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Are EMRAM Stage 7 Physicians More Successful?

Are EMRAM Stage 7 Physicians More Successful?
A 2019 KLAS–HIMSS Analytics Collaboration

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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.

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

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 or email us at


To date, over 150 provider organizations have participated with the KLAS Arch Collaborative to measure the EHR experience of their clinician users. Most of these organizations also track their HIMSS EMRAM stage—aiming to achieve the high-adoption Stage 7 designation—and many began to wonder whether there was any correlation between their EMRAM stage and their end-users’ EHR satisfaction. They wanted to know whether giving physicians “all the tools” provides a better experience or whether Stage 7 organizations have pushed adoption too quickly, alienating their physicians in the process.

What Did We Find?

The good news for aggressive organizations that have pushed to EMRAM Stage 7 is that they are also more likely to provide an above-average EHR user experience (p<.001). While this data is encouraging for organizations that are working to achieve both high technology adoption and high user satisfaction, it is important to examine the specific areas in which Stage 7 organizations achieve higher EHR satisfaction and the areas in which little difference has been measured.1

1 The Arch Collaborative measures organizations’ EHR satisfaction using the metric of the Net EHR Experience Score (NEES). The Net EHR Experience Score is a snapshot of clinicians’ overall satisfaction with the EHR environment at their organization. Respondents rate factors such as the EHR’s efficiency, functionality, impact on care, and so on. The Net EHR Experience Score is calculated by subtracting the percent of negative user feedback from the percent of positive user feedback. Net EHR Experience Scores can range from -100% (all negative feedback) to +100% (all positive feedback).

Physician Satisfaction: How Do Stage 7 Organizations Differ?

Physicians at Stage 7 organizations are significantly more likely to report higher agreeent with the following statements:

People and Processes

But in exploring the correlations between organizations’ EMRAM stage and their EHR satisfaction, we must also analyze factors that go beyond the EHR itself. What about the people and processes surrounding the EHR? The Arch Collaborative has discovered that for organizations that have a strong system, EHR success is largely driven by change management (i.e., people and processes).

This means that in addition to having a good system in place, organizations that are successful with their EHR nearly always provide strong training, ensure the EHR meets users’ specific needs (i.e., they encourage personalization), and develop shared ownership. How do Stage 7 organizations perform against these metrics?

Quality of Training: Not Much Difference Between Stage 7 and Stage 6

Physicians’ satisfaction with their initial and ongoing EHR training—which is a key predictor of their overall EHR satisfaction—is only slightly higher for Stage 7 organizations. Since Arch Collaborative research has proven that higher-quality EHR training significantly improves EHR satisfaction, the lack of a difference in training quality highlights an opportunity for many Stage 7 organizations.

Interestingly, the differences in EHR satisfaction between various Stage 7 organizations can largely be explained by the differences in the quality of training their clinicians report.

EHR Personalization Stronger Among Physicians at Stage 7 Organizations

All but three of the Stage 7 hospitals in this research use Epic (and Epic organizations at Stage 7 report higher EHR satisfaction than Epic organizations at Stage 6).

The preponderance of Epic customers among the Stage 7 organizations in the sample likely explains a key trend we see in this research: physicians at Stage 7 organizations do a better job of adopting EHR personalizations.

Arch Collaborative research shows that adoption of EHR personalizations is the most commonly reported strategy of successful physicians. It allows users to tailor a large EHR solution to meet their specific specialty needs.

Clinical/IT Teamwork Greater at Stage 7 Organizations

Teamwork is critical for EHR success. The Arch Collaborative has found that physician sentiment regarding the organization’s IT team is a major predictor of overall EHR satisfaction.

And this sentiment is impacted by whether physicians have access to the full informatics tool set—physicians at Stage 7 organizations are significantly more likely to agree that their organization’s leadership and IT teams have done a great job implementing and supporting the EHR.

Stage 7 Physicians Report Slightly Higher Job Fulfillment

85.9% of physicians at pre–Stage 7 organizations report that they find practicing medicine fulfilling, compared to 86.5% of Stage 7 organizations (p=.02). While this difference is very small, it is important to note that organizations that pursue a more comprehensive information technology offering do not risk hurting their physicians’ job fulfillment.

EMRAM Stage 7 is Only the Beginning

To most organizations, EMRAM Stage 7 feels like an incredible mountain to climb—and it is! However, EMRAM Stage 7 isn’t the peak, but rather an important milestone on the journey toward revolutionizing the delivery of healthcare.

Everyone in this field shares a common hope that the EHR and other information technology, combined with excellent people and new processes, can revolutionize healthcare.

The good news is that industry pioneers are leading the revolution by achieving high levels of technology adoption and also ensuring that their users have the help they need to maximize the technology’s value. And it’s working! Their physicians report greater confidence that their technology makes a difference.

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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.