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Creating the EMR Advantage

Creating the EMR Advantage
The Arch Collaborative EMR Best Practices Study

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We built EMRs to help clinicians deliver dramatically better care and to be more efficient in that care. If clinicians everywhere consistently praised EMRs for revolutionizing the practice of medicine, wouldn't that be an indication that the 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 organizations with the idea of creating a common end-user satisfaction survey to be used as a means of establishing satisfaction benchmarks and enabling provider organizations to learn from each other’s successes and failures. Today, this effort—called the Arch Collaborative—has collected 15,535 user perspectives from 55 organizations.

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Making EMR Success a Science

Of the 7,609 physicians who participated in this research, 43% report overall dissatisfaction with their EMR experience. The story of their dissatisfaction is not simply one of too many clicks. Rather, their dissatisfaction stems from a perception of having lost control over the care they were trained to deliver as well as a perception that they cannot improve their current situation.

More than just calling out the problems with the EMR, their feedback reveals how provider organizations can help make the EMR consistently successful for their clinicians.

Three Keys of Successful Organizatios

Key 1: Education

Successful organizations recognize the incredible impact of initial and ongoing EMR education. These organizations require newly hired physicians to spend six or more hours in training classes taught by other clinicians. This ongoing training leverages the power of peer pressure to engage users rather than relying on at-the-elbow training or classroom training not taught by a fellow clinician.


Key 2: Personalization

Successful organizations understand that personalization settings are the key to making a one-size-fits-all EMR work for everyone. Personalizations that allow clinicians to quickly retrieve data or review a chart are the most powerful in improving clinician satisfaction.


Key 3: Culture

While culture is the most difficult key to replicate, it is clear that successful organizations have built a culture of IT service and user empowerment. These organizations show the deep care they have for clinician success through their sincere efforts to listen and resolve clinician challenges. They also empower problem solving by not blaming all problems on the EMR vendor.


Key Learnings of This Report


With over 600,000 data points collected, the full Arch Collaborative report has many findings. Full findings are available only to Arch Collaborative members, but key learnings are shared below to help all organizations improve.

Drivers of Success

Initial EMR training is the top predictor of EMR user success. The effects of poor initial training remain with users for years after they come live.
(see page 15)

Organizations that require newly hired physicians to complete more than six hours of training see significantly higher satisfaction. Requiring a test for new physicians is correlated with slightly higher satisfaction.
(see page 18)

Use of personalization settings has a dramatic effect on the user experience, yet fewer than half of the personalization options that users have are actually being utilized. (see page 20) Personalization settings that help users get data out of the EMR improve satisfaction more than those that help users get data into the EMR. (see page 22)

Leadership from high-performing organizations report that good EMR governance is key to their success.
(see page 25)

The Epic Physician Builder program, which essentially makes EMR governance more responsive to the needs of users, enables higher EMR satisfaction and can be copied by other EMR customer bases. (see page 25)

Users need to invest about 6 hours per year into better learning the EMR. 54% of EMR users report engaging in no ongoing EMR training. (see page 27)

Incorporating EMR training into departmental meetings is one of the most effective training methods; on average, organizations that do this have a 30-point higher Net EMR Experience score. (see page 36)

Survey participants are asked to rate three EMR stakeholders: the end users (themselves), the EMR vendor, and the organization’s leadership/IT groups. Organizations where the users rate themselves lower than their EMR vendor and leadership/IT groups have a Net EMR Experience score 40 points higher than those who rate their vendor the lowest. This trend appears to be in part indictive of a culture in which users possess feelings of self-awareness and enablement regarding their own power to improve their EMR experience. (see page 38)

A multiple regression model of user feedback, allowing for the isolation of separate factors, highlights the importance of organization culture and its impact on EMR success.
(see page 102)

Actions That Lack Impact or Inhibit Success

Organizations spending a higher percentage of their operating budget on IT see almost no increase on average in the user experience.
(see page 65)

Worried your organization does not have the money to deliver a quality experience? The most successful organizations in the Collaborative did not report spending more to get there!

The ratio of support individuals to physicians at an organization matters to EMR success at the extremes but is not a good predictor of EMR success. (see page 67)

Secure messaging solutions have nearly no effect on EMR satisfaction. (see page 69)

Organizations with higher adoption of voice recognition as users’ primary documentation method report no increase in satisfaction. (see page 70)

The use of scribes is not tied to higher EMR satisfaction (see page 71) and is not tied to stronger physician fulfillment. (see page 72)

Automated EMR-monitoring tools do not provide a satisfaction boost for those organizations that have invested time into them. (see page 74)

Organizations with higher documentation efficiency rates report only slightly higher satisfaction.
(see page 75)

Other Trends

Organization type doesn’t seem to be a factor in EMR satisfaction, except for community hospitals, which struggle to support a quality user experience. (see page 12)

Specialties in which procedures are performed in-clinic (e.g., otorhinolaryngology) and specialties that have very demanding documentation needs tend to have the lowest satisfaction. The user experience for specialists varies widely depending on the EMR. (see page 29)

There is no correlation between years of experience with an EMR and user satisfaction, highlighting the lack of ongoing investment that organizations and users make in EMR success.
(see page 31)

While organization culture is the top predictor of user EMR success, a close second is which EMR is in use. This report details Collaborative performance by vendor, including organization Net EMR Experience scores, average personalization levels, and most/least successful user groups. (see pages 40–63)

Clinicians reporting significant amounts of after-hours charting report much lower EMR satisfaction.
(see page 78)

Younger clinicians might be the proverbial canary in the coal mine for EMR success. Older clinicians report lower satisfaction than their younger counterparts, but mostly in very high satisfaction organizations. In lower satisfaction organizations, it is most often the younger clinicians who are the least satisfied. (see page 80)

85% of physicians agree or strongly agree that they find fulfillment in their work as a physician. (see page 82)

Those clinicians who do not find fulfillment in their work are not necessarily less satisfied with their EMR. Physicians who are burned out (do not find fulfillment) often feel unempowered. (see page 83)

Physicians consistently report lower satisfaction than nurses and advanced practice providers, with ease of use being a greater concern among physicians. (see page 96)

In addition to achieving a more positive user experience, clinicians that take advantage of EMR-personalization tools also report better ambulatory documentation efficiency.
(see page 99)

Participating Organizations

Advocate Health Care
Agnesian Healthcare
Allina Health
Benefis Health System
CarolinaEast Medical Center
Compass Medical
Concord Hospital
Eastern Maine Healthcare Systems (EMHS)
Edward Elmhurst
El Camino Hospital
EMR Village
Fairview Health Services
Geisinger Health System
GoHealth Urgent Care (Northwell Health)
Good Samaritan Hospital
Grand View Hospital
Greater Hudson Valley
Hartford Hospital
HealthEast Care System Nursing
Henry Ford Health System
John Muir Health
JPS Health Network
Kadlec Regional Medical Center
Kaiser Permanente Northwest
Mayo Foundation
Memorial Health System (SIU)
Nationwide Children
New England Quality Care Alliance
Northwestern Medicine
OrthoVirginia
PeaceHealth
Rush University Medical Center
Salford Royal
Sanford Health
St. Barnabas Hospital (SBH) Health System
Sutter Health
Sydney Local Health District
Texas Tech University Health Sciences Center
Tufts Medical Center
UC San Diego
University of Toledo
University of Utah
UNM Health System
VCU Health
Wasatch Pediatrics

Wellstar Health System
Wirral University Teaching Hospital
Wood County Hospital

Getting Involved in the Arch Collaborative

What is your organization’s Net EMR Experience score?

What areas should you be targeting for improvement?

What can you learn from the most successful EMR deployments in the world?

How will you know whether you are improving if you are not measuring your progress?So that all organizations can participate, first-time measurement participation is free of charge.

We call upon all provider organizations to measure their performance, learn from industry leaders, and make the improvements that will enable EMR success.

For more information about joining the Arch Collaborative, or to gain access to the full report, email ArchCollaborative@klasresearch.com.

Join the Arch Collaborative

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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. © 2018 KLAS Enterprises, 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.