EHR Implementations 2025
Investing in People to Avoid Pitfalls & Ensure Clinician Success
EHR implementations are tremendous financial and operational undertakings with significant implications for healthcare organizations, their clinicians and staff, and ultimately, the patients they care for. In the aftermath of the COVID-19 pandemic, the challenges of such projects have only become more pronounced—since 2022, satisfaction with EHR implementations has dropped consistently, and just 38% of organizations have said their recent implementation hit the mark (see chart below). To help healthcare organizations buck the downward trend, this report emphasizes the importance of investing in the human elements of an EHR implementation—it outlines where implementations most frequently go wrong, the impact that implementations have on clinicians (one of several stakeholder groups), and the strategic priorities of organizations that have successfully managed the implementation process. Also included are ways that KLAS can provide transparency through better stakeholder alignment.
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This report leverages data from three KLAS sources:
- Customer satisfaction data from KLAS’ standard quantitative evaluation for HIT software
- Data from the KLAS Arch Collaborative EHR Experience Survey, which specifically measures the EHR satisfaction of clinician end users
- Data from KLAS’ 2023 Implementation Benchmarks report, which examines common pitfalls experienced during major HIT implementations
THE STATE OF EHR IMPLEMENTATIONS
In the US, EHR Implementations Have Been a Market-Wide Challenge Since the Pandemic
In the US, implementations and training are consistently two of the weakest elements of the EHR experience. The COVID-19 pandemic only exacerbated these issues as the industry adjusted to virtual environments and was then hit with post-pandemic staffing challenges. Since 2022, customer satisfaction with EHR implementations has dropped over twice as much as any other metric in KLAS’ standard HIT software evaluation. In that same time frame, 40% of interviewed healthcare leaders who had recently gone through an EHR implementation reported that their implementation had significant misses; another 22% reported average satisfaction with room for improvement. In this environment, successful EHR implementations can and do still happen, but not without diligent attention, planning, and effort from every stakeholder involved.
When Implementations Miss the Mark, Recovery Is Often Slow & Difficult
75% of individuals who report dissatisfaction with their EHR implementation continue to report low overall satisfaction with their EHR two or more years down the road.†
† Based on a sample of 40 respondents to KLAS’ standard quantitative evaluation who reported dissatisfaction with their EHR implementation at some point in the last five years and continued to report low overall EHR satisfaction when reinterviewed two or more years later.
Executive Voices on Recent Implementations
“When our EHR vendor was involved with the implementation, I was quite impressed with their level of engagement. I got the feeling that they also reciprocated that feeling because of our organization’s engagement and commitment to the project’s success. The implementation was still difficult, but I appreciated that the vendor could see both the technical and the human aspects of the implementation. . . . The vendor was very engaged. They were very supportive and helped us in considering aspects of the implementation that we wouldn’t have considered on our own. They offered their analysis based on their experience from other clients they had and engaged people at multiple levels of our organization.” —VP
“We sometimes expect our EHR vendor’s people to be our subject matter experts, but they push a lot of decisions off to our organization when it comes to our build. During our implementation, I would have liked to see stronger representation from our EHR vendor to let individuals in our organization know the potential ramifications of our choices. . . . We want to make sure that our vendor’s guidance is as appropriate as possible. . . . We had some younger, greener folks as part of our implementation, so they might not have known how to ask questions.” —CIO
“We had implementation people from our EHR vendor whose whole objective was to work from a list and check the boxes of what they were supposed to do. If any questions came up, we would look for a check in the box to confirm they had apparently done something. It didn’t matter whether the users understood the product, had any training, or could carry forth because their objective was checking the boxes. . . . The other thing is we had implementation project leaders who never took responsibility for anything. A problem was always somebody else’s fault, and that was really difficult.” —IT director
Implementation Misses Are Acutely Felt by Clinicians, Who Often Report Below-Average Satisfaction in Years Following Go-Live
Since the pandemic, 22 organizations with a newly implemented EHR have measured their clinicians’ EHR experience via the KLAS Arch Collaborative. 73% of these organizations had a below-average Net EHR Experience Score (NEES)† following the implementation. While organizations can expect this experience to improve somewhat over time as clinicians acclimate to the new system, how the implementation is managed greatly impacts the duration of the learning curve and the amount of time it takes clinicians to feel satisfied with their EHR experience.
The 27% of organizations whose clinicians report an above-average EHR experience post-implementation were able to achieve this by providing the technological foundation needed to ensure fast system speed and seamless integration at go-live. They coupled this with careful management of the people and process changes that must accompany technology changes, ensuring that clinicians understood how to efficiently use the new EHR and providing the necessary governance and support structure. A deeper look into the data (see section below) suggests that the human element of an implementation is often underestimated and underinvested in and is a key area for improvement across the industry.
† 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. A NEES can range from -100 (all negative feedback) to 100 (all positive feedback).
WHERE EHR IMPLEMENTATIONS MISS THE MARK
The Execution of Change Management & Training Is Where Most Implementations Fall Short
It is widely acknowledged that successful implementations must account for the human elements of the project in addition to the technical elements. However, though most organizations create plans to address the human factor, many leaders look back on their EHR implementation and feel they didn’t do enough. In particular, they feel their change management efforts were too late or had an overly narrow scope, focusing too much on functionality training without addressing the mindset and process changes critical to adoption. Often, leaders wish they had invested in more training time and workflow-specific training in the context of patient care. One director at a healthcare organization explained, “One of my biggest concerns is setting expectations that the work we are doing today will look different. A lot of people still have not been fully communicated to or involved in the process to understand that. I find myself having to tell people that we need to change and that the new system is not around to just let us keep doing what we have been doing. So there is more of a mindset change.” Additionally, many organizations approach the human factor without a method for measuring the execution, leading to a check-the-box approach rather than a focus on execution quality.
Challenges in these areas can be exacerbated by misaligned expectations around stakeholder responsibilities, as the healthcare organization, EHR vendor, and implementation partner (e.g., firms providing implementation leadership, advisory services, staff augmentation, etc.) all play a part in change management and training. Said one CMIO, “Our EHR vendor needs to spend more time understanding our current state and presenting to us the amount of change that is required in a particular area. They do a good job of talking about their product and how it works, but they don’t do a very good job of helping people understand how much the way they do things need to change when they implement the product.” There are a host of interrelated issues that can also stem from stakeholder misalignment, such as timeline discrepancies and understaffing, making it imperative that all parties work together in open partnership to achieve a successful implementation.
What Is Change Management in the Context of an EHR Implementation?
In the context of an EHR implementation, change management is a systematic approach to dealing with the transformation of an organization’s EHR goals, processes, or technologies. The purpose of change management is to implement strategies that create alignment on change, effect change, control change, and help people adapt to change to drive organizational outcomes. For more information, look out for KLAS’ Change Management Forum Executive Overview publishing in early 2025.
Majority of Clinicians Don’t Receive Sufficient Training or Support During Implementations; Nurses in Particular Are Too Frequently Overlooked
15 organizations have measured their clinicians’ satisfaction via the Arch Collaborative both before and after implementing an EHR, and on average, 57% of the clinicians report that their organization and IT department did not support the implementation well. Unsurprisingly, they point to gaps in training and change management. The burden of filling these gaps often falls to clinicians, as evidenced by a slight increase in clinicians reporting they did a great job themselves learning the EHR paired with a large drop in agreement that their initial training was sufficient. One physician said, “The training sessions were not relevant and did not prepare us for our go-live. Staff members were expected to build the new EHR by identifying deficiencies rather than using it. For the first six months, staff members were working on average five extra hours a day.” Furthermore, clinicians reported that in the shuffle of responsibilities during an EHR implementation, they were less likely to know how to request fixes or who was assigned to their department to help with the EHR.
These issues are particularly prominent for nurses. Unlike physicians, whose average satisfaction with their organizations’ delivery and support of the EHR increased post-implementation, nurses saw a decrease in satisfaction compared to pre-implementation levels. Additionally, nurse agreement that their initial training was sufficient dropped 24 percentage points after implementation. One nurse shared, “The training for the superusers and staff was too short and incomplete. Many superusers were still not comfortable using the system when it was implemented, and many of the support staff, who were supposed to be the go-to people for the superusers, knew even less than the superusers, and were not helpful or able to answer questions.” Because nurses constitute one of the largest groups of EHR users, it is critical that they be given better attention by organizations during EHR implementations.
STRATEGIC PRIORITIES FOR SUCCESSFUL EHR IMPLEMENTATIONS
Even though implementations are highly involved and challenging, well-prepared organizations can be successful. Time and effort are required up front to establish a governance structure that includes thorough action plans and stakeholder alignment. Additionally, organizations must continually work to ensure everything is delivered as expected and that change is well managed. The following section shares strategic priorities that were identified by (1) organizations KLAS worked with to measure stakeholder alignment throughout their implementations and (2) organizations that administered the Arch Collaborative EHR Experience Survey and reported high clinician satisfaction following their implementations.
Regular, Transparent Communication Between Healthcare Organization, EHR Vendor, and Implementation Partner to Ensure Continual Alignment and Accountability
Ultimately, all parties should be equal partners in the implementation and should share the responsibility of its success. However, shared responsibilities can become murky when the parties involved don’t clearly define roles and action items.
All stakeholders should help cultivate a safe environment where it is encouraged to raise a red flag when necessary.
EHR vendors and implementation partners need to provide healthcare organizations with strategic guidance around goals, roles and responsibilities, and timelines.
Healthcare organizations should prioritize the needs of their staff and clinicians throughout the implementation and help the EHR vendor and implementation partner understand their organization’s specific processes.
All stakeholders should meet frequently and ensure there is a clear understanding of progress and continued alignment.
All stakeholders should create action plans and follow up regularly with each other for accountability.
A Constant Focus on Change Management Execution
Change management must be addressed early in the process and requires constant follow-up throughout every stage of the implementation.
Healthcare organization executives must ultimately own change management within their organizations and establish the vision for why the new EHR is being implemented and what specific outcomes the organization expects to achieve; however, it is critical that EHR vendors and implementation partners also provide guidance on how to successfully manage change.
Change management needs to happen at all levels of the organization. Department leaders and managers must be involved, bought-in, knowledgeable, and given clear directions on how to communicate changes to their teams.
Organizations should consider their EHR implementation as an opportunity to optimize and standardize the broader end-to-end processes and workflows that the EHR supports and include related process and workflow changes in their change management strategy.
Organizations need to focus on the people and processes involved in their EHR implementation just as intentionally as they do the technological aspects. Regarding people, organizations too often think that training is a change management strategy; however, their approach should be much broader. The Prosci ADKAR Model one of many change management models and one that is commonly leveraged by consulting firms leading HIT implementations, comprises five elements that drive effective change: awareness, desire, knowledge, ability, and reinforcement. Organizations using the ADKAR Model create awareness and cultivate a desire for change at the end-user level before focusing on knowledge and ability (i.e., training). Communicate the “why” before the “how” and consistently reinforce that messaging to drive sustainable end-user adoption.
Strong Governance Structures That Promote Effective Communication Between Leaders and End Users
Effective governance goes beyond approving changes—healthcare organizations should use governance as a strategic and operational framework to oversee EHR management, usage (including training), and optimization.
Governance should involve decision-makers (e.g., C-suite, directors) as well as individuals across the organization who have technical and frontline workflow expertise.
Decision-makers must be aligned on a strategic plan that includes guiding principles, policies, and standardized processes that will guide consistent decision-making across the organization.
Successful organizations frequently have multiple levels of governing bodies, including executive leaders in charge of organizational strategy, operational and departmental leaders in charge of processes, and workgroups in charge of analysis and vetting change and communication.
Make sure that individuals on governance committees are allotted time to participate.
See KLAS’ recent EHR Governance 2024 report for insights on which vendors/firms can help your organization improve governance.
Deep Investment in Workflow-Specific Training That Accounts for the Entire Patient Journey
Training is a critical element that supports organizations’ broader change management initiatives; organizations shouldn’t negate their earlier efforts by skimping on training. The Arch Collaborative Provider Guidebook 2023 and Nursing Guidebook 2024 show that providers and nurses should receive at least three to six hours of initial training on a new EHR.
The training should cover not only general EHR features but also the specifics of how providers and nurses can accomplish their day-to-day work.
Training should be conducted on a model of the EHR that is specific to the organization rather than on a base EHR model.
Leverage trainers that are deeply familiar with the specific workflows of the clinicians they train; providers learn best from peer providers, and nurses often learn best from nonclinical trainers as long as the trainers are knowledgeable about nurse workflows.
Workflow-specific education needs to occur prior to go-live; it should be reinforced and supported by strong at-the-elbow support at go-live and during the weeks following.
See KLAS’ recent EHR Education Software and Services 2023 report for insights on which vendors/firms can help your organization improve workflow-specific training before or during an implementation.
How KLAS Can Help: Data-Driven Insights to Avoid Common Implementation Pitfalls, Align Stakeholders, and Support Ongoing EHR Optimization Efforts
If your organization is implementing a new EHR, KLAS can support you through the following steps to help you achieve success:
- Establish a baseline measurement of your clinicians’ experience on the legacy EHR. This allows you to identify potential pitfalls and areas for improvement as you go into the implementation.
- Throughout the implementation process, receive tailored guidance and data-driven insights from KLAS that drive implementation stakeholder alignment. KLAS interviews stakeholders from all parties at various stages to measure progress, identify potential problems and misalignment, and create action plans. The end goal is to help stakeholders address common challenges (e.g., change management, training) early in the process to enable stronger partnerships and a smooth implementation.
- After the implementation, continually measure your clinicians’ experience with the new EHR to understand the implementation’s impact and how to fine-tune the experience.
- Keep going—continue measuring your clinicians’ satisfaction and work to further optimize the EHR experience.
Voice of KLAS Customers—Two Stakeholders Engaged in the Same Implementation
“Our Arch Collaborative measurement showed us that we were in the bottom quartile compared to other health systems on our current EHR. That helped us message to our internal people that if we did not make adjustments we would spend all this money only to end up in the bottom quartile of the EHR we were moving to.” —CMIO of healthcare organization
“I found having the Arch Collaborative data during our implementation incredibly valuable. It highlighted clearly for us the pain points that exist at our customer’s organization today. In addition, one of the stakeholders at the customer organization cites the Arch Collaborative scores often when reminding colleagues of why we are doing what we are doing and what areas could be improved. I would be supportive of this on installs.” —Implementation executive of software vendor
SUCCESSFUL EHR IMPLEMENTATIONS: HEALTHCARE ORGANIZATIONS THAT BUCK THE DOWNWARD TREND
Generally, organizations that measure with the Arch Collaborative within three years of their implementation report lower EHR satisfaction compared to those that measure after having been live for four or more years. The following organizations are an exception, as they measured high EHR satisfaction within three years of their implementation.
UTHealth Houston leverages both EHR user-efficiency data (i.e., Epic Signal data) and experts throughout the organization to ensure strong EHR education. In May 2021, UTHealth Houston was one of the first organizations in the United States to implement Epic during the global pandemic. Just three years after go-live, their overall NEES ranked in the 97th percentile across the Arch Collaborative.
Keys to Success:
UTHealth Houston believes driving success with EHR education is truly a team effort. Virtual instructor-led training, both synchronous and asynchronous, launched in 2021 in connection with the EHR go-live and accounts for most of the training at this health sciences university. The organization also employs at-the-elbow support, department meeting training, one-on-one training, and in-person, instructor-led training. For more details, read this case study.
Ozarks Healthcare comprises an acute care hospital (114 beds) and 28 clinics. Ozarks was extremely successful with the workflow-specific training they provided to their physicians when they transitioned to MEDITECH Expanse in 2020.
Keys to Success:
Ozarks Healthcare required six hours of training from their physicians, and the training was delivered in multiple formats (one-on-one, at-the-elbow, and virtual). The training was also specific to trainees’ areas of practice and covered daily tasks, order management, documentation, and personalization of MEDITECH Expanse. Everything was tracked to ensure physicians completed their training. Ozarks Healthcare’s approach resulted in a 19-percentage-point increase in the number of providers who agreed that their initial training was sufficient. For more details, read this case study or watch this webinar featuring Ozarks’ CMIO, Dr. Priscilla Frase. Ozarks’ 2024 case study is also available for review.
CommUnity Health Centers, a federally qualified health center, achieved a NEES of 70.2 (on a –100 to 100 point scale) two years after their Epic implementation.
Keys to Success:
Operations leaders were at the forefront of all Epic processes and decisions and communicated all Epic information to the rest of the organization—they signed off on the newsletter, handled questions, presented at all-team meetings, participated in Microsoft Teams chat channels, and championed a specialist-training-specialist model for their implementation. CommUnity Health Centers had the operations team take ownership of Epic to (1) ensure efforts were focused on strategic goals, (2) promote and maintain standardization, (3) ensure EHR optimizations were aligned with care model, (4) ensure prioritization was done with patient care in mind, (5) foster collaboration and integrated culture, and (6) foster a close partnership between the healthcare operations team and the technical team. CommUnity also leveraged a priority scoring rubric that allowed for consistent decision-making around the Epic implementation.
About This Report
The data from this report comes from three sources: (1) KLAS performance data, (2) KLAS Arch Collaborative data, and (3) data from KLAS’ 2023 Implementation Benchmarks report.
KLAS Performance Data
Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. For this report, interviewees were from US organizations and were interviewed between January 2022 and October 2024 using KLAS’ standard quantitative evaluation for healthcare software, which is composed of 16 numeric ratings questions and 4 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.
Unless otherwise noted, sample sizes displayed for performance data (e.g., n=16) represent the total number of unique customer organizations interviewed for a given vendor’s EHR.† However, it should be noted that to allow for the representation of differing perspectives within any one customer organization, samples may include surveys from different individuals at the same organization.
† The acute care EHR vendors measured in this data include Altera Digital Health, Epic, MEDITECH, Oracle Health, and TruBridge. The ambulatory care EHR vendors measured include AdvancedMD, Altera Digital Health, Amazing Charts, athenahealth, Azalea Health, CareCloud, CompuGroup Medical, CureMD, DrChrono, eClinicalWorks, Elation Health, Epic, Experity, Greenway Health, MEDITECH, MicroMD, Nextech, NextGen Healthcare, Oracle Health, Tebra, and Veradigm.
KLAS Arch Collaborative Data
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 500,000 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.
For this report, data comes from 22 newly live organizations that have measured their clinicians’ EHR satisfaction since 2022 (“newly live” is defined as organizations who were no more than two years post-go-live at the time of measurement). Organizations had implemented Epic, Greenway Health, or MEDITECH Expanse. 15 of these organizations measured their clinicians’ satisfaction both before and after their implementation to understand the impact of changing EHRs on their clinicians’ satisfaction.
Additionally, this report acknowledges organizations that have won KLAS Arch Collaborative Awards. The Arch Collaborative EHR Experience Pinnacle Award honors members of the Arch Collaborative who have demonstrated that success is possible with the EHR. Qualifying organizations must have a NEES of at least 75.0 for nurses or a NEES of at least 60.0 for physicians. To put this in context, the average nurse NEES is 47.3 (n=113,045), and the average physician NEES is 23.4 (n=53,037).
The Arch Collaborative EHR Experience Breakthrough Recognition honors any participating organization whose NEES has increased by at least 15 points between measurements. This can be earned for physician or nurse scores.
KLAS’ 2023 Implementation Benchmarks Report
KLAS’ 2023 Implementation Benchmarks report examines feedback from 180 respondents from 113 unique healthcare organizations who were implementing or had recently implemented a major HIT solution (e.g., EHR, ERP solution, etc.). Data was collected between October 2022 and December 2022.
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Onboarding EHR Education, Ongoing EHR Education, Peer Guidance, Recognized Improvement, Shared Ownership and GovernanceThis 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.