Reports: Nursing-EHR-Success

KLAS Arch Collaborative Report Global EHR Satisfaction 2025 - Onboarding EHR Education, Ongoing EHR Education, Peer Guidance, Recognized Improvement

In today’s rapidly evolving healthcare environment, there is mounting pressure for healthcare organizations to carefully consider where to invest their limited funds and strategic resources. To warrant investment, organizational initiatives must clearly demonstrate value, efficiency, and long-term impact. As organizations face high demand for care from an aging population, high burnout rates among clinicians, and a retiring workforce, initiatives to champion the clinician experience matter now more than ever. Clinicians represent one of healthcare organization’s largest investments, and organizations who fail to prioritize a positive clinician experience will increasingly find it difficult to recruit and retain clinicians. This report examines insights from 16 healthcare organizations that actively prioritize the clinician experience to achieve mission-critical goals around staff retention, care quality, and operational efficiency.

Virtual EHR education has shifted from a rarely leveraged training modality, to a pandemic-driven necessity (mainly composed of static videos), to an innovative, engaging learning experience—one that healthcare organizations are increasingly utilizing amid tightening budgets and strained resources. Recent research from the KLAS Arch Collaborative indicates that good EHR education is the second-most important factor that can influence clinicians at risk of leaving their organization to stay. Over the past few years, nearly 70% of surveyed clinicians have reported that self-directed, asynchronous learning is helpful. To help organizations deliver successful EHR training, this report examines the benefits of virtual EHR education, its impact on clinician satisfaction, and best practices for implementing it.

KLAS Arch Collaborative Report Measuring Clinician EHR Satisfaction Via the Arch Collaborative - Clinician Efficiency and Personalization, Clinician Relationships and Communication, Clinician Wellness and Reducing Burnout, Nursing EHR Success, Onboarding EHR Education, Ongoing EHR Education, Opioid Abuse Prevention, Recognized Improvement, Shared Ownership and Governance

According to KLAS data, 59%^† of patients are using technology to communicate with their provider’s office before or after visits, and 93%^‡ of those patients plan to continue using technology for provider communication. However, this increased access to healthcare providers doesn’t necessarily equate to increased access to care, and ambulatory physicians in particular feel overwhelmed by the sheer volume of messages—projected to grow as patients’ use of messaging tools expands. This KLAS Arch Collaborative report—the first to focus on message burden—looks specifically at how ambulatory physicians within health systems are balancing message volume with patient expectations.

† Out of 5,913 interviewed patients

‡ Out of 3,474 interviewed patients

KLAS Arch Collaborative Report Operationalizing Arch Collaborative Data 2025 - Recognized Improvement

EHR implementations are tremendous financial and operational undertakings with significant implications for healthcare organizations, their clinicians and staff, and ultimately, the patients they care for. In the aftermath of the COVID-19 pandemic, the challenges of such projects have only become more pronounced—since 2022, satisfaction with EHR implementations has dropped consistently, and just 38% of organizations have said their recent implementation hit the mark (see chart below). To help healthcare organizations buck the downward trend, this report emphasizes the importance of investing in the human elements of an EHR implementation—it outlines where implementations most frequently go wrong, the impact that implementations have on clinicians (one of several stakeholder groups), and the strategic priorities of organizations that have successfully managed the implementation process. Also included are ways that KLAS can provide transparency through better stakeholder a

KLAS Arch Collaborative Report KLAS Arch Collaborative Success Pathway—EHR Reliability & System Speed - Clinician Efficiency and Personalization

On the heels of COVID-19, the healthcare industry is facing a second epidemic—one of clinician turnover. Grappling with burnout and misaligned priorities between themselves and organization leaders, many clinicians are considering their options: do they stay with their current organization, seek employment at another hospital or clinic, or leave healthcare altogether? For healthcare organizations, failing to address these challenges will lead to high turnover costs and further frustration for clinicians who remain.

To better understand this epidemic, the KLAS Arch Collaborative is—for the first time—asking clinicians who report plans to leave their organization where they intend to go. This report examines the cost of clinician turnover, how burnout and the EHR experience affect staff retention, and best practices from organizations who have improved their clinicians’ satisfaction and reversed turnover trends.

KLAS Arch Collaborative Report KLAS Arch Collaborative Success Pathway—Onboarding EHR Education - Onboarding EHR Education

KLAS Arch Collaborative Report EHR Governance 2024 - Peer Guidance, Shared Ownership and Governance

To promote collaboration between healthcare organizations, healthcare IT vendors, and professional services firms and support continual improvement of the clinician EHR experience, KLAS hosted the seventh annual Arch Collaborative Learning Summit in July 2024. 302 leaders from 93 organizations gathered to share their expertise and best practices via panels and presentations. This overview provides summaries of these discussions as well as summaries of other summit sessions (to view full presentations, click here).

KLAS Arch Collaborative Report KLAS Arch Collaborative Success Pathway—EHR Changes & Upgrades - Clinician Relationships and Communication, Ongoing EHR Education, Shared Ownership and Governance

This report looks at clinician experiences with EHR interoperability and what needs aren’t being met.

KLAS Arch Collaborative Report KLAS Arch Collaborative Nursing Guidebook 2024 - Nursing EHR Success

KLAS Arch Collaborative Success Pathway—EHR Personalization Tools

KLAS Arch Collaborative Success Pathway—Ongoing EHR Education

Four years after the start of the COVID-19 pandemic, nurses are still experiencing significant stress and burnout—according to the American Nurses Foundation’s Mental Health and Wellness Survey 4, nearly two-thirds of nurses in 2023 felt their job caused them a great deal of stress. Lengthy and repetitive charting can be a contributor, but KLAS’ Arch Collaborative data shows it doesn’t have to be. This report explores the impact of unnecessary charting on nurses and outlines a three-step process organizations can use to reduce unproductive charting and empower nurses to focus on patients, thereby reducing both burnout and turnover and saving organizations money.

Healthcare organizations are continually looking for ways to improve clinician EHR satisfaction despite tight budgets and staffing shortages. According to Arch Collaborative data, organizations who spend more of their budget on their EHR don’t necessarily realize a higher Net EHR Experience Score^†. In contrast, those who prioritize and reallocate resources toward high-impact interventions can often see improved clinician EHR satisfaction—proving that high satisfaction is possible despite budget and staffing constraints. Drawing from Arch Collaborative case studies, this report provides examples of high-performing organizations or those with improved performance who have made small but effective efforts to increase clinician EHR satisfaction.

Since 2018, burnout rates have increased for all types of clinicians, particularly physicians and nurses. Though recent KLAS data indicates burnout rates are slightly decreasing among these two groups, their burnout rates are still above pre-pandemic levels. The Arch Collaborative conducts research on burnout, focusing on how it intersects with the EHR. In the EHR experience survey, clinicians share their current level of burnout and which factors are contributing. Using this data—collected between January 2022 and August 2023—this report details how burnout rates have evolved for physicians and nurses, what the main contributors are, and how organizations can combat burnout. Data in this report comes from 20,229 physicians and 32,782 nurses, and some physicians and nurses have reported burnout levels across multiple years.

Signal (Epic’s provider-efficiency tracking tool) is a familiar sight at many organizations using the Epic platform—these organizations harness Signal data to understand the diverse and complex ways end users interact with the EHR. They often use Signal data to pinpoint providers who may be struggling and could gain the most from EHR training interventions. Many Arch Collaborative members ask KLAS whether Signal data can predict a provider’s EHR satisfaction, degree of burnout, or likelihood to leave the organization. Current analysis of Collaborative data confirms past findings: while Signal data has many effective and valuable uses, it is not a meaningful or predictive measure to discern whether providers are dissatisfied with the EHR, experiencing burnout, or considering leaving the organization.

As Arch Collaborative members recognize the positive impact that robust training and education can have on clinicians’ EHR satisfaction, they are looking for ways to scale their education programs quickly with limited staff and budgets. Organizations are increasingly turning to eLearning—both to scale clinician education efforts with small budgets and to meet the demand of recent graduates from medical and nursing schools, who often prefer this format. This report provides examples of how eLearning can be implemented strategically as a convenient, cost-effective training method that complements traditional instructor-led training.

KLAS Arch Collaborative research has highlighted EHR efficiency as one of the most impactful factors to the clinician EHR experience. However, it is one of the metrics with which clinical staff are least satisfied—only 46% of respondents agree their EHR enables efficiency. Furthermore, lack of efficiency is the NEES^† metric most correlated with clinician burnout; thus, healthcare organizations are looking for outside help to increase EHR efficiency and improve EHR experience. KLAS has validated several organizations who have leveraged vendor and firm partners to successfully increase clinician EHR efficiency. For this report, KLAS interviewed 67 organizations to validate the offerings vendors and firms provide and to help guide organizations who may be looking to enhance their clinicians’ EHR efficiency.

Arch Collaborative research continually demonstrates the effectiveness of education, shared ownership, and the ability to meet unique user needs in improving the clinician EHR experience. In July 2023, KLAS hosted the sixth annual Arch Collaborative Learning Summit—an opportunity for healthcare organizations to collaborate and learn how others are working to improve clinicians’ user experiences. 308 leaders from 105 healthcare, HIT vendor, and services firm organizations gathered to share expertise and best practices via panels on maintaining senior leadership buy-in and managing burnout and turnover (summaries of which are found below; recordings can be found on the 2023 learning summit resources track).

Arch Collaborative Provider Guidebook2023—Creating EHR Mastery: Onboarding EHR Education; Creating EHR Mastery: Ongoing EHR Education; Creating Shared Ownership: Provider Relationships and Communication; Creating Shared Ownership: Governance; Creating Provider Efficiency: Personalization; Creating Provider Wellness: Reducing Burnout; Building a Technological Foundation: System Reliability and Response Time

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.

With limited budgets and resources, Arch Collaborative members frequently ask KLAS which of their EHR vendor’s education initiatives and system features are most effective at improving EHR efficiency and satisfaction. Because Epic users make up over 60% of respondents in the Arch Collaborative’s data sample, this report evaluates several Epic-specific initiatives and features to help Epic customers determine whether they are worth the investment. While not an exhaustive list of all Epic offerings capable of improving EHR efficiency and satisfaction, the initiatives and features examined in this report are those that Epic users have identified as top of mind.

Arch Collaborative research has highlighted EHR efficiency as one of the most impactful factors to the clinician EHR experience. However, it is one of the metrics with which clinical staff are least satisfied—only 46% of respondents agree their EHR enables efficiency. Further, lack of efficiency is the NEES* metric most correlated with clinician burnout. Healthcare organizations are looking to services firms and software vendors to help drive EHR efficiency and improve the EHR experience. This report specifically highlights services offerings and software solutions that can support healthcare organizations in their EHR efficiency efforts. The report is part of a series aimed at exploring firm and vendor offerings in a variety of areas that impact EHR satisfaction.

Arch Collaborative research shows that education is one of the most impactful factors to the clinician EHR experience. KLAS recently invited vendors and firms to provide information on their offerings that can augment healthcare organizations’ efforts to improve clinician EHR education. For this report, KLAS interviewed 75 healthcare organizations to validate these vendor and firm offerings and provide guidance for others who are looking to supplement their EHR education programs.

Clinician turnover remains a major concern for healthcare organizations because high-quality clinicians make the difference for strong patient outcomes—the highest goal of healthcare. Turnover is also tied to significant financial cost. To mitigate negative impacts and improve retention, organizations must employ strategies that reduce the risk of turnover. Do you know which physicians are most likely to leave your organization? This white paper examines early data from 200+ physicians across three organizations, along with insights from 54 physicians (across all participating Collaborative organizations) who decided to stay at their organization after previously indicating plans to leave. Their experiences provide initial insights into how to identify potential turnover and which factors make the biggest difference for reducing physician turnover.

Since the early days of the Arch Collaborative, feedback from clinicians has shown training to be a key pillar of EHR success. The importance of education became even more apparent as methods for delivering training shifted throughout the pandemic. As a collaborative, we continue to ask questions and work with our member organizations—both healthcare organizations and vendors—to identify best practices for EHR education and share success stories that that illustrate them (see recent Collaborative report on vendors who offer EHR education solutions).

Arch Collaborative research has validated education as one of the most impactful factors to the clinician EHR experience. With staffing shortages and limited resources aggravated by the COVID-19 pandemic, healthcare organizations are looking to software vendors and services firms to help improve clinician EHR education. This report specifically examines services offerings and software solutions that can support healthcare organizations in their EHR education efforts.

This report is a compilation of vendor and firm claims about their services and software offerings. See KLAS’ follow-up report for customer validations of these offerings.

EHR upgrades are vital for continually improving technology, meeting regulatory requirements, expanding functionality, increasing user efficiency, and ultimately improving patient care. Arch Collaborative data shows EHR upgrades can be very challenging for clinicians. Clinicians are often frustrated and feel disconnected from the EHR when changes happen unexpectedly or appear to drive little improvement. To help healthcare organizations make upgrades smoother and more impactful for users, this report shares insights on the widespread phenomenon of user frustration with upgrades and recommends steps organizations and EHR vendors can take to improve.

The goal of the Arch Collaborative is to help organizations understand not just how to make the EHR usable but how to help clinicians embrace it as a tool essential to their ability to deliver great care. To that end, this report examines the responses of over 3,000 highly satisfied EHR users to identify what they do differently from less satisfied peers. Their insights reveal specific areas that other users and organizations can focus on to improve their own satisfaction.

Since 2017, the Arch Collaborative has used the Net EHR Experience Score (NEES) to measure and benchmark clinicians’ EHR satisfaction. This report breaks down what this score means and how the metrics behind it can help organizations pinpoint ways to improve clinicians’ experience with the EHR, thereby improving healthcare delivery and reducing burnout. Efforts to improve may involve addressing areas of opportunity directly, but they can also include addressing issues indirectly by targeting related factors.

Since the Arch Collaborative was created in 2017, KLAS has had the opportunity to partner with almost 300 healthcare organizations to measure clinician perceptions of the EHR experience. These measurements represent over 340,000 clinician responses and have revealed key insights about common areas of satisfaction and frustration. Perhaps more importantly, by evaluating the lessons learned from organizations that have completed multiple measurements over time, we have identified a continuous improvement process that any organization can implement to help their clinicians better succeed with the EHR. Outlined below, this process relies significantly on the hard work of IT and informatics personnel, clinical leaders, and clinicians. Additionally, KLAS and the Arch Collaborative are there to help every step of the way.

Following the COVID-19 pandemic, healthcare organizations have seen massive provider burnout, which ultimately leads to issues with staff shortages and quality of patient care. What can organizations do to alleviate and prevent provider burnout? Since 2018, the Arch Collaborative has conducted research on burnout, with particular focus on its intersection with the EHR. In the EHR experience survey, clinicians share their current level of burnout and which factors are contributing. Using this data and other measurements from the Arch Collaborative, this report details what organizations can do to combat provider burnout. Note that this report focuses on physicians, residents, fellows, and advanced practice providers—called “providers” throughout. Note: Data in this report comes from 181 unique provider organizations, some of which have measured provider burnout across multiple years.

KLAS Arch Collaborative Report Exploring EHR Satisfaction by Provider Specialty - Clinician Efficiency and Personalization

As the Arch Collaborative has grown, so has the voice of nurses. While past editions of the Arch Collaborative Guidebook primarily represented providers, this is the first to focus exclusively on nursing professionals. Insights come from 35 organizations who (1) surveyed nurses about their EHR experience (a total of 15,993 respondents across a breadth of organization types) and (2) completed as a leadership team the nursing section of the executive survey, sharing details about various organizational EHR practices and processes.

Clinician perceptions of three key EHR stakeholders—their organization/IT leadership, their EHR vendor, and themselves as end users—impact their Net EHR Experience Score^†. However, this impact is strongest with the first group—organization/IT leadership. A number of factors play into whether clinicians trust their organization/IT leadership, including EHR satisfaction, clinician burnout, EHR training, and support. This report aims to answer the question: How can organizations most effectively build trust with clinicians and ultimately improve their EHR experience?

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.

In the early days of the Arch Collaborative, clinician feedback revealed three fundamental factors 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). Much about an individual’s or organization’s EHR satisfaction can be understood through the lens of these three pillars. However, further research has demonstrated that industry-wide issues with system response time and reliability are creating significant barriers to clinician satisfaction. If efforts to improve EHR satisfaction are to be truly successful, organizations must first address these two foundational factors.

In 2019, KLAS published early findings on EHR satisfaction outside the United States. Since then, additional non-US organizations have participated in Arch Collaborative measurement, revealing new insights on the state of EHR satisfaction around the globe. Based on 28 Collaborative measurements from 23 health systems in Asia/Oceania, Europe, and the Middle East, this report seeks to help healthcare organizations in regions outside the US better understand the factors that contribute to clinician satisfaction with the EHR. On average, clinicians in the Middle East report the highest EHR satisfaction, but there are highly satisfied users in each global region, and we can learn helpful information from each.

Two years into the COVID-19 pandemic, healthcare organizations in the US are dealing with multiple repercussions—including major staffing shortages. Clinician turnover is high, staffing costs have risen, and even when organizations are able to hire new providers and staff, the need to train them can strain existing employees. These challenges result in overburdened clinicians, millions of additional dollars spent by healthcare organizations, and, ultimately, a diminished capacity for patient care.

72% of acute care providers in Arch Collaborative research deal with complex work arrangements—meaning they work in multiple locations or additional care settings. For reasons ranging from differences in the EHR system and workflows to differences in the level of EHR support provided by their organization, providers who have complex work arrangements generally have higher burnout, lower EHR efficiency, and lower EHR satisfaction compared to peers who work solely in a single hospital. This report details these findings and uses the Arch Collaborative’s Keys to Success to share what organizations can do to support providers in complex work arrangements. (Providers who work solely in ambulatory care are not included in this research.)

The Arch Collaborative’s first look at clinician burnout after the start of the COVID-19 pandemic revealed levels of nurse and physician burnout to be only slightly elevated. However, these numbers have continued to rise as the pandemic has trudged on and healthcare professionals have had to face challenges such as the Delta variant, vaccine reluctance and misinformation, and hostility from patients and their families. This report examines key findings regarding clinician burnout and how it is being impacted by the COVID-19 pandemic.

Allied health professionals (also often called ancillary care providers) are a group of EHR users that have—until now—received less focus in Arch Collaborative reports. This study shares core findings about this group of users and their EHR experience.

The Arch Collaborative examines many factors in trying to understand an end user’s EHR satisfaction. Some of these factors—such as training or user support—are the responsibility of the healthcare organization. Some—like self-directed mastery and time spent in the EHR—are in the hands of end users. The EHR vendor also plays a significant role: they can provide service, functionality, or enhancements that make the EHR experience better. For this report, KLAS asked Cerner and Epic to share what initiatives they have recently implemented to support strong EHR satisfaction. (No other EHR vendors have enough clients participating in the Collaborative for the effects of any improvement initiatives to be measured.)

Reporting significant benefits, including increased EHR satisfaction and more effective teamwork, four Arch Collaborative organizations have implemented EHR optimization sprints^† in their ambulatory clinics. Based on pre- and post-intervention surveys from over 400 clinicians that participated in these sprints, this report seeks to (1) evaluate the effectiveness of the sprint methodology by examining changes in participants’ overall EHR satisfaction, degree of burnout, and satisfaction with ongoing training and (2) share overarching principles and best practices for successfully implementing your own optimization sprint.

To date, over 45 Arch Collaborative organizations have used the EHR Experience Survey to measure their clinicians’ EHR satisfaction at least twice, capturing the repeat scores of over 30,000 clinicians. Between measurements, these organizations have implemented changes to training, technology, governance, and other areas in hopes of improving their end users’ EHR satisfaction. While previous Arch Collaborative reports (click here for the latest) have explored the impact of these changes at the organizational level, this report examines how the satisfaction of individual clinicians has improved or declined from measurement to measurement and what we can learn from clinicians who have seen the biggest increases.

Training is the backbone of user mastery (one of the three pillars of EHR satisfaction outlined in the Arch Collaborative 2020 Guidebook). The COVID-19 pandemic highlighted potential vulnerabilities for healthcare organizations as clinicians had to quickly adapt to new methods of care delivery, often without sufficient training.

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.

On February 10, 2021, 78 people from 10 health systems and 4 vendor organizations convened virtually for KLAS’ Arch Collaborative Nursing Workshop to discuss improving nurses’ EHR experience. High-performing nurse faculty members presented their approach to onboarding, ongoing EHR education, burnout, trust in IT, and nurse efficiency.

After the event, each attendee was asked to rate on a 1–9 scale their response to the following statement: “Our organization will change how we approach EHR delivery because of this workshop.” The average response across all responses (n=19) was 7.8, and no organization gave an average score less than 7.0. Each organization foresees the way they approach their EHR delivery to change as an outcome of KLAS’ workshop.

A clinician’s trust in their organization and IT leadership can greatly impact their EHR experience. To measure this trust, the Arch Collaborative EHR Experience Survey asks end users whether they agree their organization and IT leadership have done a great job of implementing, training on, and supporting the EHR. A number of factors—for example, training, burnout, and EHR governance structure—affect how clinicians answer this question. The Executive Insights section of this report examines the outcomes of clinician trust and shares a high-level view of what drives it. The Expanded Insights section dives deeper into the relative importance of various factors on clinician trust and what practices help end users feel supported by their organization when it comes to the EHR experience.

After a year of packed ICUs, PPE shortages, and other COVID-19 related stressors, there is hopefully light at the end of the tunnel, with vaccines becoming widely available and COVID-19 case numbers declining. However, the pandemic has certainly had significant impacts on the healthcare community. This report explores the impact on clinician burnout and examines whether healthcare technology has played a role in current levels of burnout.

KLAS’ Arch Collaborative research has found that success is possible with any EHR—the Collaborative includes organizations from a variety of EHR customer bases who feel their vendor has delivered a high-quality solution. This report shares what factors most affect end users’ EHR perceptions (these factors often require the organization and vendor to work in tandem) and how EHR stakeholders can better the EHR experience.

KLAS Arch Collaborative Report

The percentage of charts closed immediately after patient interactions is a simple measure of a complex idea: a provider’s ability to keep up with their workload, which is influenced by time, efficiency, and many other factors. Comparing immediate chart-closure rates to other indicators suggests that providers who report higher chart-closure rates also have higher Net EHR Experience Scores and lower levels of burnout. Furthermore, closure rates also correlate with factors such as a provider’s perception of the quality of their initial EHR education and the degree to which a provider has personalized the EHR.

A product of the October 2020 Arch Collaborative Summit, the Arch Collaborative Guidebook lays out the best practices identified in Collaborative data and shared by the most successful organizations in the Collaborative.

Clinician burnout is an important problem facing the healthcare industry. While previous Arch Collaborative research has explored the issue across all clinicians, this report narrows the focus specifically to nurses, one-quarter of whom report some degree of burnout. What are some of the most commonly reported causes of this burnout, and can any EHR-satisfaction best practices also help reduce burnout?

In the midst of the COVID-19 crisis, healthcare organizations are eager to learn from peers and find fast solutions to top-of-mind technology challenges. 19 executives from 18 healthcare organizations shared their status in addressing these challenges. The overarching theme? While healthcare organizations have found stopgaps in many areas, few have successfully implemented permanent solutions that serve a long-term strategy. This report details how organizations are faring against technology challenges today and—in acknowledgment that the future of healthcare is hazy for everyone—also provides links to technology-performance resources you may find useful and asks you to help peers make informed decisions by sharing your technology experiences.

Nurses are the lifeblood of healthcare, keeping organizations running while balancing the needs of patients and physicians. Though they are on average more satisfied with the EHR than their physician counterparts, nurses have unique EHR needs that may be overlooked when clinician EHR satisfaction is examined as a whole. Accordingly, this report focuses specifically on the EHR satisfaction feedback shared by the more than 70,000 nurses (from 189 unique organizations) who have completed the Arch Collaborative survey. These findings can help organizations pinpoint ways to better support nurses in their crucial roles.

KLAS’ Arch Collaborative, which has collected EHR-satisfaction data from thousands of clinical end users from hundreds of health systems, has identified and documented three best practices that lead to increased EHR satisfaction. Dubbed the Three Pillars of EHR Satisfaction, these best practices include strong user mastery, an EHR’s ability to meet users’ unique needs, and an organizational sense of shared EHR ownership. This report shows that these best practices are applicable for any acute/ambulatory care organization—regardless of how recently (or not) they implemented their EHR.

A common question KLAS hears from organizations participating in the Arch Collaborative is whether there is any correlation between EHR satisfaction and an organization’s performance in other measures of hospital quality. To answer this question, KLAS looked at the Net EHR Experience Score (NEES) of Arch Collaborative members who appear in at least one of five key hospital quality ratings: 

• CHIME’s Most Wired (levels 8–10)
• CMS Star ratings (5-star organizations)
• Healthgrades (America’s 100 Best Hospitals list)
• Leapfrog (Top Hospitals list)
• US News and World Report (Best Hospitals list)

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.

Through the Signal tool, organizations using Epic have easy access to a wealth of user-level Physician Efficiency Profile (PEP) data, including in-depth data on how physicians use In Basket, orders, notes, and clinical review. Provider executives use this data to inform their informatics strategies and identify how users compare to peers in the Epic community. Leaders looking to improve EHR satisfaction and reduce burnout among their clinicians may wonder, Can this data be used to identify individual physicians who are struggling with the EHR?

Theories are proven (or disproven) through application. Technologies from the ham radio to the microprocessor were successful applications that ended the debate about theoretical principles. Similarly, today’s EHR experience pioneers prove that they understand the science of EHR success by measuring the feedback of their clinical staff, making improvements, and then measuring again. This report details the experiences of the first organizations in the Arch Collaborative to measure their clinicians' EHR satisfaction, make changes to improve, and then measure again.

Health information technology is a commonly cited source of clinician frustration and burnout. But what about clinicians at organizations that have reached the peak of EHR adoption—HIMSS EMRAM Stage 7? Do their clinicians report more or less EHR frustration? In 2019, KLAS (in cooperation with HIMSS Analytics) examined this question as it relates to physicians. This 2020 follow-up explores how an organization’s EMRAM stage impacts EHR satisfaction among nurses.To conduct the analysis, KLAS analyzed the Arch Collaborative survey responses of over 34,000 nurses from hundreds of individual hospitals. Throughout this report, responses from the nurses are grouped by organization, with each organization designated as either Stage 7, Stage 6, or Stage Not Validated, depending on the publicly available information from HIMSS Analytics.

Many healthcare organizations wonder what recipe will lead them to EHR documentation success. Are scribes a cure-all? What factors lead to success with speech recognition? And should organizations still use dictation?

Insights shared by over 30,000 physicians reveal that EHR satisfaction is highly variable across specialties. For example, pediatrics physicians have an average Net EHR Experience Score (a measurement of overall satisfaction similar to a net promoter score) of 24.0, but other specialties report much lower satisfaction (e.g., cardiology ^†  with a score of 1.6).

KLAS Arch Collaborative Report Clinician Training - Follow-up EHR Education/Training

The Arch Collaborative’s primary focus is improving the EHR experience, and this experience involves the wellness of the clinician. Therefore, included in this study are two questions derived from the American Medical Association’s (AMA) Mini Z study. These two questions are correlated with the Maslach Burnout Inventory, which helps to properly identify when a clinician is burning out. All burnout findings in this report are shared through the lens of the impact of burnout on EHR satisfaction.This report is not a comprehensive analysis of the causes of clinician burnout, nor are its recommendations intended to be the primary solutions for this complex problem. Instead, this report is intended to show the developing relationship between burnout and EHR dissatisfaction. KLAS hopes the following insights add to a broader solution for taking care of those who continually offer care to others.

A product of the May 2019 Arch Collaborative Summit, the Arch Collaborative Guidebook lays out the best practices identified in Collaborative data and shared by the most successful organizations in the Collaborative.

Today, achieving EHR satisfaction is a global endeavor as digitization of patient records becomes more and more common throughout the world. This report aims to increase awareness of the similarities and differences in EHR challenges faced by US and non-US health systems. To date, 189 organizations across the globe have measured the feedback of their clinicians (totaling >90,000 responses) and have received benchmarking data comparing them to similar organizations. 13 of these organizations are outside the United States. Do non-US health systems have a different perception of their EHR compared to US organizations? And if there are differences, what can each group learn from the other?

In most ways, US and non-US health systems have similar experiences with their EHRs. For both groups, system reliability and internal integration are the two aspects of the EHR generating most satisfaction. The areas where more significant differences appear are efficiency (non-US health systems

With more responses from over 100,000 clinicians from more than 190 organizations, KLAS and the Arch Collaborative team have learned a ton! So much that we had to split the findings into two sessions. Here is part 1.

The second part of the Arch Collaborative learnings is a continuation from part 1.

KLAS organized committees to help guide the direction of the Arch Collaborative in key areas. These areas include: the general survey, the executive survey, nursing research, media & outreach, academic research and physician wellness.

Many organizations have shared their keys to successful EHR use. These slides highlight seven organizations and their best practices. OrthoVirginia's Road to Dramatic ImprovementMemorial Health System's Driving to Success with Cerner Clinicals and FinancialsKaiser Permanente Northwest Region's Trust and TrainingRoyal Children's Hospital's Creating a Service CultureUCLA Health's Keys to Nursing SuccessPetaluma Health Center's Educating for SuccessMetroHealth Medical Center's Success on a Small Budget

Kick off the 2019 Arch Collaborative Summit learnings with insights from Liz Johnson from Tenet Healthcare Corporation.

Organizations are beginning to remeasure their clinician's experience with the EHR. Here are some organizations who have seen significant increases in their Net EHR Experience Scores.

Part of the benefit of the Arch Collaborative is seeing how similar organizations manage their clinicians' EHR experience. The 2019 Arch Collaborative Summit provided the opportunity for comparably sized organizations to meet together and talk about common problems and potential solutions for those problems.

One of the primary goals of the 2019 Arch Collaborative Summit was to create a Best Practices Guidebook that lists out many of the successful principles for effective EHR management. KLAS partnered with some of the most successful organizations in the Collaborative to compile a list of best practices and then discussed these principles at the Summit to ensure that these concepts are widely applicable. Learn principles on Onboarding training, EHR personalization, ongoing training, physician wellness, preventing opioid abuse, how to successfully round and build clinician/IT relationships, how to build a governance with shared ownership and how to ensure that nurses voices are heard.

One of the greatest opportunities in the Arch Collaborative is the potential partnership between vendor and health system to jointly improve the EHR experience for clinicians everywhere. Clinicians, vendors and the KLAS team all met together to talk about their unique needs and how they could mutually benefit each other.

The KLAS Arch Collaborative has collected the feedback of over 80,000 clinicians at 180+ organizations across 9 countries and found that which EHR vendor they use does not determine satisfaction on its own.

In October 2018, the Arch Collaborative added an open-ended question to the end of our clinician-experience survey for those who report high satisfaction and efficiency: What do you believe that you do differently from some of your peers that enables you to be highly successful with the EHR? This question only appears for those clinicians who agree or strongly agree that the EHR enables them to deliver high-quality care and that the EHR makes them as efficient as possible. Arch Collaborative data has indicated that the keys to EHR success lie with EHR education, EHR personalization, and the organization’s culture. But what do the clinicians themselves cite? The following report highlights what the first 1,261 clinicians to answer the question above do differently to be successful, and what other clinicians who may not be using the EHR quite as successfully can learn from their peers.

Since nurses work widely with the EHR, it is crucial to measure their experience with it so that opportunities for improvement can be found. And since, on average, nurses report significantly higher EHR satisfaction than physicians, it is also important to understand their successes; doing so provides vital information about how to improve EHR satisfaction for all clinicians.

The last 10 years have seen a dramatic rise in the adoption of health information technology—as well as a dramatic rise in physician frustration with this technology. What about the organizations that have reached the peak of EHR adoption: HIMSS EMRAM Stage 7? Are their physicians more or less frustrated? To answer this question, KLAS (in cooperation with HIMSS Analytics) has used the public reporting of Stage 6 & 7 hospitals in the US to see whether there is a correlation between HIMSS EMRAM stage and EHR user satisfaction.

If there were a yellow brick road that led to higher EHR satisfaction, that path would be EHR personalization. Personalization leads to better EHR efficiency, better physician agreement that the EHR enables quality care, more provider trust that the EHR vendor has built a quality tool, and higher overall EHR satisfaction.

Enacting cultural change is one of the most challenging obstacles an organization can face. In fact, it is so difficult that dozens of books are published every year to teach successful culture principles and remind leaders of the importance of workplace culture. Because culture issues can be so hard to overcome, organizations often look to other solutions that are quicker or easier to implement. When it comes to clinician EHR satisfaction, these quick fixes include implementing voice recognition technology, hiring scribes, switching to a different EHR, or making training mandatory. Unfortunately, these are just Band-Aids that hide the real issue and postpone the heavy lift of solving EHR challenges.

EHR governance does not need to be a roadblock to provider organizations’ EHR improvement strategies. Many organizations use governance to effectively improve the EHR and as an avenue for explaining to physicians the EHR’s limitations, whether those are caused by regulations, technical architectures, or organizational capacity.

In today’s healthcare market, budgetary decisions are becoming more and more challenging as profit margins become increasingly thin for a majority of hospitals. To examine how tightening the purse strings affects providers and their EHR satisfaction, KLAS asked more than 50 organizations about the various ways they invest in their EHR(s) and also surveyed these organizations’ end users regarding their EHR satisfaction. KLAS’ analysis of the two data sets reveals two interesting findings about how EHR spending impacts EHR satisfaction: (1) the percentage of the overall budget allotted to IT and the EHR does not need to be large for providers to be successful with the EHR; and (2) the number of physician and IT personnel that are committed to IT responsibilities has a substantial impact on provider satisfaction.

Organizations occasionally look for a magical solution that will fix clinician dissatisfaction with the EHR. Unfortunately, because education is a human experience, there isn’t any one training program that will magically solve this dilemma. But what has been made clear—by analyzing survey responses from over 40,000 end users—is that good training has a profound and lasting impact on a clinician’s satisfaction with the EHR.

In May 2018, KLAS hosted the first ever Arch Collaborative Summit for health systems to share their ideas on how to achieve clinician satisfaction with the EHR. Various health systems, using various EHRs, presented their results and their programs that led to high satisfaction while others listened and asked questions. The collaboration resulted in shared concepts and new ideas to help all parties involved be better prepared to improve their clinicians' EHR satisfaction.

We built EMRs to help clinicians deliver dramatically bettercare and to be more efficient in that care. If clinicianseverywhere consistently praised EMRs for revolutionizingthe practice of medicine, wouldn't that be an indication thatthe EMR was a success?

But that is not happening.

In late 2016, in an effort to turn the tide of EMR frustration,KLAS gathered with a handful of provider organizationswith the idea of creating a common end-user satisfactionsurvey to be used as a means of establishing satisfactionbenchmarks and enabling provider organizations to learnfrom each other’s successes and failures. Today, this effort—called the Arch Collaborative—has collected 15,535 userperspectives from 55 organizations.