Reports

† Pediatrics and cardiology are cited here and in later paragraphs instead of other, more extreme examples due to their larger sample sizes and to avoid overemphasis on potential outliers in Collaborative data.

One critical factor in the difference between specialties’ satisfaction is the quality of initial training. Collaborative data shows a correlation between high physician agreement that initial training prepared them well and high agreement that the EHR has functionality needed for
their specialty.

However, while organizational efforts around training can help mitigate functionality issues, some specialties simply don’t have needed functionality in their EHR, even with great training. One common complaint is that the size or scope of the specialty does not match up with the EHR’s intended user base; for example, one dermatologist described the EHR as “overly bulky for outpatient specialty care.” Another issue is that the EHR does not support specialty-specific clinical workflows; one ophthalmologist said their EHR doesn’t meet the needs of clinicians who “need to be able to document with drawing or images.” Other physicians, notably orthopedists, have concerns with things like specialty-specific templates/order sets, slow response times, or an unintuitive user interface.

To determine how much of the physician EHR experience is reliant on training compared to the product itself, the following charts compare Cerner and Epic users (the two largest customer bases in Collaborative data), showing how training impacts their EHR experience relative to meeting specialty-specific needs.

Compared to Epic users, Cerner users tend to agree less that they have needed specialty-specific functionality, even when controlling for training quality. However, ophthalmology and dermatology stand out for lacking needed functionality regardless of EHR. This highlights EHR vendors’ responsibility to pay special attention to struggling specialties and ensure the EHR includes the functionality these specialties need to succeed.

While these findings may lead some less-satisfied physicians to believe that they can’t succeed with the EHR because of their specialty, trends within specialties debunk this assumption. In many cases, physicians in lower-scoring specialties who have had high-quality training report high overall EHR satisfaction. For example, cardiologists with strong initial EHR training have a Net EHR Experience Score of 58.3, well above the overall physician average. Conversely, physicians in higher-scoring specialties who receive poor training report low satisfaction; poorly trained pediatricians have a Net EHR Experience Score of -21.6.

While cardiology and pediatrics are vastly different specialties and use the EHR in different ways, this analysis
shows they are similarly susceptible to the positive effects of high-quality EHR training and the negative effects
of poor training.

For more insights on how other factors such as EHR personalization and organizational practices affect variation in EHR satisfaction, see the Expanded Insights section of this report, which examines several of the most- and least-satisfied specialties.

While there is variation in the typical experience of different specialties,
no specialty is immune to the effects that high-quality training, strong culture, and personalization can have on EHR satisfaction. The insights in this report show how physicians can rise above their specialty’s EHR limitations by learning effective methods of improving their EHR experience, regardless
of their specialty.

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.

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.

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:

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.

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.

For nurses, doubling down on time spent learning the EHR is far and away the most important key to success: 44% cite this as the main factor that drives their successful use of the EHR. The second most mentioned category is experience with the EHR; it appears that the more time nurses spend in the EHR, the better equipped they are to be successful with it. Personalization was mentioned less by nurses largely because of the fact that personalization tools for nurses are absent from most EHR builds.

1 While clinicians can find success using many EHRs, most of this data comes from clinicians who use Epic. This is primarily due to the high number of Epic customers who have participated in the Arch Collaborative so far.

While nurses are more satisfied than physicians in every category measured by the Arch Collaborative EHR satisfaction survey, some of the strongest satisfaction points for nurses are those related to patient care. The majority of the care-delivery support that occurs in the EHR is completed by nurses. While this time spent in the EHR reduces the amount of time nurses have to spend on direct patient care, nurses still spend more time with patients than physicians do, and Arch Collaborative data shows that the majority of nurses agree that the EHR benefits patients.

1 Some estimate that 75% of chart use can be attributed to nurses.

2 Linda W. Higgins et al., “Hospital Nurses’ Work Activity in a Technology-Rich Environment: A Triangulated Quality Improvement Assessment,” Journal of Nursing Care Quality 32, no. 3 (July/September 2017): 208–17, https://journals.lww.com/jncqjournal/Fulltext/2017/07000/Hospital_Nurses

__Work_Activity_in_a.6.aspx.

Despite the successes highlighted above, a large percentage of nurses report pain points in other, equally important metrics. Regardless of a user’s clinical background, an EHR can be difficult to learn, and nurses generally report room for improvement when it comes to factors related to EHR usability.

Nursing leaders at many organizations tell KLAS that their departments are driven by a culture of teamwork and openness to adopting changes that will help them achieve better patient outcomes and patient safety. This anecdotal evidence is corroborated by Collaborative data. The EHR satisfaction survey asks participants to rate the performance of three groups of key EHR stakeholders: (1) the clinical end users, (2) the EHR vendor, and (3) the organization’s leadership and IT groups. Nurses rate themselves as the highest-performing group (and rate their leadership/IT groups the lowest). This indicates that nurses put the bulk of EHR-mastery responsibility on themselves.

When organizations discuss EHR issues—whether related to training, usability, governance, or change management—they must make sure they seek out the opinions of their nurses. At too many organizations, nurses have been left to utilize their own teams and peers to master the EHR. Organizations can increase EHR satisfaction among their nurses—and likely other clinicians too—by working to amplify the nurse voice in EHR matters.

HIMSS Analytics is a global healthcare information and technology standards organization assisting regulatory bodies and healthcare providers in making lasting improvements in efficiency, performance, and care outcomes. Offering a suite of Maturity Models led by flagship model EMRAM, HIMSS Analytics provides prescriptive frameworks to healthcare organizations allowing for global comparability, benchmarking, and strategic clinical and financial improvement. HIMSS Analytics' Certified Consultant Program offers professional training for vendors to educate and build strategy around the Maturity Models. HIMSS Analytics is a wholly owned subsidiary of HIMSS (Healthcare Information and Management Systems Society). For more information, visit www.himssanalytics.org.

The Arch Collaborative is a global, provider-led effort to improve EHR usability and satisfaction through consistent measurement, benchmarking, and collaboration around best practices. To date, over 150 provider organizations have measured the feedback of their clinical EHR users and have begun to take steps to improve the EHR experience. If your organization is interested in maximizing the value of your EHR, learn more at https://klasresearch.com/arch-collaborative or email us at archcollaborative@klasresearch.com.