation, organizations should feel empowered to take meaningful steps to correct the trend based on their results for this question. And when organizations’ efforts result in decreased physician-reported plans to leave, they can be confident this will bear out in actual reduced turnover. Engage Physicians at Risk of Leaving with EHR Education Physicians who indicate plans to leave their organization can still be reached by their organization and are open to an improved experience. Even among physicians who ultimately decided to leave their health system, two-thirds expressed a strong willingness to engage with their organization by receiving more EHR education. Remarkably, this trend remains robust even when accounting for various other factors—regardless of their personal efforts to learn the EHR, overall satisfaction with EHR, previously reported plans to leave, or burnout levels, a majority of physicians express the desire to receive more EHR training. This highlights the broad importance of enabling physicians to acquire necessary skills and knowledge to effectively navigate EHR systems. Reversing the Trend—Insights from 54 Physicians Who Changed Their Minds about Leaving Since the Arch Collaborative began measuring turnover in 2019, 54 physician respondents have had a change of heart regarding their desire to leave their organization within the next two years (i.e., originally planned to leave but later indicated they would stay). These individuals report experiencing significantly reduced after-hours workload, along with alleviation of a chaotic environment that drove burnout. Of note, the most significant improvements were regarding alerts preventing care mistakes, the EHR’s ability to support patient safety, and the EHR’s support of better patient care. Agreement with any of these metrics is correlated with a strong perception of the EHR as a high-quality product. Comments shared by the above 54 physicians illuminate other important areas to address. These physicians specifically highlighted their efficient use of the EHR—including voice recognition, shortcuts, and macros—as a driver of improved satisfaction. While personalizing the EHR for improved efficiency may necessitate physicians investing significant time, there are strong returns for those who embrace smart phrases, personalized filters, smart orders, and a customized toolbar. Some responding physicians also highlighted improved integration with prescription drug monitoring programs (PDMPs), the rollout of telemedicine, and secure chat features as having improved their satisfaction. Organization -Focused Interventions Reduce chaos in the work environment Learn from your peers: Amid the many factors that contribute to a chaotic work environment, Bellin Health is tackling the EHR upgrade experience. They built schedules to prepare, test, and deliver communication and training for upgrades to make changes as easy for clinicians as possible. Improve alerts so they better prevent care mistakes Learn from your peers: Wellstar Health System works hard to provide meaningful best practice alerts (BPAs) that don’t contribute to alert fatigue. Wellstar uses a system-level committee that methodically evaluates a potential BPA’s impact. Also, Dayton Children’s Hospital uses a specific BPA committee and feedback from end users to ensure their BPAs are as effective as possible. Individual Physician –Focused Interventions Reduce burnout  Learn more in the Arch Collaborative report “ Provider Burnout & the EHR Experience ” Reduce after-hours charting Learn from your peers: A few years ago, St. Charles’ coders brought to light some charting backlogs. St. Charles began pulling data from their EHR database and generating reports by specialty in Power BI and Excel to provide the transparency and accountability needed to stay on top of chart-closure rates. Several times a week, these reports are supplied to managers and administrative directors, who then follow up with providers who start to fall behind. Increase use of macros Learn more in the Arch Collaborative report “ Successful User’s Guide to High EHR Satisfaction .” Highly satisfied providers most commonly cite use of personalization tools as the reason for their success with the EHR. It is important to tailor EHR personalization to providers’ needs because doing so can enhance providers’ overall experience by making the system feel reliable and efficient. EHR Vendor –Focused Interventions Better enable the EHR to support patient safety  Learn from your peers: Wellstar Health System maintains a culture of prioritizing patient care by using that as a lens through which they view the EHR. Make the EHR more patient-centered  Learn more in the Arch Collaborative report “ Successful EHR Upgrades ” Focus on delivering a high-quality EHR  Additional insights on how vendors can deliver a high-quality EHR can be found in KLAS’ report “ Role of Provider/Vendor Partnership in EHR Success .” 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.

Program Goals Help clinicians feel a part of the community, not simply part of a medical group. Create a team and a family atmosphere within departments. Organization Outcomes 92nd percentile for physicians likely staying at the organization 87th percentile for nurses not being burned out Collaborative-Verified Best Practices Clinician Wellness and Reducing Burnout What Harbin Clinic Did Harbin Clinic has made their clinicians as well as clinical/nonclinical staff feel a part of the community through activities in the office and outside of clinical hours to strengthen and build relationships with one another. They also celebrate the accomplishments of team members and encourage their participation with EHR governance to help clinicians feel valued. How Harbin Clinic Did It

Program Goals Improve clinician workflows and overall EHR satisfaction Organization Outcomes Provider NEES increased by 27 points Provider ongoing training satisfaction increased by 42% Nurse NEES increased by 10 points Nurse ongoing training satisfaction increased by 26% Allied health NEES increased by 24 points Allied health ongoing training satisfaction increased by 50% Collaborative-Verified Best Practices Ongoing EHR Education What UVM Did University of Vermont Medical Center (UVM) uses a two-week sprint program aimed at optimizing EHR workflows. The sprint initiative has a team of informatics experts and clinical leaders work with representatives from every role in the clinical setting. The program focuses on individual training and the adoption of optimized workflows. Prior to the two-week sprint, informatics experts work with medical and staff directors at the participating clinic to understand the site's unique needs and pain points, review the EHR, and complete a presurvey with the clinicians. Engaging with the clinic's staff is vital to understanding and identifying challenges ahead of time and to building trust and relationships with the clinical team. How UVM Did It

Program Goals Create a cohesive structure for EHR governance and training that will lead to more successful users Organization Outcomes 15-point Net EHR Experience Score (NEES) increase between measurements 85th percentile in agreement that in-person training is helpful 97th percentile in agreement that virtual EHR training met my needs 14-point increase in agreement that ongoing training is sufficient 5-point increase in agreement that athenahealth delivers well 90th percentile in agreement that someone is assigned to my area to help with the EHR Collaborative-Verified Best Practices Ongoing EHR Education Clinician Relationships and Communication Shared Ownership and Governance What Wahiawa Health and athenahealth Did

This report delves into many of the questions posed to clinicians in the Arch Collaborative’s User Experience and Trainer Quality Benchmark surveys † to help further demystify the specific characteristics of EHR education that lead to clinician success with the EHR. The report also provides guidance on how organizations can generate clinician enthusiasm around EHR training to better help them thrive in their EHR environment. Unless specifically stated, all findings relate to both initial and ongoing training. † The User Experience survey asks clinicians approximately 40 questions about their EHR experience and how it relates to their well-being and ability to care for patients. Key metrics from this survey are used to create an overall Net EHR Experience Score and to generate peer benchmarking. The Trainer Quality Benchmark survey asks clinicians 11 questions about their satisfaction with the EHR training they have received and the trainer who provided it. This data allows organizations to compare their training with that of other organizations and also allows them to benchmark satisfaction across individual trainers at their organization. Training Best Practices at a Glance  Train in the context of patient care: Train clinicians on how to use the EHR within the context of caring for their patients. Knowing how to do/access something is not the same as it being a seamless part of the clinician workflow. Tailor the method to the message: Provide in-person training when possible and replicate the feel when impractical. Take advantage of the ease and accessibility of tip sheets and self-guided eLearning for quick, straightforward messages. Utilize one-on-one training for specific content or individuals that require more in-depth guidance. Protect time for ongoing education: This is best formatted as 15- to 60-minute sessions, totaling 3–5 hours per year. Demonstrate the ROI: Share clinician testimonials, leverage usage data from the EHR vendor to demonstrate improved efficiency, and utilize surveys before and after training to gauge clinician-reported time savings. Prioritize mastery, not just proficiency: Even the most satisfied clinicians still have significant room for improvement. Clinicians in the top 80th percentile in terms of satisfaction with the EHR report an average score of just 58.9 (on a scale of -100 to 100). Use the Training Method Best Suited for the Message No one training method is guaranteed to be effective in all situations. It is important for organizations to choose initial and ongoing training methods that are realistic and scalable. At-the-elbow training is the method clinicians are most likely to describe as useful. However, given the time and resources it requires to consistently provide such training across an enterprise, organizations may need to carefully consider which content is best taught at the elbow and which content can be taught via other methods. Indeed, according to clinicians’ self-reported data, classroom training is the most common method by which they receive EHR training. This makes sense as it is a much more scalable approach. Data from the Trainer Quality Benchmark survey indicates that self-directed eLearning may generate the biggest bang for the buck in terms of time savings for clinicians (see chart on next page). Individual eLearning sessions most commonly last less than 60 minutes (compared to the 3–8 hours for the typical session of classroom training) and can generate a significant ROI in terms of time savings for clinicians—on average, clinicians who participate in self-directed eLearning report saving 20–25 minutes per week in the EHR for every 15 minutes of eLearning. This demonstrates that self-directed eLearning can be a valuable tool for communicating simple, straightforward information that improves clinician efficiency. Bellin Health Training Case Study Bellin Health makes upgrade-specific training as palatable as possible for their clinicians, using different approaches depending on the clinical background of the trainee and the message being shared. See Bellin Health’s case study for more details. Virtual instructor-led training generates many of the same positive impacts as in-person classroom training while being more realistic and scalable. At the start of the pandemic, organizations were forced to transition to virtual training almost overnight, resulting in a Collaborative-wide dip in training satisfaction as many organizations adjusted or put training programs on hold. However, satisfaction with virtual training has increased since 2020 as organizations have learned how to make it more effective. Some Collaborative members have found success replicating the in-person experience by providing engaging, interactive instructors and curriculum. Guthrie Clinic Case Study The Guthrie Clinic makes the best of virtual training by using engaging trainers, splitting the screen between the trainer and course content, and ensuring the EHR is available to clinicians during training to apply what they are learning. Learn more about Guthrie Clinic’s approach in their case study . Clinicians Need More EHR Training, Whether They Realize It or Not Almost half (46%) of clinicians who have taken the Arch Collaborative survey say they do not need more ongoing EHR training. However, on average, these clinicians don’t report significantly higher EHR satisfaction than peers who do want more training—as measured by the Net EHR Experience Score (NEES) † , the delta between the two groups is only about 6 points (on a scale of -100 to 100). How can organizations design ongoing EHR training that delivers tangible benefits for their clinicians? † 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. A NEES can range from -100 (all negative feedback) to 100 (all positive feedback). Shift the narrative to focus on EHR mastery: Across clinical backgrounds, the most common sentiment among clinicians who don’t want more training is that they already feel proficient with the EHR. These respondents’ average NEES indicates that this perception is likely accurate. However, even well-performing clinicians have weak spots, and regardless, EHR mastery, not general proficiency, should be the goal. Enlist the help of the least satisfied clinicians: The low average NEES of clinicians who cite poor training quality as a reason for not wanting more training is of concern. Poor experiences in the past may make these users hesitant to reengage. OrthoVirginia found success enlisting these very users to help improve the training experience for their peers. See their  webinar for more details. Demonstrate proven time savings: Advertising the potential time-saving benefits of additional training can motivate clinicians to make training a priority. This can be done by reporting time-savings data to clinicians gleaned from after-training surveys (such as the Collaborative’s Trainer Quality Benchmark), year-over-year EHR experience data (such as that collected by the Collaborative’s standard User Experience survey), data from pre/post surveys collected around implementation of a new initiative, or clinician usage data provided by the EHR vendor. Intermountain Health and Kaiser Permanente Southern California  Intermountain Health developed a flexible coaching program that increased their organization NEES by 40 points and helped clinicians save 63 minutes per week after a 1-hour session. Read more about what Intermountain Health did in their case study . This program was partially modeled after Kaiser Permanente Southern California’s ongoing EHR education master course, which 98% of attendees recommend to their peers. Read more about the training program in their case study . Workflow-Specific Training Is Linked to Higher EHR Satisfaction Agreement that initial or ongoing training is workflow specific is correlated with higher satisfaction in some hard-to-improve metrics, including the EHR’s efficiency, functionality, internal integration, external integration, and ease of learning. In fact, across the Collaborative, external integration, efficiency, and ease of learning are the three NEES metrics with the lowest satisfaction . However, teaching clinicians to use information from the EHR within their workflow might be as important as working to improve the EHR itself. Clinicians who report that training is workflow specific are also  less likely to report burnout and less likely to report plans to leave their organization . Higher satisfaction with personalization training is also correlated with a higher overall NEES. When asked an open-response question about what they found useful about training, clinicians repeatedly mention the importance of getting training that applies to real-life scenarios (see examples in the "Voice of Clinicians" section). Many clinicians say they want scenario-based training and a trainer with specialty-specific clinical knowledge who can answer questions in real time. The Voice of Clinicians “For training to be more useful, it really needs to be directed by providers who use the system. There is a big difference in the theory of how it should work and the reality of what it looks like using the system in practice.” —Physician “In-person training was helpful. Changes to charting that are directed and taught online are difficult to follow and often not directed to what we chart in my clinical setting. In person, the charting can be focused on what I need, and I can get my questions answered right away.” —Nurse “I enjoyed asking questions that directly related to problems that occurred in the past or ways to be more efficient in my specific workflows. I enjoyed when the trainer had also used the application the way I have used the application (pharmacist to pharmacist). I appreciated when the trainer had the opportunity to see how I utilized the EHR and could understand my frustrations with certain workflows or information-gathering issues.” —Pharmacist “In-person training helped me spend time playing around in the play environment and asking direct questions to a content expert. Often, the class instructor helped us implement the curriculum into our everyday workflows in a personalized manner. We were able to ask our location-specific questions and play around with our own what-if scenarios instead of following only a prescribed scenario. Discussion with a content expert also helps the end user learn and apply a real-life perspective. Experts taught us several different ways to approach documentation for the same item and spoke to how they integrate each approach into their daily routine.” —Nurse Clinicians Need Just 3–5 Hours of Quality Ongoing Training Each Year Many clinicians claim that training takes too much time, but it doesn't have to. Just 3–5 hours of follow-up training per year correlates with a higher NEES than 2 hours or less. This holds across all clinical backgrounds. The length of individual training sessions does not need to be excessive either. Responses from the Trainer Quality Benchmark survey indicate that satisfaction with training does not increase as training length increases beyond 30–60 minutes. Keep ongoing training manageable and demonstrate the value of investing time into training. 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 400,000 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.

Program Goals Improve overall clinician satisfaction with the EPR Organization Outcomes Increased physician Net EPR Experience Score (NEES) from 3.9 to 32.7 Increased nurse NEES from 25.1 to 38.1 Collaborative-Verified Best Practices Ongoing EHR Education Clinician Relationships and Communication What The Trust Mental Health Did Birmingham and Solihull Mental Health Foundation Trust (the Trust) believed that small changes could increase EPR satisfaction. They introduced a new intranet, created more accessible training by segmenting the training into relevant and manageable topics that could be accessed individually and on demand, upgraded the EPR system, and improved communication through frequent and consistent updates. How Birmingham and Solihull Mental Health Did It

Program Goals Reduce the length of planned instances of downtime and prevent unplanned system outages Organization Outcomes UW Health’s providers are in 97th percentile for agreement that their EHR is available when they need it and has almost no downtime Collaborative-Verified Best Practices Technological Foundation: Reliability What UW Health Did Scheduled instances of downtime at the University of Wisconsin Hospital (UW Health) and its clinics are planned monthly, allowing for critical maintenance without relying on ad hoc maintenance. UW Health’s schedule includes server maintenance, network maintenance, and EHR maintenance. UW Health views outages as patient safety events and challenges their teams to think about how they can minimize the impact on clinical care providers during instances of downtime. How UW Health Did It

Framework of Services Offerings & Software Solutions for EHR Education See Vendor- and Firm-Reported Descriptions of Offerings section for descriptions and contact information for measured firms and vendors. Services Offerings Strategy/program development Includes building education programs, assessing and optimizing current programs, selecting education software, and creating a plan for communicating and marketing educational content; also can help with change management. Content building Creates content that can be used in classrooms or eLearning education sessions; may include build services for simulation environments. Staffing Provides outsourced EHR education resources, ranging from completely outsourced education programs to go-live and/or ongoing education services; assists with EHR educator development or coaching, including providing trainers to fill staffing gaps (with the option to hire those trainers at the end of the contract). Software Solutions Content Involves how content from multiple sources is created, kept current, and delivered (e.g., via self-authoring tools, video/documentation, or out-of-the-box EHR-specific content). Scheduling and communication Assigns or enables clinicians to sign up for courses, coordinates course order/flow, and notifies end users about education opportunities via different outreach options that end users can configure to their preference. Assessment and analysis Tracks completion and proficiency, skills validation (test-out option) may be available; uses dashboards, reporting, and EHR efficiency data to analyze the progress and effectiveness of training efforts. Vendor- and Firm-Reported Services Offerings Ability to Support EHR Vendors Vendors/firms reporting ability to support the EHR vendor; vendor/firms ordered alphabetically Atos, The HCI Group, Optimum Healthcare IT athenahealth, Optimum Healthcare IT 314e, Atos, CSI, Divurgent, Epic, Evergreen Healthcare Partners, Experis Health Solutions, The HCI Group, Healthcare Triangle, Medasource, Medix, Nordic, Optimum Healthcare IT, ReMedi Health Solutions, Sedona Learning Solutions, Tegria Experis Health Solutions, Healthcare Triangle, Nordic, Sedona Learning Solutions, Tegria 314e, Atos, CSI, Divurgent, Experis Health Solutions, The HCI Group, Healthcare Triangle, Medasource, Nordic, Optimum Healthcare IT, ReMedi Health Solutions, Sedona Learning Solutions, Tegria Vendor-Reported Software Solutions Ability to Support EHR Vendors Vendors reporting ability to support the EHR vendor; vendors ordered alphabetically 314e, Assima, uPerform 314e, Assima, athenahealth, Epilogue System, uPerform 314e, Amplifire, Assima, Epic, Sedona Learning Solutions, uPerform 314e, Amplifire, Assima, MedPower, Sedona Learning Solution, uPerform 314e, Amplifire, Assima, Sedona Learning Solutions, uPerform Vendor- and Firm-Reported Descriptions of Offerings  Vendors/firms ordered alphabetically Arch Collaborative member   Casey Post SVP | Sales and Client Services casey.post@314ecorp.com 314e helps hospitals and health systems drive digital transformation, improve staff efficiency, manage compliance, and enhance the patient experience. Our professional services division provides consulting services, managed services, and staff augmentation services for all aspects of education. Our digital services team assists customers with eLearning content development and ongoing maintenance. Our education software, Jeeves, is a just-in-time learning platform designed to provide instant access to on-demand training embedded directly into the EHR. Users can maximize their investment in learning by making assets available in context through the high-quality, full-text search, which provides a modern, world-class help experience to healthcare providers.   Rebecca Kaufman Vice President, Marketing and Communications rkaufman@amplifire.com Amplifire is the leading adaptive online learning platform, built from brain science discoveries. Amplifire’s advanced training solution (co-developed by leading health systems) helps physicians, nurses, and clinical support staff more effectively navigate the patient record workflow, reduce onboarding and training time, and optimize overall system use to enhance EHR investment. Healthcare leaders enjoy better results in less time, and clinicians benefit from a personalized learning experience that respects their time and expertise. Nicole Featheringill Head of Business Development nicole.featheringill@assima.net Assima provides an innovative patented software program that allows healthcare professionals to obtain competency at the fastest speed in terms of understanding and using critical processes across all healthcare systems. Assima’s software allows professionals to learn by using a digital platform that looks and acts like the EHR, personal health record, personal medical record, and ERP systems. Additionally, the Assima software reduces the total cost of training, increases learning effectiveness, and greatly enhances data security. It ensures that training is carried out on the latest application versions, thereby ensuring that users have the most secure, up-to-date environment for learning. Kristin DeMonico Training Strategy Manager kdemonico@athenahealth.com athenahealth’s training offering spans from interactive online modules, live and virtual instructor-led training, on-site elbow-to-elbow support, and one-on-one coaching for more advanced topics. We provide role-based curricula that build on each other to first establish basic product knowledge and then focus on optimizing workflows and driving change management around each product release. We additionally aim to proactively recommend applicable training to customers via communication and guidance directly within our application. Nanette Koch VP, Business Development, Breakaway Adoption Solutions nanette.koch@atos.net Breakaway Adoption Solutions provides a proven, research-based methodology that includes organizational change management, effective education, performance metrics, and sustainment services to optimize your adoption journey for years to come. Along with instructor-led training and customized simulators to provide base proficiency, our solution guarantees adoption rates of 90% or higher. In addition, we have trainers and go-live support for any EHR implementation, regardless of vendor. Holly Brown Vice President, Training Services hbrown@csicompanies.com CSI offers comprehensive training services, including EHR training programs, outsourced steady-state training, training-program optimization assessments, LMS services, and instructional/eLearning design services. Whether we are augmenting an existing team or delivering a full training solution, our expert trainers leverage CSI’s proven training methodologies and customize proprietary tools to meet clients’ objectives. Through efficient classroom training and our focus on provider success, we prepare end users to harness the EHR effectively and integrate it into their daily workflows, leading to smoother and faster adoption. Joe Grinstead Executive Vice President, Client Service joe.grinstead@divurgent.com Divurgent’s holistic training offering includes (1) program planning and design, (2) data-informed training approaches, and (3) results-oriented virtual, in-person, and hybrid training models. Wherever an organization may be on their EHR journey, we offer a variety of training services, such as pre-implementation planning, credentialed/principal training teams, just-in-time training, at-the-elbow go-live support, advanced post-go-live training, and ongoing eLearning for new team members or acquired physician practices. Arch Collaborative Case Study Read about how Baptist Health Jacksonville worked with Divurgent to create an interactive and engaging eLearning approach to decrease onboarding EHR education time during the COVID-19 pandemic. Jenna Timm Epic Training Experience Lead jenna@epic.com Epic customers can choose either organization-led or Epic-led end-user training services. With organization-led training, end users receive workflow-based, role-specific training through classes taught by their organization’s training staff, who use Epic’s role-based curricula, eLearning content, lesson plans, readiness materials, and environment recommendations for success during go-live and beyond. With Epic-led end-user training services, end users are trained by experienced Epic trainers through live virtual classes for pre-go-live and ongoing training. Users access Epic-maintained content (including classes, supportive content, eLearning content, and hands-on exercises) through the Epic Learning Platform. Readiness materials are available to support organization-led change management activities. Vincent Lucey VP of Sales info@epiloguesystems.com Opus by Epilogue Systems increases self-sufficiency and end-user adoption of critical healthcare IT systems (EHRs, ERP solutions, finance solutions, etc.) by automating the creation of job aids, simulations, training manuals, and in-application walkthroughs (Follow Me). These assets are used by PTs, CTs, and other staff members in more than 28 languages. Opus, which is hosted through AWS, also provides high security compliance for PI and HIPAA. Amanda Roberts Director of Solutions and Partnerships Operations amanda.roberts@evergreen.partners As former clinicians, healthcare leaders, and technologists, Evergreen offers EHR training programs designed to help clinicians spend more time with their patients and less time on administrative tasks. Our industry-leading expertise in quantifying and understanding real-world EHR usage is the core of our programs, which include program development, training leadership, and post-go-live efficiency training/coaching. Evergreen will be your partner in this data-driven approach to transforming your EHR from a source of clinician frustration to a powerful tool that enhances patient care. Margaret Ptacek  VP, Client Solutions margaret.ptacek@experis.com For 16 years, Experis Health Solutions has been successfully delivering training resources and programs to both large and small healthcare clients. Experis Health Solutions’ training support services encompass the entire training project life cycle and include training program creation, talented instructional designers and trainers, scheduling, LMS support, remote or on-site training, one-on-one sessions, personalization efforts, provider engagement, and go-live support. Tom Griga SVP Sales tom.griga@thehcigroup.com The HCI Group’s services are designed to cover the full training life cycle, from pre-go-live program design through post-go-live development of enduring training strategies that support new hires and improved clinician adoption. With instructor-led approaches, virtual classrooms, and asynchronous eLearning, we will create a sustainable, scalable training program that meets your healthcare system’s needs as well as increases system utilization and efficiency. Damien David Senior Director of Sales and Business Development damian.d@healthcaretriangle.com  Building on experiences gained over the last three decades, Healthcare Triangle approaches training program and curriculum development knowing what end users need to move from adoption to acceptance of new systems. We break training into blocks of information and align them with processes and workflows. We supplement instructor-led training with eLearning and self-guided lessons, whether developed by our team or by a customers’ training content provider. Brian Donahue Vertical Director, Technology Practice bdonahue@medasource.com Medasource is a proven partner in providing professional services for software modernization projects of all shapes and sizes. We understand each healthcare provider is unique, and we approach every client partnership with flexibility and customization. Our expert consultants can support training initiatives (whether on-site or virtual) from initial strategy and curriculum development through education and ongoing training. Jason Kulaga, RN, BSN, PMP Practice Director, EHR Solutions jason.kulaga@medixteam.com As a part of the Medix family, Medix Technology has been providing expert Epic consulting and staffing solutions for over a decade. We help organizations at every stage of their Epic journey, from initial implementation through ongoing optimization and maintenance. Medix Technology partners with Epic organizations to evaluate existing training and optimization programs, develop curriculum and supporting content, and provide both temporary and permanent training team members (including strategic leaders, principal trainers, and credentialed trainers). Craig Wallace Business Development craig@medpower.org As the exclusive online learning partner for MEDITECH, MedPower is the only vendor who can offer out-of-the-box MEDITECH EHR content. Whether for an enterprise-wide implementation or day-to-day onboarding needs, the MedPower solution offers customers the highest-value, lowest-maintenance approach to training MEDITECH users. By combining our proven micro-eLearning approach with exclusive MEDITECH-certified Expanse EHR content, our Expanse customers can effectively educate and train users while realizing unmatched performance and cost efficiencies. Sarah Rosebrock Director, Education Solutions sarah.rosebrock@nordicglobal.com Nordic is proud to offer solutions that help create, implement, deliver, maintain, and optimize training and education services for our clients and their end users. Our methodologies focus on partnership by tailoring the solutions to our clients’ needs and culture. We aim to reduce the forgetting curve, support learning retention by creating opportunities for reinforcement, and enable sustainable long-term adoption. Kristi Lanciotti  Vice President klanciotti@optimumhit.com Optimum Healthcare IT offers a wide breadth of technology and EHR training services specifically for healthcare organizations. We provide implementation and change management support, staff augmentation, provider optimization projects, at-the-elbow go-live support, ongoing new-user virtual training services, contract-to-hire talent as service replacements, and advisory services related to LMS selection and training team design. Our leadership team includes experienced clinicians and educators that bring decades of healthcare IT expertise and world-class experience and service to every client engagement. GP Hyare  Managing Director g.hyare@remedihs.com ReMedi Health Solutions specializes in peer-to-peer EHR training, personalization, and optimization sessions, emphasizing physician and nurse efficiency at scale. Our clinical staff supports healthcare leaders as an outsourced chart abstraction partner to help make better use of EHR data. ReMedi’s executive leadership team actively participates in healthcare IT industry roundtables, forums, and speaking engagements to steward a better future for healthcare and more efficient use of the EHR system. Mary Everett VP of Sales and Marketing mary.everett@iatric.com Sedona Learning Solutions specializes in creating custom EHR learning materials that mirror each client’s build, best practices, and workflows. Sedona is a full-service education provider that offers role-based custom tutorials, classroom guides, just-in-time refresher tools, training strategy and project management services, and supplemental instructors for EHR systems. Meg Johnson Change Management and Learning Transformation meg.johnson@tegria.com At Tegria , we believe end-user satisfaction and system adoption are critical to the health of your EHR and the ROI that you should expect from it. Comprehensive change management, efficient training program design, effective training, and ongoing adoption and support efforts are our expertise and passion. Our solutions focus on empowering end users through training, personalization, and organizational alignment with site-specific, scalable programs suited to your specific goals. Andrea Rolland Senior VP of Sales and Marketing for North America andrea.rolland@uperform.com At uPerform , we are on a mission to empower clinicians to become more productive and more satisfied users of technology through higher-quality software education. uPerform offers digital onboarding and at-the-elbow support to address inadequate software training and poor user efficiency—the crux of EHR success. We work with health systems to develop a scalable, effective digital training strategy that keeps up with growth and the pace of change. Arch Collaborative Case Study Read about how Baylor Scott & White Health worked with uPerform to utilize technology to make clinician training content more up to date and accessible. 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.

Program Goals Track charts closed with 72 hours and hold providers accountable to that standard Adjust workload to make charting more manageable Organization Outcomes Advanced practice providers at 98th percentile for more than 50% same-day ambulatory chart closure Providers at 81st percentile for less than five hours a week of at-home charting Collaborative-Verified Best Practices Clinician Relationships & Communication Shared Ownership and Governance Keys to Success Proactively track chart closure rates and follow up with providers who are falling behind Adjust in-basket workload by specialty and location Pool in-basket and patient messages to equitably distribute the workload What St. Charles Health System Did St. Charles Healthcare (St. Charles) created a transparent reporting system to track chart closure rates and adjusted workflow burdens to make in-basket burdens more equitable. How St. Charles Health System Did It

Ongoing Efforts to Improve EHR Upgrades: To address the need for deeper insights on what factors correlate with upgrade success, the Arch Collaborative recently added a question to our end-user survey, asking respondents how the latest EHR upgrade has impacted their experience. In addition, we have begun surveying organizations in more detail about upgrades in the EHR education survey—which dives into education programs, trainers and educators, vendors and third-party education partners, and organizational processes for upgrades. Investing in Positive Upgrade Experiences Pays Off in Clinician Trust  Two key aspects of user trust in their organization/IT leadership are communication around upgrades and giving users input into EHR changes. Focusing on these areas can have strong dividends in organization-clinician relationships. As shown below, clinicians who strongly agree EHR changes are well communicated are 62.6 times more likely (compared to those who strongly disagree) to feel their organization/IT department delivers well. Those who strongly agree they have a voice in EHR changes are 29.5 times more likely to agree their organization/IT department delivers well. (Additional insights on trust in IT can be found here .) Plurality of Clinicians Are Indifferent about Impact of Recent EHR Upgrades Just over one-fourth of clinicians agree or strongly agree recent changes have improved their EHR experience. A plurality express a neutral opinion of recent upgrades. While moving the needle will be challenging, organizations and EHR vendors have the opportunity to reverse the trend by listening to end-user feedback, clarifying what users need from upgrades, and partnering to better communicate the why behind EHR changes. (Read on for more recommendations.) Disruption, Communication Gaps, and Insufficient Education Are Common Themes of Upgrade Issues The Arch Collaborative survey asks respondents to share details of their EHR experience, and the vast majority of respondents who mention upgrades share negative sentiments about the changes. Disruption is the top complaint—this includes downtime, slower system response times, and decreased efficiency from EHR changes. The next two most-common issues go hand in hand: lack of communication from the organization and insufficient education around upgrades (e.g., new functionality, workflow changes). Many clinicians share suggestions for how organizations can improve in this area, highlighting the opportunity for organizations and vendors to implement robust communication and education strategies around upgrades. Frustration with layout changes is also often mentioned by clinicians. Respondents feel some upgrades provide little to no apparent value or are redundant; these clinicians want to see fewer cosmetic changes to things like layout and more focus on improving the actual user experience.   Best Practices for Organizations to Improve EHR Upgrade Satisfaction Communicate early through various methods/tools: emails, posters in restrooms and hallways, newsletters, superuser communication, tip sheets, town hall meetings, etc. Allow  end-user testing of upgrades Create role- or specialty-specific education , including in-person sessions (led by EHR trainers, superusers, clinician informaticists, etc.) and options like videos and tip sheets that teach users about upcoming EHR changes; leverage available education from your EHR vendor Create specialty-specific release notes for upgrades Phase out outdated EHR education, tip sheets, and videos Round or send out a survey after the upgrade to ask users for suggestions about the process (not necessarily the upgrade itself) Communicate in advance about any expected downtime from an upgrade, and monitor the actual downtime experienced by end users 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 370,000 clinicians have responded. Impact 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.

In the Arch Collaborative data, “highly satisfied” users are defined as those who agree or strongly agree that (1) the EHR enables them to deliver high-quality care and (2) the EHR makes them as efficient as possible. Clinicians who respond in the affirmative to both of these questions are then asked a follow-up question: What do you believe you do differently from some of your peers that enables you to be highly successful with the EHR? This report looks at the feedback of 3,061 highly satisfied clinicians; data was collected December 2021—December 2022. Highly Satisfied Users Embrace the Three Pillars of EHR Satisfaction On average, highly satisfied users report a Net EHR Experience Score (NEES) more than twice as high as the average clinician. Similar trends are also evident when it comes to the Arch Collaborative’s three pillars of EHR satisfaction—user mastery, shared ownership, and personalization. User mastery Highly satisfied users are 3.8x more likely to agree or strongly agree that initial training prepared them well to use the EHR. Shared ownership Highly satisfied users are 6.6x more likely to agree or strongly agree that their organization implemented the EHR well. Personalization Highly satisfied users are 1.8x more likely to have highly personalized the EHR. The Most Successful EHR Users Take Personal Ownership for Mastering the EHR Highly satisfied EHR users give a variety of responses when asked what differentiates them from less satisfied peers, but the most common success factor (reported by 27%) is personal initiative. This includes proactive efforts by the clinician to learn the EHR and seek help when they have questions. The second most common response is that the clinician is experienced with the specific EHR in use (from years of use at either the current organization or a previous employer). Personalization and having a good attitude tie for the third most common factors. The table below outlines these and other top factors and shares relevant case studies (where available) from Arch Collaborative organizations that give insight into how these factors can be encouraged. Providers: Use of Personalization Tools Is the Top Success Factor Highly satisfied providers † most commonly cite use of personalization tools as the reason for their success with the EHR. EHR personalization is important for providers because it can enhance their overall experience with the system by making it feel reliable and efficient. However, provider comments about personalization reveal that too often, providers feel they are on their own when it comes to understanding what personalizations are available to them and how to make them and then finding time to implement them. This aligns with the second most common factor in provider success, which is personal initiative to learn the EHR. The webinar from Collaborative member OrthoVirginia highlights the importance of fostering a sense of personal initiative among providers. † In Collaborative research, the term “providers” refers to physicians, physician residents, and advanced practice providers. Nurses: Personal Initiative Is by Far the Most Influential Factor for Highly Successful Nurses 30% of highly successful nurse respondents say being proactive about learning the EHR is the key to their success, making it the clear dominant factor among the highly satisfied. Experience with the EHR and a positive mindset are the second and third most common responses. Personalization tools are less important for nurses than they are for providers, given that they are less prevalent in nurse workflows. Key Takeaways Personal accountability is the most commonly reported reason for EHR success, coming in as the first or second reason for providers, nurses, and all clinicians combined. Leadership should empower their clinicians to take ownership of their own EHR satisfaction journey. Highly successful providers commonly use personalization tools to enhance their use of the EHR. Implementation of these tools is frequently driven by the providers themselves and represents an opportunity for healthcare organizations and vendors to better support providers. Health systems should create time and environments to allow providers to personalize the EHR to better fit their workflow needs. Experience with the EHR is consistently a top-cited success factor across providers, nurses, and all clinicians combined. Download the full report to see additional data on highly successful users of athenahealth, Epic, MEDITECH, and Oracle Health (Cerner). 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.

Program Goals Effectively communicate EHR changes and other important information to clinicians Organizational Outcomes Providers: 99th percentile for communication satisfaction Nurses: 94th percentile for communication satisfaction Collaborative-Verified Best Practices Clinician relationships & communication What Bellin Health Did Bellin Health System (Bellin) uses consistent, expected methods of communicating important information to their clinicians, such as weekly updates and a CMIO newsletter. They also employ various other strategies, such as a shift huddle or notes in the bathroom, depending on the audience and the nature of what is being communicated. This communication feeds through a process that includes governance groups, operational leaders, optimization specialists, and superusers. All team members play a role in creating and implementing communication plans for each project. How Bellin Health Did It