Exploring EHR Satisfaction by Organization Type
The various healthcare organizations in the Arch Collaborative differ widely in terms of size, focus, patient demographics, EHR systems, and leadership structures. These differences can affect end users’ EHR satisfaction, particularly when it comes to key indicators like training and governance. This report examines organization-specific trends uncovered by the Collaborative data and highlights opportunities and strategies for improvement.
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For this research, Collaborative member organizations are categorized as one of the following organization types:
Community hospital
(single hospital, =500 beds)
Community health system
(multiple facilities, =1,000 beds)
Midsize health system
(multiple facilities, 1,001–1,500 beds)
Large health system
(multiple facilities, >1,500 beds)
Children’s hospital
Academic health system
(affiliated with academic setting or university)
This report includes data only from those Collaborative member organizations that have completed the executive survey (an in-depth survey specifically for organization leadership). Analysis is based on organization-level data (i.e., scores and responses aggregated for each organization), rather than individual respondent–level data. Non-US health systems and ambulatory care groups are excluded; insights on these types of organizations can be found here and here.
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).
Community Hospitals: Focus on the Factors within Your Control
Clinicians in community hospitals report the lowest overall EHR satisfaction. However, the difference in satisfaction between these clinicians and clinicians at the most highly satisfied organizations (community health systems) is not statistically significant when the analysis controls for the EHR in use. This suggests that the EHRs typically used by community hospitals—who often have fewer resources and thus tend to use less expensive, lower-functionality solutions—may account for a good portion of clinicians’ lower satisfaction. This is corroborated by the fact that these hospitals are the least likely to be satisfied with their EHR vendor’s delivery (see stakeholder chart in next section).
However, strong EHR satisfaction is still possible for community hospitals, regardless of the EHR in use. Past Arch Collaborative research has shown that only about 33% of the variation in a user’s EHR experience can be attributed to the solution itself, which explains why satisfaction can vary widely across any given vendor’s customer base. Community hospitals can take heart knowing that efforts to improve user mastery (via initial and ongoing EHR training) and foster an organization-wide sense of shared ownership can lead to significant improvements for end users.†
When it comes to improving shared ownership, a good place for community hospitals to start might be IT rounding—community hospitals are the least likely to be doing it, yet the 2020 Arch Collaborative Guidebook identifies it as a best practice of EHR governance.
†For example, a Collaborative report detailing findings from organizations that have re-measured clinician satisfaction after implementing changes found that improvements to EHR governance and clinician training are both associated with an approximately 10-point increase in NEES.
Case Study: IT Rounding at a Community Hospital
Peninsula Regional Medical Center has built a nursing governance structure that represents all nursing divisions. But they believe for the structure to fully work, they need regular rounding so that pain points can be identified and resolved. Rounding is done by not only the informatics team but also the executive team and directors. This results in high engagement with the frontline nurses and high nursing EHR satisfaction (89th percentile among Arch Collaborative participants).
Midsize Health Systems: Manage Complexity with Strong Training & Governance
Midsize health systems have an average Net EHR Experience Score of 25.9, meaning clinicians at these organizations see room for improvement. Factors that complicate EHR satisfaction for these organizations include providing EHR support across multiple locations, maintaining multiple EHR systems, and navigating the layers of communication that may exist between EHR decision-makers and end users. Lack of optimization resources is another barrier reported by some midsize organizations.
Compared to peers at other organizations, clinicians at midsize health systems report the lowest satisfaction with their own efforts to learn the EHR and some of the lowest satisfaction with their organizational and IT leadership (see stakeholder chart above). This suggests the need for midsize health systems to focus satisfaction-improvement efforts on driving better user proficiency and higher trust in organizational leadership.
Case Study: Improving User Proficiency & Trust at a Midsize Health System
Through their Super Thrive program, Legacy Health has increased both end-user proficiency and clinician trust in IT. The program focuses on treating providers well throughout a three-day off-site training course. Legacy Health analyzes Epic Signal and PEP data to identify the providers most in need of help to become more efficient with the EHR. The course provides training and also focuses on clinician wellness through things like yoga sessions and midday walks. Legacy Health was able to fund the program via a grant.
Children’s Hospitals: EHR Training Key to Meeting Your Users’ Unique Needs
Children’s hospitals are obviously unique from other organizations in their need to document things such as immunizations, well-child visits, and patient growth. However, their EHRs are typically not optimized to support pediatric care, and clinicians often have difficulty finding or documenting needed information. In fact, clinicians at children’s hospitals have the lowest levels of self-reported charting efficiency, with less than one-third of inpatient clinicians closing most of their charting immediately after rounds. This is a particular concern since low charting efficiency is also correlated with higher levels of clinician burnout (see chart in next section about academic health systems).
At the same time, one-third of children’s hospitals (as reported by organization executives) see insufficient EHR training or education as their biggest obstacle to higher satisfaction with the EHR. Children’s hospitals are the least likely to focus their initial EHR training on workflows and are also the least likely to offer ongoing training in the form of in-person classes, with resource constraints such as lacking financial support and insufficient trainers and superusers being common concerns. Training best practices outlined in the 2020 Arch Collaborative Guidebook can help children’s hospitals provide the EHR education that pediatric care providers need to serve their unique population. can help children’s hospitals provide the EHR education pediatric care providers need to serve their unique population.
Case Study: Improving Ongoing EHR Education at a Children’s Hospital
Children’s Hospital and Medical Center ranked in the 85th percentile for provider agreement that ongoing EHR training is sufficient and in the 94th percentile for nurses’ satisfaction with ongoing EHR training. They allow nursing and physician leadership groups to train in the ways that best meet the needs of their clinicians. The organization consistently sets up a training booth every Tuesday at the same time in the same location so providers know when and where to get help. Providers can immediately get answers that help them improve their efficiency. The informaticists who support the nurses are all nurses who still do clinical shifts, so they can match nurse education materials to nurse-specific workflows in each department.
Academic Health Systems: Make Clinician Wellness a Top Priority
As with children’s hospitals, academic health systems have unique requirements that often result in longer charting times. Because they are being recorded in an educational setting, patient records in academic health systems often require a higher level of detail than may be necessary elsewhere. Additionally, many providers in these settings work as both healthcare providers and teaching faculty, making inefficient charting even more onerous. Particularly worrisome is that clinicians at academic health systems also report some of the highest levels of burnout compared to clinicians at other types of organizations.
Case Study: Improving Clinician Wellness at an Academic Health System
Clinicians at SUNY Upstate Medical University showed above-average levels of burnout. Their well-being dropped even further after the onset of the COVID-19 pandemic. The organization’s leadership pledged to use their Arch Collaborative survey results to connect with all departments and improve wellbeing. SUNY Upstate analyzed clinicians’ comments and grouped the issues based on how difficult they were to fix. Then they started to take action to fix those issues. The organization created new training paradigms by listening to clinicians’ concerns, and they developed at-the-elbow support. This improved clinicians’ trust in the organization by showing their feedback mattered and would be addressed.
Large Health Systems: Increase Communication & Mitigate the Impact of Size-Related Complexity
Clinicians at large health systems report the second highest satisfaction with the EHR and also report relatively high satisfaction with all three EHR stakeholders (i.e., the vendor, the provider organization leadership, and the end users themselves). According to executives at large health systems, the challenges these organizations do face with EHR satisfaction often stem from the organization’s size. These include communication challenges (e.g., difficult to efficiently communicate with and engage clinicians across the organization) as well as challenges that arise from having more complex EHR arrangements (e.g., multiple layers of EHR support, multiple EHRs, or multiple configurations of the same EHR). When asked to identify the top factors that contribute to their EHR success, 17% of large health system executives point to having a good EHR system or EHR vendor relationship (see chart in next section). Across the other organization types, only four other organizations cited this particular factor.
Case Study: Using Communication to Build a Culture of Empathy & Accountability at a Large Health System
Novant Health is in the 94th percentile for provider trust in IT, and this reflects the culture of empathy and personal accountability the organization has built. The leadership at Novant Health regularly asks questions to better understand what they can do to help the clinical teams improve. This inquisitive attitude is tied to their principle of empathy, which includes a focus on physician wellness. Novant Health holds providers accountable to certain metrics, such as closing encounters within three to four days. By evaluating these metrics, Novant Health can identify provider pain points and provide extra assistance or training as needed. The goal is not to punish providers but rather to ensure efficient practices and high quality.
Community Health Systems: Continuous Improvement Is the Goal
With an average Net EHR Experience Score of 40.3, community health systems have the highest EHR satisfaction among all organization types and lead out in many of the key metrics examined in this report, including satisfaction with EHR stakeholders, IT rounding, and charting efficiency. Interviewed executives at community health systems commonly attribute their success to having clinician-led governance structures and fast internal support for the EHR. Community health systems have the opportunity to capitalize on the successful structures already in place and continue to improve the EHR experience for their clinicians.
Case Study: Continuous Improvement Is the Goal at High-Performing Community Health System
Guthrie Clinic has been a consistent top performer in clinician EHR satisfaction (their Net EHR Experience Score is in the 94th percentile). However, exit interviews at the organization still showed that EHR frustration was a leading factor in physician turnover. To combat this, Guthrie Clinic has worked to improve their EHR training programs, including providing repeat trainings to allow information to sink in. The dedicated training programs have enhanced relationships with providers, who are now more comfortable and empowered to reach out for help. Over a two-year period, the organization has seen a 24–30 percentage point increase in clinician agreement that the EHR training is sufficient.
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.