Reports

Clinician Training

Bryant Wood & Anna Beyer | Friday, September 6, 2019

Why Provide EHR Training?

Clinicians are hungry for more information about the EHR. They want to be able to master it to make their lives easier and their patients’ lives safer. One of the earliest findings of the Arch Collaborative was that initial training makes a significant impact on clinicians’ EHR satisfaction. There is a 90-point difference in Net EHR Experience Score between clinicians who strongly agree their initial EHR training prepared them well and those who strongly disagree.

Who Should Be Involved in Training?

There are many options for who can effectively lead initial and ongoing training, but there is no single right answer for who can do it best. The key is rather to focus on the quality of trainers and where they can most effectively train.

How Much Training Is Needed?

Feedback from EHR users suggests that 5–8 total hours of initial training and 3–5 hours of ongoing training per year sets clinicians up for success. It is important to remember that training shouldn’t be so time-consuming that it contributes to clinician burnout. Instead, organizations should plan and communicate about training sessions ahead of time—this improves both attendance and overall clinician engagement in training.

What Methods of Training Are Most Effective?

Organizations can use a variety of types of training and classes for onboarding training or ongoing education to educate clinicians on the EHR. Having a rich mix of content-delivery methods appears to be most impactful on clinician’s overall EHR satisfaction. Some training practices are shown to be more helpful—for example, in-person training, rounding, and training on personalization tools and specialty-specific workflows.

Where Should Training Be Held?

Finding the most effective location to host training sessions can be difficult. Collaborative data shows that while some locations have been shown to support strong training, the location of training is less impactful than the quality of training. There has been evidence from a handful of organizations that holding trainings off-site can be highly effective, though this method can be more difficult to carry out.

Clinician Burnout

An Arch Collaborative Impact Report 2019

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.

Connor Bice | Friday, August 2, 2019

Arch Collaborative data indicates that 28% of providers report some degree of burnout; this is a lower percentage than industry reports on burnout. One possible explanation for this is that organizations who participate in the Collaborative have already proved a willingness to measure their clinicians’ satisfaction and are therefore among the more progressive organizations in attempts to understand the daily experience of clinicians. This proactive approach and possible self-selection bias may make a difference in clinicians’ wellness experience.

A strong Net EHR Experience Score is correlated with lower burnout; the more satisfied providers in a certain organization are with their EHR, the less likely it is that many providers in that organization are experiencing burnout.

net emr experience score vs physician burnout rate

The second question asks, “What are the primary contributors to your feelings of burnout (if any)?” The most common contributor to provider burnout is too much time spent on bureaucratic tasks, followed by the impact of the EHR or other IT tools on efficiency, and then a heavy after-hours workload.

Key Takeaway

There is a correlation between clinicians’ Net EHR Experience Scores and burnout, but the Arch Collaborative has not seen an R² greater than 0.2, indicating that at most, the EHR experience explains only 20% of the variation in clinician burnout. The takeaway from this report should be that burnout extends beyond the EHR. Best practices that lead to higher EHR satisfaction may help, but focusing solely on the EHR is unlikely to eliminate burnout.

Arch Collaborative Guidebook 2019

Arch Collaborative Guidebook 2019
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.

Taylor Davis and Connor Bice | Thursday, July 25, 2019

Guidebook Participants

KLAS is grateful for the dedication and participation of several leaders who have given their time and insights to ensure that the information in this guidebook is accurate and helpful. We commend and thank the following individuals for their guidance:

Onboarding EHR Education Panel

David Niland, Medical Information Officer at Galway Clinic
Mike McNamara, CMIO at Kaiser Permanente Northwest
Heidi Garzo, EHR Training Manager at Petaluma Health Center
Sean Johnson, VP of Applications and Analytics at Sansum Clinic

Ongoing EHR Education Panel

H.C. Eschenroeder Jr., Orthopaedic Surgeon and CMIO at OrthoVirginia
Benjamin Suratt, Vice Chair of Medicine for Academic Affairs at University of Vermont College of Medicine
David Michael, CMIO at Vidant Health

Clinician Relationships & Communication Panel

Corey Joekel, CMIO at Children’s Hospital & Medical Center
David Kaelber, CMIO at The MetroHealth System

Shared Ownership & Governance Panel

Dhrumil Shah, CMIO at Compass Medical
John Lee, CMIO at Edward-Elmhurst Health
Jean Adams, CNIO and ACIO at Geisinger Health System
David Graham, CIO at Memorial Health System

Clinician Efficiency & Personalization Panel

Amy Chaumeton, Clinical Vice President and CMIO at Legacy Health
Keith Griffin, CMIO at Novant Health
Melissa Jost, Manager of Clinical Informatics at UC Davis Health
Eric Cheng, CMIO at UCLA Health

Clinician Wellness & Reducing Burnout Panel

Thomas Moran, VP and Chief Medical Information Executive at Northwestern Memorial Health Care
Paul Testa, CMIO at NYU Langone Health
Vicki Laurie, Consulting CIO at Tenet Healthcare
Neal Chawla, CMIO at WakeMed

Nursing EHR Success Panel

Ryan Zulkoski, Manager of Nursing Informatics at Children’s Hospital & Medical Center
Teresa Niblett, Director of Clinical Informatics at Peninsula Regional Medical Center
Ellen Pollack, CNIO at UCLA Health
Samantha Richards, VP and CNO at WVU Medicine

Opioid Abuse Prevention Panel

Laura Polito, Assistant Medical Director of Health Information Systems and Urgent Care Services at Sansum Clinic
Rob Schreiner, President at WellStar Medical Group
David Rich, CMIO at WVU Medicine

What Is the Arch Collaborative Guidebook?

The Arch Collaborative Guidebook is the result of thousands of hours of combined effort. Over 190 provider organizations around the world have measured the feedback of their clinicians, and the 100,000 clinicians who have participated by completing Collaborative surveys have dedicated an estimated 1,600 hours total to sharing their voices.

This incredible effort has allowed the Arch Collaborative to identify those organizations with the most successful EHR users. Leaders from these successful organizations have partnered with KLAS while also utilizing Arch Collaborative research findings to build this guidebook for EHR success.

There is no checklist for strong leadership; similarly, while this guide could be read as a checklist, it will be most effective when read as principles and opportunities for success meant to be skillfully applied according to an organization’s specific culture and circumstances.

This guidebook lays out the best practices identified in Collaborative data and shared by the most successful organizations in the Collaborative. If your organization is struggling with EHR satisfaction, start here!

It is expected that the principles in this guidebook will mostly remain consistent in future editions, but this guidebook may see significant additions over time as the Arch Collaborative continues to learn the science behind EHR success.

The principles in this guide come from two sources:

Evidence-Based Practices: Best practices validated by Arch Collaborative research that differentiate the high-performing organizations or have been documented to help organizations improve.

Leading Practices: Commonly reported keys to success as identified by leading organizations, though not yet broadly validated or too unquantifiable to fully validate.

Improving EHRs Globally

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

Connor Bice | Friday, June 28, 2019

us and non us health systems ehr satisfaction

While there are some key differences, like the impact of EHR personalizations, KLAS has confirmed that non-US health systems follow Arch Collaborative trends for two of the three pillars of success: EHR education and a culture of shared ownership.

When it comes to initial training, US and non-US clinicians have very similar experiences. Just over half of the clinicians in each group agree initial training prepared them well; US clinicians are just slightly more likely to strongly agree.

This trend persists for ongoing training, which US and non-US clinicians agree is sufficient in equal numbers (53% in each group). Again, US clinicians are slightly more likely to strongly agree ongoing training is sufficient.

Clinicians’ relationships with and trust in IT leadership are similar throughout the world. Building a symbiotic relationship and creating shared ownership between the clinicians who use the EHR and the IT and informatics personnel who support the EHR is essential for achieving EHR satisfaction, no matter the geography.

The biggest difference between US and non-US health systems is in adoption of EHR personalization tools. In the US, personalization tools help clinicians get data in and out of the EHR more quickly in the face of stringent documentation requirements. Outside the US, these requirements are less burdensome, so clinicians need less EHR personalization to be efficient. However, if the global community were to see increased regulatory burdens similar to those in the US, the use of EHR-personalization tools would likely have a significant impact on EHR satisfaction.

2019 Summit Slides - Arch...

2019 Summit Slides - Arch Collaborative Learnings Part 1
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.