Impact Report: EHR Satisfaction for Recent Go-Lives
Over the next couple of years, many international health systems will be going live with new EHRs. Rachel Dunscombe, Global Arch Collaborative Lead, and Jeremy Goff, KLAS VP of International Clinical & Services Solutions, had the foresight to ask these questions: Is there anything that can be done to minimize the effects of getting started with a new EHR? Are there any best practices that can help organizations adapt to a new system quickly? Or do organizations that have been live for a while always perform better?
Data collected by the Arch Collaborative from hundreds of thousands of healthcare professionals confirms conventional wisdom but still gives hope to organizations that are about to go live. Yes, your organization is more likely to have a higher overall EHR satisfaction score the longer you have been live with your EHR. But the three most significant factors to individual clinicians’ EHR satisfaction—the quantity and quality of training, the personalization of EHR settings, and a sense of shared EHR governance—can be leveraged to increase EHR satisfaction regardless of how long an organization has been live with an EHR.
Our impact report, EHR Satisfaction for Recent Go-Lives, dives deeper to show how the results of these three pillars of EHR satisfaction are affected by your organization’s go-live date.
One key thing to note with this report is that very few organizations that have gone live since 2017 have participated in the Collaborative. So, while the trends exist and support the overall findings of the Collaborative, they are preliminary. This also means that we make some assumptions. The data suggests that the three pillars—EHR mastery, shared ownership, and  meeting unique user needs—all still apply to recent go-lives. We therefore assume that the underlying data that supports the three pillars also applies.
Training
Based on all the data that the Arch Collaborative has analyzed, the first of the three pillars, which is EHR mastery, or the agreement that EHR training has prepared a user to use the EHR well, makes a significant, lasting, and positive impact on a clinician’s EHR experience regardless of when his or her organization went live with the EHR. Our data shows that clinicians should attend between three and five hours of initial training to maximize their investment in EHR satisfaction. Training is most effective when it is led by another clinical user. When another trained physician leads the training with a trainee for three to five hours, training will likely be a much better experience than it would be if someone from IT were to lead the training. The shared knowledge, workflows, and actual use case knowledge that come from another clinician are hard to compensate for. It is possible to have an effective training led by someone from IT, but that person must become absolutely fluent in clinical workflows and must not just focus on buttonology.
As organizations go live, they want to make sure that they set up the best training as quickly as possible. Initial training should not be an afterthought; it should be a significant focus and part of the comprehensive go-live plan. Obviously, overall satisfaction will be a bit exacerbated in either extreme of go-live timing. For example, if your organization has been live for 10 years and you had a stellar training, it will most likely be easier for you to perform well than if your organization had just gone live a couple of weeks ago. And unfortunately, if you experienced lackluster training and your organization just went live, you're more likely to experience more frustration than the physicians with suboptimal training at organizations that have been live for 10 years.
But the individual trend does not change with go-live timing; the better your initial training, the more successful and satisfied you will be with your EHR.
Personalization
The data shows that when the EHR meets unique user needs through EHR personalization, satisfaction rises. Again, regardless of when an organization went live, this trend appears to be true. Organizations going live should also teach physicians how to personalize their EHR as quickly as possible. But organizations should also be wise about how they approach that. Anecdotal evidence from a few organizations suggests that teaching personalization without an adequate explanation of how it helps leads to useless knowledge. Some organizations elect to wait a few months to teach personalization so the physicians fully understand their own workflows and can then choose how to best optimize their EHR to match. It would be wise to assess what timing would work best for you and your organization. What is irrefutable is when you're taught how to personalize and adapt your workflow, particularly within your specialty, then you're more likely to experience higher levels of satisfaction. This is especially true for providers in more specific specialties because they are generally less satisfied than general practitioners are.
Many EHR users feel that they don’t have the time to personalize their EHR or that they aren’t acquainted enough with even the basics of their system. So why should they take the time to try and personalize something when they can just learn the bare minimum they need in order to function? At the end of the day, end users need to take it upon themselves to invest time in personalizing. If they will do that, then our data proves they will have higher EHR satisfaction.
Shared Ownership
There are three questions that the Arch Collaborative asks that allow us to get to the concept of shared ownership. We ask clinicians about their agreement that the EHR vendor has built a high-quality EHR, that their IT and leadership teams support the EHR well, and that the clinicians themselves have learned the EHR well. This triadic partnership is crucial in assessing EHR satisfaction. The question about trust in IT is especially important when considering EHR satisfaction around go-lives. Organizations should expect this agreement to dwindle during a go-live and immediately after. The transition is massive, and the disruption to work is acute for the end users. And the blame often falls on IT and leadership. How an organization reacts to this initial negative experience is crucial. The sooner and quicker the relationship can be mended, the better the clinicians' EHR satisfaction will be. Clinician feedback tells us that key stakeholders need to give clinicians a certain amount of attention for clinicians to feel like the stakeholders are invested in their success. That is hard to measure, and it often comes down to how often clinicians meet with IT assistants. Frequent rounding can help, and obtaining clinical feedback during the assessment phase of a go-live can make an impact. Ensuring that proper training and preparation before the go-live take place is essential. Each organization has to work out their culture for themselves and build trust between clinicians, IT staff, and vendors.
How long an organization has been live does affect how much trust clinicians have in their IT staff. Shared trust between clinicians and IT staff is a strong predictive factor for EHR satisfaction. By being live longer, you inherently develop more trust in your IT staff. The silver lining is if you’re invested and are taking personal accountability, there is only a slight difference in satisfaction based on go-live timing.
To find out more about the specific data that supports these claims, read our full report.
   Photo Credit: Adobe Stock, ViDi Studio