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Providing High-Quality Care: The EHR Factors at Play
May 2020

Providing High-Quality Care: The EHR Factors at Play

Authored by:  Matt Brunken, 05/01/2020 | Read Time: 4 minutes

One of the biggest promises of EHRs is that they will help healthcare providers deliver higher-quality care to their patients—the main measure of healthcare success. But do they? This report shares frontline clinicians’ feedback on how well their EHR is living up to the promise of enabling high-quality care.

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agreement that ehr enables high quality care
Current data suggests over 40% of clinicians are not satisfied with (or indifferent about) their EHR’s effect on care quality. Comments from both satisfied and dissatisfied clinicians suggest a few possible reasons why EHRs sometimes fall short.

How Do Clinicians Successfully Leverage Their EHR for High-Quality Care?

keys to ehr support of high quality careWhile the EHR itself undoubtedly affects clinicians’ perception of its support of care quality, user accountability is actually much more impactful. Many satisfied clinicians attribute their EHR proficiency to their ownership in mastering the EHR. Because they have accepted that the EHR will be part of patient care, they take accountability for their EHR proficiency in pursuit of improving the patient experience. In this case, initiative to learn the EHR improves perception of how well the EHR supports quality care. A smaller (but significant) percentage of clinicians talk about the EHR itself improving care, including a few who say it helps them more easily access patient information and be more efficient, and say that it provides helpful functionality like speech recognition, free-text searches, and HIE data.

What EHR Barriers Hinder High-Quality Care?

barriers to ehr support of high quality careComments from clinicians having a negative EHR experience (i.e., strongly disagree their EHR enables high-quality, safe, patient-centered care) illuminate what they expect from their EHR in terms of enabling high-quality care—and what barriers and gaps they see today.

Dissatisfied clinicians mention many challenges that hinder their ability to deliver high-quality care. Most often, clinicians say the EHR distracts them from interacting with patients. Other EHR shortcomings include inefficiencies, unintuitive user interfaces, occasional downtime, and functionality gaps. For many, this results in a feeling that they are delivering “computer-centered care” rather than patient-centered care. They report that often they spend more time dealing with the EHR and its more frustrating aspects than they do interacting with the patient during a visit.

For some clinicians, quality care means efficiency—and many deem the EHR a roadblock in their efficiency. Charting requirements take up a lot of time and can limit how many patients that clinicians can care for in a day. Others feel that all EHRs are designed primarily for charge capture or billing—not for patient-care workflows—and therefore inherently don’t adequately support high-quality care.

Another common concern is patient safety, typically in the form of documentation errors or poor access to patient information. Clinicians sometimes feel the templated charting functionality in their EHR makes it difficult to either document sufficiently or understand others’ documentation. Others feel that poor access to essential patient information, like medical histories or orders, puts patients at risk. These types of accessibility issues usually result from lack of EHR integration or cumbersome user interfaces. Occasionally, clinicians also cite system downtime as a hindrance to patient safety.

Fortunately, KLAS has found that many of these issues can be combatted with not only strong user accountability but also organizational support. There are many organizations in the Collaborative who have helped their clinicians improve their efficiency, documentation habits, or access to patient information through training, increasing personalization use, or improving their integration. These efforts can be essential in improving providers’ care and keeping patients safe. For more details about these organizational efforts, see the Expanded Insights section.

Quantitative Data Trends Support the Voice of Clinicians

Quantitative measurements in Arch Collaborative data also back up what makes an EHR supportive (or not) of high-quality care. For example, some dissatisfied clinicians talk about alerts posing a threat to patient safety: as one said, the “high alert fatigue is frustrating and causes important messages to be overlooked.” Collaborative data backs this up—showing a strong relationship between the quality of alerts and how well the EHR enables high-quality care.

ehr support of quality care vs agreement that alerts prevents mistakes60% of the variation in organizations’ average quality-of-care rating can be explained by their helpfulness-of-alerts rating (R2=0.60). When alerts prevent mistakes in care delivery (rather than causing them), clinicians feel that their EHR enables high-quality care. To learn about an organization who has helped their clinicians set up meaningful alerts, read Novant Health’s case study “Building Effective Best Practice Alerts.” Alerts are just one example of a wider trend in KLAS data that lines up well with clinician commentary on what makes an EHR supportive of high-quality care. For more details on these findings, see the Expanded Insights section.

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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.