The Science of Improving the EHR Experience 2021 Update
A total of 46 Arch Collaborative member organizations have now measured clinician EHR satisfaction at least twice. These organizations understand that improvement is an iterative process, with repeat measurements serving to gauge the efficacy of implemented interventions. This report is based on findings from these repeat measurements and offers an update on our understanding of how organizations best support, implement, and educate on the EHR.
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59% of Organizations Have Seen Statistically Significant Improvement
What Drives Improvement? An Intermountain Healthcare Case Study
Intermountain Healthcare’s first Arch Collaborative measurement (in June 2019) showed widespread dissatisfaction with the EHR. Seeking to improve the clinician experience, Intermountain invited KLAS and four high-performing Collaborative members (Kaiser Permanente Northwest, Memorial Health System, Sharp HealthCare, and UCLA Health) to an on-site “peer guidance” program. As a result of the insights gained, Intermountain launched a series of new training efforts, including flexible, individualized EHR coaching for providers. Early efforts targeted 87 family and internal medicine providers, and Intermountain used the Collaborative’s pre- and post-surveys to measure the training’s impact. This pilot revealed that a one-hour session saved providers a perceived 63 minutes per week and increased their NEES by an average of 40 points. Following this early success, Intermountain shifted 15 FTEs from design, development, and support areas to coaching and mastery.
By the end of 2020, providers across Intermountain reported an average NEES 33 points higher than at Intermountain’s original measurement. Newly hired providers now receive a one-week follow-up session and four to six optimization sessions, and Intermountain continues to develop various training modalities—including webinars and short videos—to expand access.
Intermountain utilizes the following strategies to boost participation among providers:
- Enlists clinical leaders, EHR champions, and division chiefs to promote the coaching
- Emphasizes that coaching leads to less time in the EHR as well as improved clinician wellness (i.e., “there is no downside to doing this”)
- Highlights that benefiting from coaching is universal, not atypical (using this Atul Gawande article in The New Yorker as a talking point)
- Makes it easy to attend:
- User chooses the time/location of the coaching (either in person or virtual)
- Direct sign-up links sent via email
- Screen savers include a QR code for signing up from personal smartphones (no login required)
Continued Improvement beyond Second Measurement
Several Collaborative members have now measured EHR satisfaction organization-wide three or more times and have continued to see improvement in their clinicians’ EHR experience (including among their least satisfied users). Franciscan Health has done four organization-wide measurements. After their first measurement (2017) revealed the need to improve clinician satisfaction with the EHR, Franciscan reorganized their governance structure to improve operational ownership of EHR improvement. Following their 2019 follow-up measurement, the organization centralized their training program and began using the Collaborative’s trainer quality benchmark survey to measure trainer quality. In 2020 (even in the midst of the pandemic), a majority of their providers completed an EHR refresher course. Today, Franciscan is working to improve onboarding for nurses and make sure each provider receives one-on-one attention. (More details on Franciscan’s improvement efforts can be found here.)
Patterns of Success
Of the 46 organizations that have measured EHR satisfaction organization-wide at least twice, 36 have also filled out an executive survey describing what changes they have made as a result of their measurement and what impact these changes are having. 17 of these organizations have achieved statistically significant improvements (increase of at least 8 points) between their two most recent measurements. The most common pathways of success reported by these organizations were identified via a qualitative comparative analysis and are summarized in the graphic below.
Though not as commonly implemented as the above strategies, improving EHR governance actually has one of the biggest positive impacts on EHR satisfaction. Of the 36 organizations that filled out the executive survey, 7 report implementing major changes to their EHR governance, and 4 of these have seen statistically significant satisfaction increases among repeat respondents. More details on this and the other findings noted above can be found in the Expanded Insights section of the report.
Key Takeaways
- No matter what EHR satisfaction is like at your organization today, efforts to improve will likely yield results.
- Improvement is an iterative process—initial satisfaction measurements identify areas for improvement, and repeat measurements can help gauge the efficacy of implemented interventions.
- Going big (e.g., making major changes to EHR governance or retraining a significant portion of clinicians) isn’t without risk but will likely be successful and yield the largest rewards.
- Efforts to improve the EHR experience are likely to also improve efficiency and the EHR’s effect on quality of care.
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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.