USE DATA TO UNLOCK THE POWER OF THE EHR

Arch Collaborative
Join hundreds of healthcare organizations working together to revolutionize healthcare quality by improving the EHR experience



 



The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience.



Maximize Your EHR Experience

KLAS works with each member to improve their EHR experience by uncovering opportunities for change through standardized surveys and benchmarking.
KLAS meets with members regularly, and the whole Collaborative meets annually to facilitate learning from other healthcare organizations.
 
Satisfaction ratings for the Acute Care EMR market segment have been lower than the software average for over five years. The Arch Collaborative is working to change this.
Best in KLAS Rankings, 2014-2022


EHR SATISFACTION RESEARCH
Where It All Started


While sifting through our initial Collaborative data, we noticed a pattern that caused us to ask:
How can two organizations using the same EHR report such disparate satisfaction with the user experience?


Percent of Surveyed Clinicians Who Are Satisfied with Their EHR

Percent of Surveyed Clinicians Who Are Satisfied with Their EHR

 
Why is there a 62 percentage points difference between different organizations using the same EHR?


Conclusion

“The truth? All EHRs see a wide spread in user experience from organization to organization. Benchmarking your organization against similiar organizations allows you to find out if you have truly maximized your investment.
This insight led us to dig deeper into what factors are most likely to create satisfied EHR users.
Over and over, the data revealed that satisfied users:
  • Are able to personalize their EHR experience
  • Share ownership for EHR governance
  • Are expert users of their EHR solution
More insights like these continue to be uncovered as additional organizations decide to measure and collaborate. Benchmark against your peers to determine whether you have truly maximized your EHR investment.
Statisfied Users

quote "Without data, you're just another person with an opinion."

— W. Edwards Deming


Benefits of the Arch Collaborative
For Healthcare Organizations


Become a member of the Arch Collaborative to:


  • Benchmark EHR satisfaction against similar organizations
  • Connect with and learn from other healthcare organizations
  • Improve clinician satisfaction with your EHR
  • Fine-tune your clinician education
  • Alleviate technology-related burnout
  • Deliver better care
98% of organizations see an improvement in EHR satisfaction when remeasured.

Provider
The Science of Improving the EHR Experience 2021, July 2021
Photo by Christina @wocintechchat.com on Unsplash

success stories
From the Members Themselves
Real stories from the front-lines. See how the Arch Collaborative made an impact with these healthcare organizations.


how to participate
Become a Member
Real leadership requires data. Put the insights of over 200,000 clinician respondents at 250+ healthcare organizations to use.


Number 1
Express your interest. Discuss membership options.

Number 2
Pick the membership that fits your needs.

View Plans & Pricing
 
hr See Sample Benchmark Survey
Number 3
Dive deeper into the research. Start seeing value.

Visit the Learning Center


250+
Healthcare organizations
and counting
14+
Healthcare IT companies
and counting
Become a Collaborative member. Start your EHR improvement journey today.
Benefits of the arch collaborative
For Healthcare IT Companies (Vendors)
Use Arch Collaborative findings to give your solutions the edge they need to excel.


Get Crucial Information

  • Key pain points using the EHR
  • Best practices that drive high user satisfaction
  • Tips for improving clinician efficiency

Proactively Optimize

  • Fix problems before they become detrimental
  • Help customers deliver better healthcare

Express Interest

  • Reach out to our vendor specialist if you have any questions or would like to participate.




Vendor Participation
By participating in the Collaborative, healthcare IT companies can dramatically reduce the time it takes to implement changes based on end-user feedback.

314e
3M
Amplifire
Aquity Solutions
athenahealth
Atos
Cerner
Chartis Group
Dedalus
DeliverHealth
Divurgent
Epic
Goliath Technologies
Greenway Health
InterSystems
Medix
Nordic
Tegria
uPerform




Report
KLAS article icon
The Science of Improving the EHR Experience
Steps to Improving Clinician Satisfaction with the EHR Measure your clinicians’ current EHR experience Understand the impact of a poor EHR experience Identify groups in need of targeted intervention Evaluate and select improvement initiative(s) for deployment Deploy selected initiative(s) Remeasure and repeat Key Findings from Repeat Measurements To date, 95 Arch Collaborative members have completed at least two organization-wide measurements of clinician satisfaction with the EHR 40% of organizations that have remeasured have seen significant improvements (8.0+ point increase in Net EHR Experience Score) since their first measurement (see chart on next page) On average, organizations with repeat measurements achieve Net EHR Experience Scores (NEES) 10.6 points higher than organizations that have measured only once Of all measured clinician groups, nurses have seen the largest improvements in EHR satisfaction since 2017; nurse satisfaction has increased by 12.4 points (n=22,744 respondents) Physicians have also seen improvement, achieving an 8.0 point increase in NEES (n=20,114 respondents) Step #1: Measure Your Clinicians’ Current EHR Experience Historically, conclusions about clinician satisfaction with the EHR were often based on anecdotal data and feedback rather than formal measurement. Depending on the volume of this feedback (in terms of quantity or decibels), one could draw a variety of conclusions about the clinician EHR experience, some perhaps less accurate than others. To correctly identify—and then improve—the real issues your clinicians are experiencing with the EHR, the first step is standardized, organization-wide measurement. The data collected by the Arch Collaborative over the past five years serves as a benchmark to this measurement and can help organizations understand the markers of high satisfaction and the most effective ways to create a better EHR experience for clinicians. Step #2: Understand the Impact of a Poor EHR Experience One potential cost of a poor EHR experience is clinician turnover. Nearly one-fifth of respondents to the Collaborative survey say it is likely or very likely they will leave their organization within the next two years, meaning Collaborative members could be facing a significant turnover expense. Based on existing literature outlining the cost of turnover, estimates show that the expense could be as high as $1.9–$3.4 million per organization to replace nurses and $6.4–$25.6 million per organization to replace physicians. † The combination of these estimates and KLAS models on the correlation between clinician EHR satisfaction, burnout, and turnover shows how much of this cost could be attributed to EHR dissatisfaction: $93,000–$170,000 per organization per year for nurses and $319,000–$1.3 million for physicians. These estimates illuminate the potential financial cost of not addressing clinician dissatisfaction with the EHR. † Cost estimates are based on data from the following sources: 2022 NSI National Health Care Retention & RN Staffing Report , published by NSI Nursing Solutions, Inc. Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being . JAMA Intern Med. 2017; 177 (12): 1826–1832. doi:10.1001/jamainternmed.2017.4340 Step #3: Identify Groups in Need of Targeted Intervention Organizations should first focus on departments, specialties, clinical roles, or other cohorts that have communicated a desire for improvements to their EHR experience or that report low satisfaction via the Collaborative survey. The best candidates for intervention will be groups with strong leadership willing to engage in a change initiative. Additionally, Collaborative data has identified several clinical backgrounds, specialties, and departments that generally haven’t seen much improvement over time and may therefore benefit from targeted intervention. For example, EHR satisfaction among allied health professionals has not improved over time and has in fact decreased slightly. Many provider specialties have also not seen improvement and may benefit from extra attention; among these specialties, those with the largest samples include pulmonology, radiology, and urology. While nurses on the whole report improved satisfaction, many nursing focus areas haven’t seen as much improvement. The largest groups include nurses that work in emergency care, inpatient care, and surgery. A case study from Sutter Health shares details on how that organization was able to move the needle for their perioperative nurses by focusing on workflows. Step #4: Evaluate and Select Improvement Initiative(s) for Deployment Organizations looking to implement an improvement initiative will naturally wonder which are most worth the investment. Organizations that have standardized to one EHR across their enterprise or have implemented a new EHR altogether have seen the highest increases in average NEES (more on that in the next paragraph). However, that approach may not be a feasible option for many organizations. Other improvement initiatives that have garnered noteworthy improvements include deploying third-party tools aimed at improving usability, investing in clinical-improvement initiatives (such as adopting new clinical EHR functionality), implementing at-the-elbow training, and improving online training options. Arch Collaborative resources can help member organizations seeking further guidance on selecting and successfully carrying out an EHR improvement initiative. One such option is peer guidance. These services connect organizations with external peer experts who can help evaluate and develop plans of improvements (see Intermountain case study on next page). Case Study Intermountain Healthcare Leverages Peer Guidance Intermountain Healthcare’s first Arch Collaborative measurement in June 2019 showed room for improvement in satisfaction with the EHR. Seeking to improve the clinician experience, Intermountain Healthcare invited KLAS and four high-performing Arch Collaborative members (Kaiser Permanente Northwest, Memorial Health System, Sharp HealthCare, and UCLA Health) to an on-site peer guidance session. As a result of the insights gained, Intermountain Healthcare launched a series of new training efforts, including flexible, individualized EHR coaching for providers. By the end of 2020, providers across Intermountain Healthcare’s organization reported an average NEES 33 points higher than Intermountain Healthcare’s original measurement. Newly hired providers now receive a one-week follow-up session and four to six optimization sessions, and Intermountain Healthcare continues to expand access by developing various training modalities, including webinars and short videos. For more details, see Intermountain Healthcare’s full case study on the KLAS website. The data from the Arch Collaborative continues to demonstrate that organizations can find success with any EHR vendor. That being said, some of the organizations that have seen the greatest improvements over time are those that have standardized to one EHR across their enterprise or have implemented a new EHR. Improved satisfaction following an EHR change can be attributed to multiple factors aside from the specific product chosen, including a renewed focus on EHR training and education and improved infrastructure (e.g., improved internal and external integration). Implementing a new EHR is obviously an enormous undertaking that requires significant investment in terms of time, resources, and change management. As a result, organizations that choose this route commonly see a decrease in clinician agreement that the EHR is easy to learn. The case study below from Ozarks Medical Center shares some best practice recommendations to making an EHR implementation successful. Case Study Ozarks Healthcare Implements a New EHR Ozarks Healthcare has seen significant improvements since implementing a new EHR. Over 200 stakeholders from across the organization participated in the selection process, sitting in on demonstrations and submitting scorecards for each solution evaluated. After the selection, training became a high priority. To make the transition as smooth as possible, Ozarks required each user to complete a minimum of six hours of EHR education prior to the go-live. The training consisted of one-on-one education with an IT person, at-the-elbow support, and online, self-led learning modules. After completing the six-hour training, providers had additional training opportunities available if they wanted to learn more about the system. Providers also had the chance to play in the new system’s environment on their own time as much as they wanted. For more details, see Ozarks Healthcare’s full case study on the KLAS website. Step #5: Deploy Selected Initiative(s) After selecting an improvement initiative, organizations must then determine how to successfully implement the change. Effective change management is critical and if not planned and executed well can result in less-than-hoped-for improvement. Below are summaries of the deployment strategies of several Collaborative members who have seen significant improvement after implementing new EHR initiatives. Case Study Henry Ford Health System Boosts Nurse EHR Training In preparation for a significant user interface enhancement, Henry Ford Health System brought together nursing leaders, educators, and informaticists to develop and implement a comprehensive EHR training program for nurses. Using their Arch Collaborative survey results as a reference, leaders vetted a new curriculum, explored the financial implications of such an undertaking, and painstakingly outlined the logistics of training over 4,000 nurses across a variety of care settings. The outcome of these efforts was a 52% improvement in NEES. Learnings from this successful but resource-intense experience led those involved to also develop guidelines for additional training. Henry Ford now requires at least a 30-day buffer for training prior to a major feature upgrade. This allows for timely and more regular education. In addition, virtual training was created to provide a more distributable and cost-effective training alternative. This relied heavily on training superusers through webinars and classroom training. Webinars prepared for superusers were also distributed to nursing staff to back up the trainers’ efforts. These efforts have led to a further 16% improvement in EHR satisfaction. For more details, see Henry Ford Health System’s full case study on the KLAS website. Case Study OrthoVirginia as a Model for Improvement OrthoVirginia has been able to continually improve the EHR experience for their orthopedic physicians—a specialty that has historically felt the EHR does not meets their needs. Through internal efforts and direct partnership with their EHR vendor, OrthoVirginia saw a 31-point increase in NEES over three years. The first hurdle was that some providers did not fully understand how the EHR worked. To counteract this problem, OrthoVirginia created the Provider Support Specialist (PSS) program, in which PSS team members are strategically placed geographically to enable them to have one-on-one, at-the-elbow interactions with providers every one to two weeks. The PSS team is mostly made up of scribes who have a solid working knowledge of the EHR and the social skills to establish relationships with providers. To further improve satisfaction and understanding, OrthoVirginia modeled their governance structure after Kaiser Permanente Northwest’s “Pyramid of Change.” In collaboration with providers, analysts and PSS team members design, build, test, and implement changes at a rapid pace. This collaboration generates provider investment in their EHR success. For more details, please see OrthoVirginia’s full case study . Case Study Guthrie Clinic Decreases Turnover by Enhancing Training Six years ago, The Guthrie Clinic was experiencing an above-average turnover rate, and the EHR was frequently mentioned as a factor in people’s decisions to leave. Guthrie conducted listening tours with providers and learned there was a perception that the IT department didn’t care about providers and that feedback from providers outside the main campus wasn’t heard. Guthrie took that feedback and realized their technology and training needed to be enhanced. Now, new providers receive EHR training within their first week. If providers have used the EHR at other organizations, they have the option to test out and receive abbreviated training to ensure new providers learn Guthrie-specific workflows. New providers can also import their smart phrases from their previous organization into Guthrie’s system. Guthrie has also implemented virtual trainings, and they make the EHR available to new providers while they are completing the trainings so that they can test on what they’re learning and create their own personalization as they go. Agreement that initial training for physicians is sufficient has increased 24%, and agreement that ongoing training is sufficient has increased 30%. For more details, read the Guthrie Clinic case study . Case Study Door County Medical Center Improves Satisfaction through One-on-One Onboarding After making EHR training for new physicians a priority, Door County Medical Center saw a 38-point increase in NEES. New physicians at the organization get two to four hours of in-person EHR training with a registered nurse. During this training, physicians get a brief overview of the EHR functionality. In addition to the one-on-one overview, new physicians receive two to five days of at-the-elbow support in which a registered nurse shadows them while they are seeing patients and then helps with documentation or placing orders immediately after the patient visit is over. Though nurses are typically the ones to place orders, new physicians place orders themselves at the beginning to ensure they know the process if they ever need to complete it themselves. Ongoing training consists of emails, rounding, and teach-and-learn sessions. See Door County Medical Center’s full case study for more details. Step #6: Remeasure and Repeat Improving clinician satisfaction with the EHR is a continuous process that requires ongoing measurement. While surveying your entire organization multiple times a year may not be feasible, the Arch Collaborative offers several options for interim measurements, including pre- and post-initiative surveys, which measure a subset of users before and after an intervention, and pulse surveys, which can be used to increase understanding of a specific group’s EHR experience. On average, organizations see significant improvement in NEES when they measure clinician satisfaction both before and after implementing an initiative targeting a specific department or goal. In these measurements, the NEES of repeat respondents increases an average of 22 points (see chart below). 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. 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 291 healthcare organizations have surveyed their end users and over 340,000 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. To participate in the Arch Collaborative, go to klasresearch.com/arch-collaborative .
Report
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Provider Burnout and the EHR Experience
High-Level Insights: Rates of burnout are still very high but appear to have plateaued since 2021 High trust in organization leadership/IT around the EHR is correlated with lower provider burnout Reducing the after-hours workload can decrease burnout significantly Organizations that implement burnout-prevention programs are seeing real results Help Us Learn More New questions recently added to the EHR experience survey aim to glean deeper insight into how organizations can address provider burnout. Please consider including these questions in your organization’s next measurement. Topics include: The burnout-prevention measures providers want from their organization How often patient messages could be handled by other care team members Patient care activities below the provider’s licensure How providers define after-hours time Burnout Has Leveled Out in 2022; Staffing Shortages Rise as a Contributing Factor In 2018 when the Arch Collaborative first began measuring burnout, 27% of providers reported at least some degree of burnout (i.e., they chose one of the following responses: definitely burning out, symptoms of burnout won’t go away, or completely burned out). Burnout has since increased, with 2021 seeing a large spike in the number of providers who report at least some amount of burnout. However, rates have leveled off in 2022 and are holding steady at 34%. The same trend is true for other, non-provider clinicians (not measured in this study). It should be noted that since 2020 the percent of providers reporting higher levels of burnout has increased slightly—particularly those who report they are definitely burning out (up 3 percentage points). Most measured contributors to burnout have become less prevalent than they were at the start of the COVID-19 pandemic. There are a few exceptions. The percent of providers citing a chaotic work environment as a contributing factor has stayed consistent at 28% pre- and post-pandemic. Staffing shortages—a newly-measured contributor as of 2021—are more frequently reported by all types of clinicians, especially in the last year. In 2022, 40% of surveyed providers said staff shortages contribute to their sense of burnout. As providers report higher degrees of burnout, they are more likely to report a higher number of total burnout contributors. With Foundation of Trust in Leadership/IT, Less After-Hours EHR Time Tied to 19% Lower Burnout One key to lessening provider burnout is strong provider agreement that their organization delivers well around the EHR—specifically, that the organization has done a great job of implementing, training on, and supporting the EHR. Higher trust in organization leadership/IT in these areas is tied to providers being less likely (by 16 percentage points) to feel burned out. Even among providers who spend more after-hours time in the EHR—who would be expected to have higher rates of burnout—trust in leadership/IT around the EHR is correlated with lower burnout. Providers who chart six or more hours a week but have trust in their leadership/IT experience burnout rates lower than the Collaborative average. Providers who both trust their leadership/IT and chart after-hours for less than five hours per week have an average burnout rate 19 percentage points lower than other providers. Learn from Your Peers The following organizations have successfully improved their clinicians’ EHR experience through specific, targeted efforts. To learn more, read their case studies linked below. UW Health and AQuity partnered to reduce after-hours documentation for providers by implementing virtual scribes. 88% of providers who participated felt this program reduced the time they needed to spend on after-hours documentation. Providers also were less likely to report feeling burned out. Legacy Health created the Super Thrive program, a three-day off-site training that has helped increase trust between clinicians and their organization. Following the program, clinicians reported higher trust in the organization leadership/IT (up 38%) and lower rates of burnout (down 7%). Community Health Network built a provider informatics team to help support providers in their efforts to personalize the EHR. Similarly, Rush Health created a team of physician EHR builders to bridge the gap between providers and IT professionals and build a culture of cooperation. Both efforts highlight the importance of strengthening relationships between providers and their organization. Timely and Well Communicated EHR Fixes Strongly Correlated with Lower Provider Burnout At times, providers can view IT as a black hole, and this dynamic reduces interactions and collaboration between the two groups. However, providers who feel they are supported in their EHR by organizational IT teams report lower levels of burnout. One of the most telling indicators is whether EHR fixes are made in a timely manner. In general, providers who agree with this statement and report trust in IT have an average burnout rate 16 percentage points lower than their peers (see second chart below). Additionally, communication around EHR changes is important; providers who agree changes are well communicated have a burnout rate 11 percentage points lower than those who disagree. When IT and support personnel are more transparent—for example, they update providers regarding requested changes—providers feel more supported and empowered around the EHR experience and their overall experience in the organization. This transparency is also tied to lower burnout. Learn from Your Peers The following organizations have successfully improved their clinicians’ EHR experience through specific, targeted efforts. To learn more, read their case studies linked below. Southern Illinois Healthcare (SIH) improved their EHR support by developing and updating governance committees. These groups helped foster transparency between providers and IT. Providers were taught how to make and track EHR change requests. This facilitated requests being made in a timely manner and made providers feel they had a voice in EHR changes. The ticketing system also allowed requests to be more easily submitted. Dayton Children’s Hospital prioritized transparency to the benefit of providers by defining how resources related to EHR optimization are allocated. They did this by strengthening their IT governance model and developing committees whose job is to assist providers with their EHR concerns. Burnout-Prevention Programs Are Making a Positive Impact Healthcare organizations have successfully improved their clinicians’ experience at work by implementing programs specific to reducing burnout. Many organizations who participate in the Arch Collaborative have asked their clinicians about participation in a burnout-prevention program and whether the program was helpful. KLAS recommends that all organizations implement one or more of the programs measured in the chart below, since all have significant potential to alleviate provider burnout. Insights from Successful Organizations on Combatting Burnout To learn more about these organizations’ efforts, read their case studies linked below. Ozarks Makes a United Decision on a New EHR—Trust in the Organization Increases, Burnout Levels Decrease Ozarks Medical Center (Ozarks) improved provider trust in the organization leadership/IT around the EHR by involving a unified group of providers from across the organization in the decision to switch EHRs. Over 200 clinicians participated in the process. They were separated into 20 different groups to determine which EHR would best suit them. These clinicians were almost unanimous in their decision for a go-forward EHR. Upon implementation of the EHR, Ozarks also required that all clinicians receive a minimum of six hours of EHR training prior to the go-live. Following the change in EHR, provider agreement that the organization delivers well around the EHR improved by 34%, and the overall rate of provider burnout decreased by 10%. Ozarks Medical Center shared that their approach to deciding on the EHR helped unify the organization and strengthened trust in leadership. This in turn made providers more excited about working at the organization and resulted in reduced feelings of burnout. Yuma Credits Lower Burnout to Availability of Continual At-the-Elbow EHR Support and Peer-Based Support Yuma Regional Medical Center credits their providers’ low burnout rates to the EHR onboarding process and ongoing support—this includes at-the-elbow support from IT technicians and providers’ peers. Yuma has a larger-than-average number of provider leadership positions for an organization of their size (for example, they have 27 staff medical directors), and this means more physicians have the opportunity to lead among their peers. It also results in a more simplified process for providers to reach out to someone when they have questions or concerns about the EHR. This has resulted in reduced feelings of burnout. Traditionally, there is a knowledge gap between IT technicians and providers, so Yuma leverages certified, trained physicians who work with EHR analysts and help design the EHR. This ultimately helps bridge that gap for both sides. One large pain point for Yuma providers was getting patients through care encounters on time because of EHR issues. By implementing a point of contact that providers can speak to after a patient visit, the atmosphere of visits has improved for providers and patients. In the organization’s most recent EHR experience measurement, 19% of their providers reported feeling burned out, which is 14 percentage points lower than the current Arch Collaborative average. Recommendations for Decreasing Provider Burnout Build trust in organization leadership/IT—put structures in place that give providers a voice in the EHR, facilitate quick responses to enhancement requests, and ensure the EHR is continually being improved. Engage providers in decision-making processes. Decrease after-hours workload. One helpful approach can be the use of scribes for clinical documentation. Some organizations also benefit from “sprint” events that facilitate an intensive environment where providers can learn skills or implement interventions to reduce after-hours charting. Implement programs designed to alleviate provider burnout. Peer-mentoring programs can be particularly effective at improving the provider experience, including reducing burnout rates. What is the Arch Collaborative? What is the 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. 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. To participate in the Arch Collaborative, go to klasresearch.com/arch-collaborative .
Report
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Exploring EHR Satisfaction by Provider Specialty
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 .