Exploring EHR Satisfaction by Provider Specialty

Physicians and advanced practice providers who are very satisfied with the EHR are almost five times more likely to report plans to stay at their organization, compared to peers who are very dissatisfied (see chart below); this illustrates how impactful technology can be on the clinician experience. One of the ways organizations can target improvements for those who are less satisfied is to look at EHR satisfaction by specialty—there is currently a gap of about 30 points between the most satisfied specialty (hospital medicine) and the least satisfied specialty (ophthalmology). The goal of this report is to help readers understand this variation and learn some ways the gaps between specialties might be addressed.

Note: Arch Collaborative respondents are asked to rate the main EHR solution used at their organization. For ratings on the ancillary EHR solutions designed for specific departments, visit the KLAS website.

† 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).

EHR Satisfaction for Orthopedics & Cardiology Consistently Below Average across Vendors

Examining how specialties score compared to other users of their same EHR demonstrates that satisfaction can depend more on a user’s specialty than on which EHR is used and can help organizations pinpoint which specialties are most in need of extra focus. Vendor-specific specialty data is available only for Cerner and Epic users (other EHR vendors do not have large enough representation in the Collaborative to be broken out). In both customer groups, orthopedics and cardiology have some of the lowest scores compared to peers using the same EHR; regardless of the vendor’s average NEES, some common areas of frustration for these two specialties include functionality, ability to deliver quality care, and vendor delivery of a high-quality EHR.

The specialty that scores the highest compared to each vendor’s average is also the same across Cerner and Epic—for both customer groups, hospital medicine providers report an NEES over 10 points higher than the average for their respective EHRs. These providers are particularly pleased with their workflow training, the EHR’s functionality, and how easy the EHR is to learn.

By implementing new EHR training, support, and governance programs, OrthoVirginia was able to improve their orthopedic providers’ NEES by 44 points. Some keys to success include:

• Creation of the Provider Support Specialist (PSS) program: Each provider has a touch point with a member of the PSS team every one or two weeks, resulting in greater EHR knowledge and efficiency.
• Implementation of an EHR governance structure: Modeled on Kaiser Permanente Northwest’s “Pyramid of Change,” OrthoVirginia’s governance creates structure and process for handling EHR change requests.

Individual involvement in EHR governance to better understand EHR changes and the reasoning behind them

The ability for providers to ask the IT department, EHR analysts, or their peers for help with quick fixes and recommendations for being more efficient with the EHR

Significant use of EHR personalization tools that enhance EHR use and make documentation easier

Good EHR education, including required organization trainings and self-learning to increase EHR knowledge and understanding

Specialty-Specific Workflow Training Tied to Higher Satisfaction with EHR Functionality

Though it may take significant time and effort to build specialty-specific workflow training, providers who strongly agree their training was specialty-specific are almost 25 times more likely to agree that the EHR has the functionality they need. Both organizations and EHR vendors can help all providers find success with the EHR by ensuring that initial and ongoing education are tailored to the needs of different specialties.

A case study from Kaiser Permanente Southern California outlines their efforts to improve both initial and ongoing EHR education programs by incorporating workflow-specific training. Clinicians attend education classes based on their specific work environment and receive training tailored to their unique needs. These education programs are then supported by rounding efforts.