EHR Response Time & Reliability
Foundational to Satisfaction Yet Far from Sufficient
In the early days of the Arch Collaborative, clinician feedback revealed three fundamental factors key to EHR satisfaction: (1) strong user mastery, (2) an organization-wide sense of shared ownership, and (3) EHR technology that meets users’ unique needs (personalization). Much about an individual’s or organization’s EHR satisfaction can be understood through the lens of these three pillars. However, further research has demonstrated that industry-wide issues with system response time and reliability are creating significant barriers to clinician satisfaction. If efforts to improve EHR satisfaction are to be truly successful, organizations must first address these two foundational factors.
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Few Organizations Excel with Reliability, None with Response Time
The digitalization of healthcare has been ongoing for some time, yet some aspects foundational to success in such an environment have not been addressed sufficiently to allow healthcare’s most valuable resources—clinicians—to excel. Overall, almost half (44%) of clinicians do not agree that their EHR is fast enough, and no Collaborative organizations have over 90% of respondents who agree the EHR has the response time they expect (see chart to the right). In terms of system reliability, 23% of clinicians do not agree their EHR is available when needed. Of the over 270 organizations that have participated in the Collaborative, only 18 have more than 90% of respondents reporting few or no difficulties with system availability.
Response Time & Reliability Issues Compromising Patient Safety
Across the Collaborative, over half (57%) of clinicians agree their EHR enables patient safety, and satisfaction with system response time and reliability factor into these clinicians’ perceptions. Clinicians who strongly agree their system is reliable are much more likely to also agree the EHR enables patient safety. This trend is even more significant when it comes to system response time.
“[Our EHR] is extremely slow. It takes 5–10 minutes to log on to a computer, and when we are providing direct care to sick people, that time really matters. There are numerous alerts that pop up all the time that are not helpful at all—not at all. These alerts are repetitive, inappropriate, immediately dismissible, and just another button to push when I am already busy, I have been waiting for 10 minutes for the EHR to load, and my patient who just had major surgery is screaming in pain.” —Nurse at a large health system
Poor Response Time & Reliability Are Barriers to Overall EHR Satisfaction
Organizations with stronger clinician agreement that their EHR has the expected speed or reliability have significantly higher EHR satisfaction than organizations that lack this agreement—for both metrics, the gap between the two groups’ Net EHR Experience Scores is more than 100 points. Further, response time and reliability are not a common concern for the Collaborative organizations with the highest overall EHR satisfaction—almost all organizations in the 80th percentile for Net EHR Experience Score have fewer than 40% of their clinicians identify response time as an issue and fewer than 20% of clinicians identify reliability as an issue.
Note: 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).
Reliability Can Still Be a Problem for Organizations with Very Little Downtime
Clinician perceptions of the EHR’s reliability don’t depend solely on how often the system is completely down. If the EHR drags, even clinicians at organizations that experience very little downtime can report poor system reliability. In fact, of the various EHR aspects rated by clinicians in the Collaborative survey (e.g., external integration, functionality, EHR training, etc.), response time is the one most closely correlated with clinician perceptions of the system’s reliability. This is especially significant given that response time is also one of the aspects with which clinicians across the Collaborative report the lowest satisfaction. If an organization is experiencing high uptime but low satisfaction with system reliability, they may need to focus on increasing the system’s speed.
Challenges with Response Time & Reliability Often Tied to Broader Infrastructure Issues beyond the EHR
A plurality of clinicians who report dissatisfaction with their EHR’s response time or reliability also mention issues with their computer, monitors, laptop, workstation, or other IT equipment. Compared to clinicians who strongly agree they have the response time/reliability they expect, clinicians who strongly disagree are 53% more likely to organically mention hardware issues and 67% more likely to report slow login times. For example, one nurse respondent indicated that it takes 60 seconds for the system to load after a password is entered. Given the frequency with which clinicians must log in during a shift, this nurse spends almost 10% of the workday waiting for the EHR to load.
Next Steps: Response Time & Reliability Self-Examination
Your organization may find the following questions to be a helpful starting point as you work to improve system response time and reliability:
- Do we comply with our vendor’s infrastructure recommendations?
- Do we adhere to a hardware inventory schedule?
- How does the Wi-Fi perform in our clinics and hospitals?
- Do our single sign-on and EHR vendors work together to improve the user experience?
- Do we know how long it takes a user to get into the system?
- Do we know how long it takes to shift between windows or tabs in the EHR?
- Are we on the latest version of our vendor’s EHR?
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. 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 https://engage.klasresearch.com/klas-arch-collaborative/.
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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.