What You Should Know:
– One of the ways organizations can target improvements for those who are less satisfied is to look at EHR satisfaction by specialty—there is currently a gap of about 30 points between the most satisfied specialty (hospital medicine) and the least satisfied specialty (ophthalmology).
– The goal of this new report from the KLAS Arch Collaborative, “Exploring EHR Satisfaction by Provider Specialty,” is to help readers understand this variation and learn some ways the gaps between specialties might be addressed.
Insights Into EHR Satisfaction by Provider Specialty
Satisfaction with the EHR varies widely across specialties, with a gap of about 30 points† between the most satisfied specialty (hospital medicine) and the least satisfied specialty (ophthalmology). This variation highlights the fact that providers within different specialties experience the EHR differently—they may work in different environments, experience training differently, have different workflow and functionality needs, and vary in their involvement with EHR governance and leadership. Physicians and advanced practice providers who are very satisfied with the EHR are almost five times more likely to report plans to stay at their organization, compared to peers who are very dissatisfied; this illustrates how impactful technology can be on the clinician experience.
A new report from KLAS explores EHR satisfaction across specialties and highlights how successful organizations are in improving satisfaction for specific groups of providers. Insights from the report are listed and explained down below:
1. EHR Fundamentals: Functionality, Efficiency, and Patient-Centered Care
A provider’s overall NEES is closely correlated with their agreement that the EHR has the functionality they need. Across specialties, the average percentage of providers who agree that the EHR has the functionality needed for their specific area of focus is 54.6%, and most specialties report percentages lower than that. The following are some other notable trends in specialty-specific satisfaction when it comes to functionality:
– Orthopedics, pulmonology, radiology, and ophthalmology providers feel the EHR does not have the functionality needed for their specific practice area. This is especially notable for radiologists as they have a mid-tier overall Net EHR Experience Score.
– That trend is reversed for anesthesiologists, who also report a mid-tier NEES but are in the top quartile for satisfaction with functionality.
– Providers who work in the specialties of hospital medicine, family medicine, internal medicine, and emergency medicine are the most likely to agree that the EHR has the functionality they need.
There is also variation across specialties when it comes to agreement that the EHR enables efficiency. Family medicine and emergency medicine score about average for efficiency; this contrasts with their above-average NEES scores and top-quartile satisfaction with functionality. Otolaryngology, urology, and orthopedics remain near the bottom of the pack, as they do for functionality satisfaction.
Across specialties, the average percentage of providers who agree that the EHR enables patient-centered care is 44.9%. Most specialties score below that average (the average is inflated by the large sample for family medicine). Of particular note, radiology has higher-than-average agreement than the EHR enables patient-centered care despite reporting a lower NEES.
2. Specialty-Specific Education Improves Provider Perceptions of EHR Functionality
Providers who receive specialty-specific workflow training are over 24 times more likely to agree that the EHR has the functionality they need. A case study from Kaiser Permanente Southern California outlines their efforts to improve both initial and ongoing EHR education programs by incorporating workflow-specific training. Maintaining a high level of EHR education and support can be difficult for the organization due to its large geographic spread. Their onboarding education is based on the needs of clinicians’ unique work settings, and each session features physician champions and site-support rounding. The ambulatory education reinforces workflow-based training through specialty-specific case studies, and the ED onboarding allows for customization and partnership with mentors on the floor.
3. Specialty-Specific Perceptions of Vendor Delivery
The Arch Collaborative clinician survey asks respondents to rate the performance of three key stakeholders: the EHR vendor, the organizational and IT leadership, and the end users themselves. There are some noteworthy differences in how the various specialties rate their EHR vendor’s delivery—hospital medicine providers are the most satisfied with their EHR vendor, while ophthalmologists have the lowest satisfaction. Commentary from respondents who practice in the specialties that report a lower agreement that their EHR vendor delivers well shows that many feel that their EHR does not have all the functionality needed for their specialty, that the EHR detracts from patient care, and that it hinders efficiency. “The EHR has not been tailored to meet the needs of an ICU environment and is one of the highest causes of stress and frustration at work.” —Physician in critical care.
4. Trends in Specialty-Specific Satisfaction by EHR vendor
Examining how specialties score compared to other users of the same EHR demonstrates that EHR satisfaction can depend more on an individual user’s specialty than on which EHR is used and can help organizations pinpoint which specialties are most in need of extra focus. Vendor-specific specialty data is available only for Cerner and Epic users (other EHR vendors do not have a large enough representation in the Collaborative to be broken out). In both customer groups, orthopedics and cardiology have some of the lowest scores compared to peers using the same EHR; regardless of the vendor’s average NEES, some common areas of frustration for these two specialties include functionality, ability to deliver quality care, and vendor delivery of a high- quality EHR.
The specialty that scores the highest compared to each vendor’s average is also the same across Cerner and Epic—for both customer groups, hospital medicine providers report a NEES over 10 points higher than the average for their respective EHRs. These providers are particularly pleased with their workflow training, the EHR’s functionality, and how easy the EHR is to learn.
5. Best Practices from Organizations and Specialties that Buck the Satisfaction Trends
A number of organizations that recently measured EHR satisfaction through the Arch Collaborative survey had abnormally high satisfaction in anesthesiology, cardiology, gynecology and obstetrics, and orthopedics. To understand the drivers of this unique success, KLAS conducted in-depth interviews with leaders from these organizations and also analyzed survey comments from their highly satisfied providers.
Anaesthesiology: Though anesthesiologists score in the middle of the pack for NEES, their score has seen the biggest decrease (13 points) since 2017 of any specialty examined in this research. Although personal effort is a commonly mentioned theme among highly satisfied anesthesiologists, it is important that providers don’t feel like they must learn the EHR on their own. According to the 2020 Arch Collaborative Guidebook, clinicians should spend 3–5 hours annually refreshing their EHR knowledge. This can include many different types of education, such as classroom education, emails about updates, tip sheets, one-on-one training, rounding, and so forth.
Cardiology: With an average NEES of 16.3, cardiologists report some of the lowest EHR satisfaction. The 2020 Arch Collaborative Guidebook notes that because personalization tools take time to set up, just teaching personalization is often not enough. Organizations will see more success with personalization tools if they provide protected time for setting them up. The guidebook also notes that providers who finish their documentation the same day as the patient encounter report significantly higher satisfaction than those who do not. An important contributor to higher rates of same-day documentation is ensuring that IT leadership understands end users’ current workflows.
OBGYN: The average NEES for gynecology and obstetrics has stayed in the middle of the pack since 2017, increasing just a little over one point.
Orthopedics: Orthopedics providers report some of the lowest EHR satisfaction. The majority of these providers work in the ambulatory environment, and many feel the EHR is not made with them in mind. A case study from OrthoVirginia explains how they improved their orthopedic providers’ EHR satisfaction by 44 points. Their providers felt they lacked knowledge of the EHR, support and use of advanced functionality were inconsistent, and the governance program created to channel provider feedback to improve the EHR was immature. After identifying these main problems, OrthoVirginia created the Provider Support Specialist (PSS) program to improve the EHR experience and enhance interactions between providers and their patients.