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Arch Collaborative Provider Guidebook 2023
Sep 2023

Arch Collaborative Provider Guidebook 2023

Authored by:  Tyler Hendricks, Lauren Manzione, Connor Bice, 09/08/2023 | Read Time: 8 minutes

Arch Collaborative Provider Guidebook2023—Creating EHR Mastery: Onboarding EHR Education; Creating EHR Mastery: Ongoing EHR Education; Creating Shared Ownership: Provider Relationships and Communication; Creating Shared Ownership: Governance; Creating Provider Efficiency: Personalization; Creating Provider Wellness: Reducing Burnout; Building a Technological Foundation: System Reliability and Response Time

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What Is the Arch Collaborative Provider Guidebook?

The Arch Collaborative Provider Guidebook—which focuses solely on providers (i.e., physicians, residents, fellows, and advanced practice providers)—is the result of thousands of hours of combined effort. Over 300 health systems around the world have used the Arch Collaborative survey to measure the EHR satisfaction of their providers. With the survey taking roughly 10 minutes to complete, the 145,000 providers who have participated have dedicated more than 24,000 hours to providing feedback about their EHR satisfaction.

This incredible effort has allowed the Arch Collaborative to identify universal best practices that any health system—regardless of their size, region, or EHR vendor—can use to improve their providers’ EHR satisfaction. These best practices are shared here to help healthcare leaders find their organization’s own path to EHR success. While the guidebook could be seen as a checklist, it will be most effective when its principles are skillfully customized to an organization’s specific culture and circumstances.

The EHR House of Success

The principles in this guidebook are organized according to the Collaborative’s EHR House of Success, which includes three pillars of EHR satisfaction and a foundation. The three pillars are (1) user mastery via strong education and training, (2) an organization-wide sense of shared ownership, and (3) EHR technology that meets users’ unique needs (personalization). Collaborative analysis has shown that these three variables explain up to 70% of the variation in a clinician’s EHR satisfaction and that focusing on these key areas can greatly improve the EHR experience. Each section of this guidebook will focus on the supporting data behind a given pillar. Additionally, these pillars rest on the foundation of system reliability and response time. Dissatisfaction in these areas creates significant barriers to provider EHR satisfaction and must be addressed in order for the three pillars to effectively support provider EHR satisfaction.

ehr house of success

The guidebook also includes a section on provider burnout prevention and wellness. While the EHR is not the key driver of provider burnout, Arch Collaborative data shows that higher satisfaction with the three pillars and with the EHR correlates with higher clinician wellness and lower provider turnover.

Key Changes from the 2020 Guidebook

The findings in this 2023 guidebook largely support those reported in the 2020 version. Some subtle differences are noted below.

  • The three pillars of success have evolved into the EHR House of Success.The three pillars of success now rest on the foundation of system reliability and response time—a section focused on this foundation is included in the guidebook.
  • This guidebook is focused solely on providers. KLAS intends to share updated nursing insights in our next version of the Arch Collaborative Nursing Guidebook (click here for the 2022 guidebook).
  • Case studies from top-performing organizations are included in each section of the Appendix.
  • Since 2020, new questions have been added to the Arch Collaborative EHR Experience Survey and the Executive Survey (conducted with the leadership teams at healthcare organizations), and the data from those surveys is reflected in this guidebook.
  • Some best practices (and their accompanying charts) have been removed or revised.

Next Steps after Reading This Guidebook

  • Measure with KLAS’ Arch Collaborative to determine your organization’s current EHR end-user experience
  • Identify opportunities for improvement at your organization
  • Use the included best practices to enhance your providers’ EHR experience
  • Measure with KLAS’ Arch Collaborative again to see how your organization’s end-user experience has changed

Data Methodology

KLAS surveys clinicians using our Arch Collaborative EHR Experience Survey. This survey captures clinician feedback on various metrics, including 11 metrics (see the accompanying chart) that are aggregated into an overall Net EHR Experience Score (NEES). The NEES represents a snapshot of the clinician’s overall satisfaction with the EHR environment at their organization and can range from -100 (all negative feedback) to 100 (all positive feedback).

individual metrics behind the nees

Additionally, the insights in this guidebook draw from the following recommendations and resources:

Evidence-based practices: Best practices validated by Arch Collaborative research that differentiate high-performing organizations or that have been documented to help organizations improve.

Leading practices (included in Appendix): Keys to success that are commonly identified by leading organizations but have not yet been broadly validated or are too unquantifiable to be fully validated.

Case studies (included in Appendix): Case studies of top-performing organizations that have worked with their vendor to improve different aspects of the EHR experience.

Please note that you may find some repetition between the different sections of this guidebook. This is intentional—each section is designed to be a standalone resource for a given topic and some principles and best practices apply to more than one area. That said, improving EHR satisfaction is rarely, if ever, a single-factorial effort. To truly have an impact, healthcare organizations should implement a variety of the best practices most applicable to their organization.

Creating EHR Mastery: Onboarding EHR Education

Onboarding education includes training that occurs when an EHR solution is upgraded or first implemented, but it more commonly refers to the EHR training offered to newly hired providers during their first 90 days at an organization.

Evidence-Based Practices

Providers should receive a minimum of three hours of onboarding EHR education and would greatly benefit from eleven or more hours

net ehr experience score--by amount of required initial training

Provider EHR education should be taught by providers

net ehr experience score--by who conducts initial training

EHR education is more effective at supporting a strong EHR experience when it is workflow specific

percentage statisfied with ehr metric--by agreement raining is workflow specific

Creating EHR Mastery: Ongoing EHR Education

Ongoing EHR education builds on effective onboarding education, and most principles of success for onboarding training apply to ongoing EHR training as well.

Evidence-Based Practices

Providers should spend 3–5 hours annually refreshing their EHR knowledge; the majority of providers do not meet this threshold

net ehr experience score--by self-reported ongoing education per year
self-reproted ongoing ehr education per year

The quality of the training is more important than the type of training

usefulness of training programs
net ehr experinec score--by types of training and their usefulness
types of ongoing ehr training provdied by 10 most satisfied organizations types of ongoing ehr training provided by 10 least-satisfied organizations

Providing a distraction-free learning environment leads to higher EHR satisfaction

net ehr experience score--by location of ongoing training

Providers want more training

provider desire for more ehr training reason providers don't want more ehr education

Creating Shared Ownership: Provider Relationships and Communication

EHR success is a journey, not a destination, so IT and informatics leaders must build strong working relationships with clinical and operational leaders. These relationships are healthiest when IT and informatics leaders create a framework within which clinical and operational leadership can successfully guide organizational goals (see Creating Shared Ownership: Governance).

There is significant overlap between the success principles for (1) provider relationships and communication and (2) shared ownership and governance. However, for readability, these topics are broken out into two sections.

Evidence-Based Practices

For organizations to be able to build relationships with all users, a minimum of 2–4 providers should be employed by IT/informatics (full or part time) per 1,000 provider users

net ehr experience score--by number of providers employed by it/informatics per 1,000 provider users

Consistent IT rounding works 

net ehr experience score--by frequency of it rounding

Higher IT spending does not guarantee higher EHR satisfaction

net ehr experience score vs percentage of budget spent on it (operational expenses)

Creating Shared Ownership: Governance

The success principles for shared ownership and governance are closely related to those shared above for provider relationships and communication. However, for readability, the two areas have been broken out into two sections.

Evidence-Based Practices

Organizations with broad, multi-disciplinary team engagement in EHR governance see higher EHR satisfaction

net ehr experience score--by who leads ehr governance

Creating Provider Efficiency: Personalization

Efficiency with the EHR is an area of acute pain for providers and one of the lowest-rated areas of EHR satisfaction. The power of personalization tools to allow organizations and individuals to meet the needs of end users without making any code changes (i.e., using functionality built into the system) is well documented in Collaborative research. We expect findings in this area to continue to expand in future years.

The effect of personalization tools on standardized care and care quality has not been studied by the Collaborative. There are many personalization tools that do not impact standardized care (e.g., personalized reports and chart filters).

Evidence-Based Practices

Personalization tools (sometimes called “user settings”) are key to provider efficiency with the EHR

top-selected personalization tools that have had positive impact on workflows net ehr experiences score--by whether providers use ehr personalization tools

Whether they work in inpatient or ambulatory settings, providers who finish their documentation the same day report significantly higher satisfaction than those who do not

net ehr experience score--by ambulatory documentation efficiency
net ehr experience score--by inpatient documentation efficiency

Creating Provider Wellness: Reducing Burnout

The mission of the Arch Collaborative is to ignite a revolution in EHR satisfaction. As part of that mission, the Collaborative measures provider satisfaction with the EHR and works to understand how the EHR experience impacts burnout. While the Collaborative is not focused on alleviating or preventing burnout, the following insights are valuable for organizations to consider as they work toward that goal.

28% of providers who have participated in the Arch Collaborative report symptoms of burnout. For providers, the EHR is a commonly reported source of burnout, after workload (including lack of control over workload and after-hours workload), time spent on bureaucratic tasks, and staffing shortages. Across clinician roles, the sense of administrative work being prioritized over clinical care is exacerbated by extra clicks, confusing screens, low-value alerts, and other EHR complexities. Organizations can lessen burnout by empowering IT teams to engage with providers to help them solve problems (whether through training or technology), ensuring providers’ voices are heard and their concerns are addressed (see also Shared Ownership: Provider Relationships and Communication and Shared Ownership: Governance).

Evidence-Based Practices

Healthcare organizations should proactively optimize technology’s ability to alleviate burnout by reducing time spent on bureaucratic tasks and reducing after-hours work

self-reported burnout status contributors to burnout

Inefficient charting can increase the likelihood of burnout

self-reported burnout status--by inpatient documentation efficiency self-reported burnout status--by ambulatory documentation efficiency

On average, providers who feel their organization is doing a great job with the EHR have lower rates of burnout

trend in percentage reporting burnout 2018-2023--by agreement organization has implemented, trained on, and supported ehr well
percentage reporting burnout--by agreement organization has implemented, trained on, and supported ehr well
percentage reporting burnout--by amount of after-hours charting per week
percentage reporting burnout--by agreement ehr fixes are timely

Providers who are completely burned out are 17 times more likely to report they are planning to leave their organization

odds of reporting plans to leave--by self-reported burnout status

Building a Technological Foundation: System Reliability and Response Time

Meeting providers’ basic technological needs—not only with the EHR but also with everything it touches (including internet and hardware)—is critical to EHR satisfaction. System reliability and response time play an important role in meeting providers’ needs, yet they don’t receive a lot of attention unless they aren’t working as intended. While most organizations report having a moderately reliable system, those with unreliable systems have significant problems. Response time is a more common pain point across Collaborative respondents and requires more focus from the organization (proactively tracking login time, using solutions from other vendors, keeping software and hardware up to date, etc.). Organizations who are most successful with their system reliability and response time seek out and manage technological recommendations from vendors and proactively address updates, fixes, and hardware replacements.

Evidence-Based Practices

Consistent remote access to the EHR is correlated with response-time satisfaction

agreement with statements on speed and reliability

Poor response time can negatively impact perception of reliability, even if there is very little downtime

percentage reporting ehr availability/response time issues

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 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.

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.