EHR Satisfaction in Providers with Complex Work Arrangements
72% of acute care providers in Arch Collaborative research deal with complex work arrangements—meaning they work in multiple locations or additional care settings. For reasons ranging from differences in the EHR system and workflows to differences in the level of EHR support provided by their organization, providers who have complex work arrangements generally have higher burnout, lower EHR efficiency, and lower EHR satisfaction compared to peers who work solely in a single hospital. This report details these findings and uses the Arch Collaborative’s Keys to Success to share what organizations can do to support providers in complex work arrangements. (Providers who work solely in ambulatory care are not included in this research.)
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Clinicians in the Most Complex Arrangements More Likely to Experience Stress or Burnout from EHR Issues
More than one-third (36%) of providers who have the most complicated work arrangements and also report symptoms of burnout cite the EHR or other IT issues as factors in their burnout. In contrast, these factors are cited by only 20% of burned out providers with simpler work arrangements. Similar patterns appear among nurses and allied health professionals.
Providers in the Most Complex Arrangements Spend More Non-Business Hours Charting
Nearly 80% of providers who have the simplest work arrangements spend less than 5 hours per week charting outside of normal business hours. In contrast, that number is only 57% for those with the most complex arrangements. More than one-third of this group spends 6–15 hours per week on afterhours charting.
Reasons for EHR Dissatisfaction in Complex Arrangements
Different EHR systems across locations
“The fact that the two locations are not integrated and are still on two different systems is a huge inconvenience for providers who are seeing patients in both places. It is also dangerous because it complicates patient care.” —Nurse practitioner, academic health system (2 locations, acute care & ambulatory)
Different system configurations (when using the same EHR)
“We are using one system, but the different environments do not communicate with each other, so it is hard to find the information we need, and that can lead to miscommunication.” —Physician, academic health system (4 locations, acute care & ambulatory)
Workflows not streamlined for multi-setting or multi-location providers
“Portability is a problem for providers who practice in multiple locations. There are no adjustments in the system to improve workflows for anyone who isn’t a PCP doing simple work in one location.” —Physician, academic health system (3 locations, acute care & ambulatory)
Varied levels of EHR support across settings and locations
“The boots-on-the-ground clinical engineering people and IT support vary from facility to facility. [Location A] has a good response. [Location B] is decent. [Location C] is below average.” —Physician, large health system (4 locations, acute care & ambulatory)
How to Achieve Strong EHR Satisfaction in Complex Work Arrangements
Providers who work in multiple settings or locations aren’t all struggling with the EHR. 30% of those in the highest-complexity group (those working in acute care and other settings across multiple locations) are considered highly satisfied with their EHR experience. How can organizations improve the EHR satisfaction for all providers in complex work arrangements?
1. Provide training that targets workflow and location differences
In the Arch Collaborative survey, participants are asked to share the top three things they want addressed to improve their EHR experience. The need for better or more EHR training is cited about 27% more often by dissatisfied users in the most complex arrangements compared to those with simpler work arrangements.
Vidant Health is an example of how to provide successful EHR training. They specifically target clinicians who work in multiple locations by requiring them to receive video instruction specific to their workflows before the standard classes. Clinicians also attend a three-hour, setting-specific class (inpatient, ambulatory, or ED), and those who work in multiple settings are required to go to each related class.
2. Encourage use of personalization tools
Clinicians that work in multiple settings see bigger satisfaction gains from use of personalization tools than those that work in a single setting. Personalization tools are cited as a reason for high EHR satisfaction about four times as often by clinicians in complex arrangements compared to clinicians with simpler work arrangements.
Kaiser Permanente Northwest has developed their own method to improve personalization use. They noticed that some EHR users find it more difficult to invest time and energy on their own into learning and using personalization tools, and these users are typically the ones who struggle with EHR efficiency. Kaiser Permanente Northwest built tools tailored to all providers in a given department, with the philosophy that similar providers will benefit from similar tools, improving efficiency and workflows across the department.
3. Ensure the voices of clinicians in complex arrangements are heard when it comes to workflow differences
Different providers have different support and communication needs, and improving the EHR requires input from diverse clinical backgrounds and settings. This is especially true with providers who work in multiple settings as the effects of setting-specific issues will be compounded for them. One provider from an academic health system illustrated this concept, explaining, “Too many of the doctors that assist the IT folks don’t actually practice in locations or care settings that well represent the others. They are not good representatives of the masses. . . . Rarely do they deliver any resolution or true improvement.”
MemorialCare designed their training programs to cover multiple service lines for clinicians of various backgrounds. In 1997, they established their best-practice team, which includes members from multiple hospitals, physician groups, and offices who come together to share diverse ideas for enhancing care and improving patient safety. This team obtains feedback from a variety of clinicians so every service line has a voice in the EHR changes. As an example, the critical care team recently updated over 100 order sets by removing benzodiazepine in response to the FDA’s warning about it increasing fall risks for elderly patients. Among Collaborative organizations, MemorialCare ranks in the 99th percentile for provider EHR efficiency and in the 97th percentile for the EHR’s support of quality care.
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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Clinician Wellness and Reducing Burnout, Nursing EHR Success, 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.