Personalizing the EHR 2023
Improving Physician Satisfaction and Efficiency
Since the Arch Collaborative’s early days, analysis of clinician feedback has identified three pillars 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). This last pillar is the focus of this report. While it is important for physicians to have the flexibility to care for patients and document in a way that fits their workflow, too much freedom to change the EHR can hinder efficiency and patient safety. This report identifies the benefits of personalization as well as best practices for leveraging it.
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Key Takeaways
Encourage physicians to use personalized tools as their primary documentation method: Physicians who use personalized tools have a higher Net EHR Experience Score, have higher immediate chart-closure rates, and spend less time charting after hours than those who use other documentation methods.
Discourage physicians from using more than one documentation method: Physicians who use multiple documentation methods have higher rates of burnout, spend more time charting after hours, and are more likely to cite after-hours charting as a contributor to their burnout.
Target interventions toward those who don’t use templates since they are more likely to be disengaged and at more risk for dissatisfaction: Templates are the most commonly used personalized tool and are correlated with higher EHR satisfaction, more effective physician charting, and lower rates of burnout.
Provide high-quality training: Strong personalization training is correlated with higher chart-closure rates, leading to a cascade of positive effects, including less after-hours charting and lower burnout.
Physicians Who Use Personalized Tools for Documentation Report Highest EHR Satisfaction
Though direct entry is the most commonly used documentation method, use of personalized tools is the approach most correlated with high EHR satisfaction (as measured by the Arch Collaborative’s Net EHR Experience score, or NEES). While other documentation methods (such as dictation/transcription and speech recognition) might help reduce burnout (see chart on next page), they result in the user being more removed from the EHR and thus are less likely to improve EHR satisfaction. In contrast, individuals who take the time to personalize the EHR demonstrate a desire to master the technology, rather than step away from it. Physicians who use personalized tools for documentation, whether alone or in conjunction with other methods, have an average NEES 15.5 points higher than those who do not use personalized tools.
Case Study: OrthoVirginia
When rolling out a new EHR, OrthoVirginia set their providers up for success by providing staggered EHR training and utilizing superusers to provide at-the-elbow support during class and personalization guidance after class. Learn more about their success here.
Use of Multiple Documentation Methods Correlated with Higher Rates of Burnout
With the exception of physicians who use both dictation/transcription and direct entry, physicians who use just one documentation method—regardless of what it is—tend to report lower levels of burnout. Additionally, physicians who use multiple documentation methods are more likely to cite after-hours charting as a contributor to their burnout compared to those who use a single documentation method. As noted above, physicians who use dictation/transcription, scribes, or speech recognition report lower levels of burnout but not higher levels of EHR satisfaction. This is likely because these methods remove users from the EHR, rather than encouraging them to master it.
Organizations Must Help Physicians Find the Right Personalization Tool for Their Needs
Different personalization tools improve efficiency in different parts of the physician workflow—for instance, templates, macros, and shortcuts are particularly helpful in documentation, while other tools assist with data retrieval. EHR satisfaction does not vary widely based on which tools a physician has adopted, and regardless of the tool in question, physicians who don’t use the tool are less satisfied than those who do. This suggests that no one personalization tool is inherently more likely than the others to improve EHR satisfaction. Rather, it is important that physicians adopt the tools that best fit their individual needs and workflows. While efficiency-tracking tools from the EHR vendor can help identify a physician’s EHR pain points, observation of and communication with the end user are also vital in determining which personalizations will be most beneficial.
Case Study: Penn Medicine
Collaborative member Penn Medicine has helped their providers tailor their personalization to enhance EHR usage and maximize efficiency. See their case study for more details.
Template Use Correlated with Higher Efficiency and Lower Burnout
As the chart on the previous page shows, physicians who do not use templates are the most likely to be dissatisfied with the EHR. Templates are often one of the first personalizations physicians choose to adopt, and failure to do so may indicate poor engagement with the EHR in general. A large majority (80%) of physicians—either in ambulatory or acute care settings—who use templates report being able to complete more than 50% of their charting immediately after seeing a patient. Additionally, physicians who use templates are the most likely to say they do less than five hours a week of after-hours charting, and they are the least likely to say they are experiencing burnout (see charts on next page). In general, the amount of after-hours charting a physician does is highly correlated to their likelihood to be experiencing burnout.
Order lists and filters are also associated with higher rates of immediate chart closure. Both tools reduce the number of clicks, leading to higher physician efficiency. Layouts, shortcuts, report views, and sort orders are reported as the least helpful when it comes to efficiency, with physicians who don’t use these personalization tools reporting higher immediate chart-closure rates than those who do. This further demonstrates that not all personalization tools are relevant and helpful in all areas of a physician’s workflow.
Organizations and Vendors Can Support High EHR Satisfaction through Strong Documentation Training
Organizations wishing to improve EHR satisfaction through adoption of personalized tools—or any documentation method, for that matter—would do well to examine their documentation training. Regardless of the documentation method used, there is a difference in NEES of at least 30 points between physicians who describe their documentation training as satisfactory and those who do not. A variety of factors contribute to this disparity, but top among them is the fact that much of the time a physician spends interacting with the EHR is spent documenting. The better trained physicians are to document quickly and effectively, the more success they will have with the EHR overall.
Better Documentation Training Is Correlated with Higher Chart-Closure Rates, Less After-Hours Charting, and Lower Burnout
Regardless of the documentation method in use, physicians who agree that their documentation training was effective also report higher immediate chart-closure rates. This is true across both ambulatory and acute care settings. Physicians who utilize personalized tools or speech recognition are the most likely to complete over half of their charting immediately after seeing the patient. They also report less after-hours charting and therefore less burnout.
Those who agree or strongly agree that documentation training was helpful have a higher chance of not being burned out, which is one reason that encouraging effective training is one of the pillars of the Arch Collaborative. Training will make or break a physician’s experience in more ways than one, and the EHR can function only as effectively as the user’s knowledge of how to use it.
Case Studies: University of Vermont Medical Center & Mayo Clinic
Collaborative member University of Vermont Medical Center is an example of the positive impact training can have. After implementing EHR training sprints, the organization saw impressive improvement in their providers’ overall EHR satisfaction. (For more details, see their case study.) After implementing a speech recognition training program, Mayo Clinic saw a NEES increase among their providers of almost 14 points. (Details can be found in their case study.)
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 300 healthcare organizations have surveyed their end users and over 415,000 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.
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Clinician Efficiency and Personalization, Clinician Relationships and Communication, Nursing EHR Success, Onboarding EHR Education, Ongoing EHR Education, Recognized ImprovementThis 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.