Reports: Nursing-EHR-Success

Virtual EHR education has shifted from a rarely leveraged training modality, to a pandemic-driven necessity (mainly composed of static videos), to an innovative, engaging learning experience—one that healthcare organizations are increasingly utilizing amid tightening budgets and strained resources. Recent research from the KLAS Arch Collaborative indicates that good EHR education is the second-most important factor that can influence clinicians at risk of leaving their organization to stay. Over the past few years, nearly 70% of surveyed clinicians have reported that self-directed, asynchronous learning is helpful. To help organizations deliver successful EHR training, this report examines the benefits of virtual EHR education, its impact on clinician satisfaction, and best practices for implementing it.

KLAS Arch Collaborative Report Measuring Clinician EHR Satisfaction Via the Arch Collaborative - Clinician Efficiency and Personalization, Clinician Relationships and Communication, Clinician Wellness and Reducing Burnout, Nursing EHR Success, Onboarding EHR Education, Ongoing EHR Education, Opioid Abuse Prevention, Recognized Improvement, Shared Ownership and Governance

KLAS Arch Collaborative Report KLAS Arch Collaborative Nursing Guidebook 2024 - Nursing EHR Success

Four years after the start of the COVID-19 pandemic, nurses are still experiencing significant stress and burnout—according to the American Nurses Foundation’s Mental Health and Wellness Survey 4, nearly two-thirds of nurses in 2023 felt their job caused them a great deal of stress. Lengthy and repetitive charting can be a contributor, but KLAS’ Arch Collaborative data shows it doesn’t have to be. This report explores the impact of unnecessary charting on nurses and outlines a three-step process organizations can use to reduce unproductive charting and empower nurses to focus on patients, thereby reducing both burnout and turnover and saving organizations money.

Since the Arch Collaborative’s early days, analysis of clinician feedback has identified three pillars key to EHR satisfaction: (1) strong user mastery, (2) an organization-wide sense of shared ownership, and (3) EHR technology that meets users’ unique needs (personalization). This last pillar is the focus of this report. While it is important for physicians to have the flexibility to care for patients and document in a way that fits their workflow, too much freedom to change the EHR can hinder efficiency and patient safety. This report identifies the benefits of personalization as well as best practices for leveraging it.

With limited budgets and resources, Arch Collaborative members frequently ask KLAS which of their EHR vendor’s education initiatives and system features are most effective at improving EHR efficiency and satisfaction. Because Epic users make up over 60% of respondents in the Arch Collaborative’s data sample, this report evaluates several Epic-specific initiatives and features to help Epic customers determine whether they are worth the investment. While not an exhaustive list of all Epic offerings capable of improving EHR efficiency and satisfaction, the initiatives and features examined in this report are those that Epic users have identified as top of mind.

The goal of the Arch Collaborative is to help organizations understand not just how to make the EHR usable but how to help clinicians embrace it as a tool essential to their ability to deliver great care. To that end, this report examines the responses of over 3,000 highly satisfied EHR users to identify what they do differently from less satisfied peers. Their insights reveal specific areas that other users and organizations can focus on to improve their own satisfaction.

Since the Arch Collaborative was created in 2017, KLAS has had the opportunity to partner with almost 300 healthcare organizations to measure clinician perceptions of the EHR experience. These measurements represent over 340,000 clinician responses and have revealed key insights about common areas of satisfaction and frustration. Perhaps more importantly, by evaluating the lessons learned from organizations that have completed multiple measurements over time, we have identified a continuous improvement process that any organization can implement to help their clinicians better succeed with the EHR. Outlined below, this process relies significantly on the hard work of IT and informatics personnel, clinical leaders, and clinicians. Additionally, KLAS and the Arch Collaborative are there to help every step of the way.

As the Arch Collaborative has grown, so has the voice of nurses. While past editions of the Arch Collaborative Guidebook primarily represented providers, this is the first to focus exclusively on nursing professionals. Insights come from 35 organizations who (1) surveyed nurses about their EHR experience (a total of 15,993 respondents across a breadth of organization types) and (2) completed as a leadership team the nursing section of the executive survey, sharing details about various organizational EHR practices and processes.

The various healthcare organizations in the Arch Collaborative differ widely in terms of size, focus, patient demographics, EHR systems, and leadership structures. These differences can affect end users’ EHR satisfaction, particularly when it comes to key indicators like training and governance. This report examines organization-specific trends uncovered by the Collaborative data and highlights opportunities and strategies for improvement.

72% of acute care providers in Arch Collaborative research deal with complex work arrangements—meaning they work in multiple locations or additional care settings. For reasons ranging from differences in the EHR system and workflows to differences in the level of EHR support provided by their organization, providers who have complex work arrangements generally have higher burnout, lower EHR efficiency, and lower EHR satisfaction compared to peers who work solely in a single hospital. This report details these findings and uses the Arch Collaborative’s Keys to Success to share what organizations can do to support providers in complex work arrangements. (Providers who work solely in ambulatory care are not included in this research.)

A total of 46 Arch Collaborative member organizations have now measured clinician EHR satisfaction at least twice. These organizations understand that improvement is an iterative process, with repeat measurements serving to gauge the efficacy of implemented interventions. This report is based on findings from these repeat measurements and offers an update on our understanding of how organizations best support, implement, and educate on the EHR.

On February 10, 2021, 78 people from 10 health systems and 4 vendor organizations convened virtually for KLAS’ Arch Collaborative Nursing Workshop to discuss improving nurses’ EHR experience. High-performing nurse faculty members presented their approach to onboarding, ongoing EHR education, burnout, trust in IT, and nurse efficiency.

After the event, each attendee was asked to rate on a 1–9 scale their response to the following statement: “Our organization will change how we approach EHR delivery because of this workshop.” The average response across all responses (n=19) was 7.8, and no organization gave an average score less than 7.0. Each organization foresees the way they approach their EHR delivery to change as an outcome of KLAS’ workshop.

KLAS’ Arch Collaborative research has found that success is possible with any EHR—the Collaborative includes organizations from a variety of EHR customer bases who feel their vendor has delivered a high-quality solution. This report shares what factors most affect end users’ EHR perceptions (these factors often require the organization and vendor to work in tandem) and how EHR stakeholders can better the EHR experience.

The percentage of charts closed immediately after patient interactions is a simple measure of a complex idea: a provider’s ability to keep up with their workload, which is influenced by time, efficiency, and many other factors. Comparing immediate chart-closure rates to other indicators suggests that providers who report higher chart-closure rates also have higher Net EHR Experience Scores and lower levels of burnout. Furthermore, closure rates also correlate with factors such as a provider’s perception of the quality of their initial EHR education and the degree to which a provider has personalized the EHR.

A product of the October 2020 Arch Collaborative Summit, the Arch Collaborative Guidebook lays out the best practices identified in Collaborative data and shared by the most successful organizations in the Collaborative.

Nurses are the lifeblood of healthcare, keeping organizations running while balancing the needs of patients and physicians. Though they are on average more satisfied with the EHR than their physician counterparts, nurses have unique EHR needs that may be overlooked when clinician EHR satisfaction is examined as a whole. Accordingly, this report focuses specifically on the EHR satisfaction feedback shared by the more than 70,000 nurses (from 189 unique organizations) who have completed the Arch Collaborative survey. These findings can help organizations pinpoint ways to better support nurses in their crucial roles.

A common question KLAS hears from organizations participating in the Arch Collaborative is whether there is any correlation between EHR satisfaction and an organization’s performance in other measures of hospital quality. To answer this question, KLAS looked at the Net EHR Experience Score (NEES) of Arch Collaborative members who appear in at least one of five key hospital quality ratings: 

• CHIME’s Most Wired (levels 8–10)
• CMS Star ratings (5-star organizations)
• Healthgrades (America’s 100 Best Hospitals list)
• Leapfrog (Top Hospitals list)
• US News and World Report (Best Hospitals list)

Theories are proven (or disproven) through application. Technologies from the ham radio to the microprocessor were successful applications that ended the debate about theoretical principles. Similarly, today’s EHR experience pioneers prove that they understand the science of EHR success by measuring the feedback of their clinical staff, making improvements, and then measuring again. This report details the experiences of the first organizations in the Arch Collaborative to measure their clinicians' EHR satisfaction, make changes to improve, and then measure again.

Health information technology is a commonly cited source of clinician frustration and burnout. But what about clinicians at organizations that have reached the peak of EHR adoption—HIMSS EMRAM Stage 7? Do their clinicians report more or less EHR frustration? In 2019, KLAS (in cooperation with HIMSS Analytics) examined this question as it relates to physicians. This 2020 follow-up explores how an organization’s EMRAM stage impacts EHR satisfaction among nurses.To conduct the analysis, KLAS analyzed the Arch Collaborative survey responses of over 34,000 nurses from hundreds of individual hospitals. Throughout this report, responses from the nurses are grouped by organization, with each organization designated as either Stage 7, Stage 6, or Stage Not Validated, depending on the publicly available information from HIMSS Analytics.

The second part of the Arch Collaborative learnings is a continuation from part 1.

Many organizations have shared their keys to successful EHR use. These slides highlight seven organizations and their best practices. OrthoVirginia's Road to Dramatic ImprovementMemorial Health System's Driving to Success with Cerner Clinicals and FinancialsKaiser Permanente Northwest Region's Trust and TrainingRoyal Children's Hospital's Creating a Service CultureUCLA Health's Keys to Nursing SuccessPetaluma Health Center's Educating for SuccessMetroHealth Medical Center's Success on a Small Budget

Part of the benefit of the Arch Collaborative is seeing how similar organizations manage their clinicians' EHR experience. The 2019 Arch Collaborative Summit provided the opportunity for comparably sized organizations to meet together and talk about common problems and potential solutions for those problems.

One of the primary goals of the 2019 Arch Collaborative Summit was to create a Best Practices Guidebook that lists out many of the successful principles for effective EHR management. KLAS partnered with some of the most successful organizations in the Collaborative to compile a list of best practices and then discussed these principles at the Summit to ensure that these concepts are widely applicable. Learn principles on Onboarding training, EHR personalization, ongoing training, physician wellness, preventing opioid abuse, how to successfully round and build clinician/IT relationships, how to build a governance with shared ownership and how to ensure that nurses voices are heard.

In October 2018, the Arch Collaborative added an open-ended question to the end of our clinician-experience survey for those who report high satisfaction and efficiency: What do you believe that you do differently from some of your peers that enables you to be highly successful with the EHR? This question only appears for those clinicians who agree or strongly agree that the EHR enables them to deliver high-quality care and that the EHR makes them as efficient as possible. Arch Collaborative data has indicated that the keys to EHR success lie with EHR education, EHR personalization, and the organization’s culture. But what do the clinicians themselves cite? The following report highlights what the first 1,261 clinicians to answer the question above do differently to be successful, and what other clinicians who may not be using the EHR quite as successfully can learn from their peers.

Since nurses work widely with the EHR, it is crucial to measure their experience with it so that opportunities for improvement can be found. And since, on average, nurses report significantly higher EHR satisfaction than physicians, it is also important to understand their successes; doing so provides vital information about how to improve EHR satisfaction for all clinicians.