Notes from the Arch Collaborative: EHR Challenges in 3 Different Facility Types

I was excited to learn I would be attending the Arch Collaborative Summit held in Salt Lake City in May. Knowing about just some of the pain points of implementing and using the EHR, I was eager to learn about the perspectives of clinicians who have found success.

As I listened to the variety of EHR experiences across facility types, I could see that the Collaborative had been a massive catalyst of conversation. Some organizations had been able to make incredible changes over the last year because of feedback from fellow Collaborative members.

However, it also became clear to me that KLAS and the Arch Collaborative have only started to scratch the surface of the EHR challenge. There are so many unique healthcare organizations in the world, each with its own struggles and needs.

With this realization in mind, I attended some breakout sessions for some of the different facility types. Here are some highlights of what I learned from the sessions for academic hospitals, children’s hospitals, and community/midsized health systems.

Academic Hospitals

Academic hospitals as a whole face an extra layer of complexity of governance because of the number of added roles (such as deans, students, and full-time and part-time faculty members). Getting clinicians involved in ongoing education and experience in the EHR is also difficult because they understandably have a lot on their plates. An academic hospital’s strategy for ongoing education and implementation must be incredibly broad.

Personalization is both a pain point and a widely recognized need. For example, depending on the vendor, a clinician may not be able to personalize the EHR until they are with an actual patient.

One facility at the breakout session combated this issue by including live sessions the week before new clinicians started work; that allowed the residents time to get into the EHR environment and have access that day. Then, the next time they were in the system on their own, they were able to redo the setup they had used in the live sessions.

Children’s Hospitals

Children’s hospitals in general have some of the highest scores in the Arch Collaborative. They also show trends of strong, well-received training and high levels of trust in the IT department.  However, children’s hospitals also tend to score lower on personalization. While KLAS needs more data on why this could be, participants in the discussion noted that most complaints seemed to be about getting data out of the system, even when a search feature was available.

Another reason for the low scores could be that physicians don’t necessarily know what can be customized. Satisfaction rates are sometimes high and personalization scores low because the end users, who are not part of the build process, don’t realize that the software has already been personalized. 

One issue specific to EHRs in children’s hospitals is fixing the medication build that comes out of the box. Though vendors are learning about children’s dosing needs, for now, organizations must go through a process to get dose by weight and the proper alerts into the system. Even organizations that have this issue under control say that building their solutions is labor intensive and time consuming.

Community/Midsized Health Systems  

A major challenge for these community hospitals is governance and resources. One physician builder commented that their eight-hospital system simply didn’t have governance or an informatics program in place.

Some community hospitals have a representative from every specialty and have more associate CMIOs and CIOs. However, when trying to create governance and informatics from nothing, it can be hard to get approval to hire more people in the first place.

One financially viable solution to this problem was to utilize PAs, NPs, and APPs. APPs especially seem to focus more of their attention of making the system work for them and not so much on parsing information. They may or may not already have informatics training, but they are easy to train and have broader clinical backgrounds than many other clinicians.

Moving Beyond One-Size-Fits-All

The broad scope of the EHR means that it’s impossible to create one-size-fits-all solutions for all facility types. However, in getting these specialized providers in a room together, we come closer to a better EHR experience across the board. In attending this summit, I came to believe that the lifeblood of innovation is collaboration.

True to its name, the Arch Collaborative aims to give all providers the chance to bring their problems to the table and see what others have done with data-driven information. It is through summits like this that we get closer to the dream of efficient, lifesaving EHRs at every type of facility that treats our loved ones.



     Photo Cred: Shutterstock, Gts