EHR Optimization

Unproductive Charting Detrimental to Nurse Productivity & Well-Being  Arch Collaborative data shows that unproductive charting is a significant time waste. Specifically, 35% of nurses report spending three or more hours per week on unproductive charting. † The data also identifies a connection between poor nursing efficiency and higher rates of burnout—nurses who report more than three hours of unproductive charting in a week report higher levels of burnout than those who do not. Given this added stress, it is unsurprising that these nurses also report a higher likelihood of leaving their organization. † The Arch Collaborative survey defines unproductive charting as charting that is duplicative or adds no value. The Nurse Perspective Comments come from nurse respondents to the Arch Collaborative EHR Experience Survey “Nursing charting takes up so much time that it decreases patient care significantly.”  “[Charting] takes time away from our patients. For example, for patients with CRRT, a recent update (about two years ago) added an additional three clicks every hour to care for this very sick patient population. Three clicks means less time with patients, which means less care, which means poorer outcomes.“ “Things requiring charting are verging on ridiculous and make it difficult to provide patient care due to the immense amount of charting required.”   While not all nurses follow through with their intentions to leave, preliminary Arch Collaborative data indicates that nurses who report an intention to leave their organization are 5x more likely to actually leave within two years. Given the expense of staff turnover, helping nurses become more efficient and satisfied can lead to significant cost savings for organizations. With staffing shortages cited as one of the top three contributors to nursing burnout, nursing turnover can further exacerbate the current state of burnout, leading to more financial loss and an increased burden on existing nurses. Steps for Reducing Unnecessary Charting Efforts to reduce unnecessary charting should focus on helping nurses feel that the EHR enhances, rather than hinders, their delivery of patient care. Arch Collaborative data indicates that nurses who report less time on unproductive charting have higher general satisfaction with the EHR ‡ than nurses who report more unproductive charting. This higher satisfaction is evident across all aspects of the EHR measured by the Arch Collaborative survey, though the biggest divergence is seen in nurse agreement that the EHR enables efficiency, patient-centered care, quality care, and patient safety (for more information about the NEES metrics, see this report on drivers of clinician EHR satisfaction). So what can organizations do to improve the nurse outlook? The next sections highlight three steps based on analysis of Arch Collaborative data. ‡ The Arch Collaborative measures satisfaction with the EHR via the Net EHR Experience Score (NEES). Each individual nurse’s responses to the Arch Collaborative EHR Experience Survey regarding core factors such as the EHR’s efficiency, functionality, impact on care, and so on are aggregated into an overall NEES, which represents a snapshot of the nurse’s overall satisfaction with the EHR environment at their organization. A NEES can range from -100 (all negative feedback) to 100 (all positive feedback). Step 1: Assess Current State of Charting through Surveys and Usage Data The first step in reducing unproductive charting is to complete a comprehensive assessment of the nurse experience across your organization. This can be accomplished in multiple ways, but using industry-wide data about inefficient charting in addition to organization-specific data and feedback from individual nurses can help generate buy-in to improve nurse efficiency: Internal perception surveys  can be used to ask nurses to self-report their experience and satisfaction. Additional benchmarking information —such as KLAS’ Arch Collaborative survey—can be used in lieu of or to supplement an internal survey. Additionally, some EHR vendors provide EHR usage tools —such as Epic’s NEAT or Oracle Health’s LightsOn—that can provide details on which users spend a disproportionate amount time on certain tasks. Key Groups to Focus On Each organization’s individual circumstances vary, so organizations will want to assess their own nurses to ensure they direct their efforts to the groups most in need at their own organization. However, the Arch Collaborative’s collective data reveals some general trends: The nursing groups most impacted by unproductive charting are full-time RNs and those practicing in inpatient settings . The specialties in the Arch Collaborative who report the highest frequency of unproductive charting are critical care , perinatal (mother/baby) , med/surg , and acute care . Learn from Your Peers Houston Methodist uses Epic Signal and NEAT data to identify and address EHR issues. They also foster collaboration through shared ownership councils and committees that include nursing and support personnel, and they focus on improving workflows and end-user/clinician efficiency based on user feedback. The organization also uses virtual nursing to alleviate the nursing documentation burden and enhance the patient experience. Step 2: Optimize Nursing Flow Sheets in Problem Areas Using Nurse/Informatics Input After completing the assessment, it is time to identify problem areas and make an improvement plan. Some areas may need substantial flow sheet changes; in other areas, improvement might be achieved simply through additional training. In these latter instances, you can move directly to step 3. For areas that need to be revamped, create a multidisciplinary team to prioritize which flow sheets need optimization, ensure charting matches nurse workflows, and remove unnecessary clicks and duplicative fields. Additionally, this team should establish standard procedures and criteria for making future charting changes. The team should include the following: Frontline nurses and nursing leadership: Frontline nurses can explain how the documentation is used, identify redundancies, and speak to the effects of unnecessary charting on patient care and burnout. Nursing leadership can provide a broader perspective to ensure continuity across focus areas. Informaticists: Informaticists will be able to highlight the technology’s capabilities and limitations and identify ways to create flow sheets that are streamlined but still in sync with the nurse workflow. EHR vendor resources: Organizations should also partner with their EHR vendor to include the right kind of expertise where it is needed. Stakeholders with regulatory expertise: These resources add value to the process by ensuring that regulations are met and that unnecessary tasks are removed when regulations change. Nurses who report having a more active role in optimizing the EHR generally report fewer hours spent on unproductive charting. They also have higher satisfaction with the EHR. Many nurses view this collaboration as an active partnership between all key stakeholders—end users, IT resources, and the EHR vendor. One way to involve nurses in EHR governance is to create a standard process (such as a ticketing system) for the submission, review, and implementation of EHR optimization requests from nurses. Keeping nurses apprised of the status of their requests throughout the process will help manage expectations. Nurses should also receive regular updates about any changes to flow sheets and be given additional training as needed. The Nurse Perspective Comment comes from a nurse respondent to the Arch Collaborative EHR Experience Survey “The redundancy is overwhelming at times. The documentation is considerably more cumbersome than the documentation at my previous, Magnet-designated hospital. At my previous hospital, the nurses contributed to the reduction of excessive documentation by having a representative nurse on the domain team with [the EHR]. The domain team met bimonthly to go over documentation and review policies and procedures together. It saved the hospital money and incidental overtime by having simplified and precise documentation.” Learn from Your Peers Sutter Health’s multidisciplinary team dramatically improved the efficiency and satisfaction of their perioperative nurses by fostering collaboration between nurses and the IT support team to streamline the nursing workflow and documentation requirements. CentraCare Health uses nurse optimizers to connect nursing with the organization’s information systems group. This collaboration helps nurses stay engaged and provides the information systems group with EHR-improvement ideas. TidalHealth Peninsula Regional has reduced their nurses’ documentation burden by fixing existing issues through strong clinical engagement and IT support and also preventing additional burden by adhering to defined change management protocols for nursing documentation requirements. Step 3: Provide Consistent, Workflow-Specific Training The third crucial step in the process is to provide consistent training. Nurses who get better training generally report fewer hours of unproductive charting. Receiving initial training that is specific to their workflow can help newly hired nurses start off on the right foot with efficient charting practices. Ideally, nurses’ initial EHR training teaches them the best way to perform a function for their role rather than showing them a variety of ways to complete the same task. Learn more about providing workflow-specific training in the Arch Collaborative’s Clinician Training 2023 report . Ongoing training is just as vital to efficient charting. Educating nurses about flow-sheet changes is an essential part of the optimization process. Additionally, organizations can always look for ways to help nurses chart more efficiently, regardless of whether a flow sheet has been changed. Nurses who are newer to the profession generally report fewer hours of unproductive charting (see chart). Those who have been in the field for five or more years could benefit the most from additional training to master the most up-to-date and efficient charting methods. The Nurse Perspective Comment comes from a nurse respondent to the Arch Collaborative EHR Experience Survey “Not everyone is trained the same, and if we all chart differently, it can make it harder to find medical information than in a paper chart.” Another strategy that can improve charting efficiency is to standardize organizational charting practices and include charting by exception as the model. Training nurses to chart only patient data that is outside of expected norms can help reduce charting time and make documentation quicker to review—all without requiring any actual changes to the EHR. The Nurse Perspective Comments come from nurse respondents to the Arch Collaborative EHR Experience Survey “Charting should be simple and not take away from patient care. I see a lot of repetitive motions, such as daily safety care, every hour. We should chart by exception and note changes.” “All the charting impedes patient care. I don’t waste time with care plans or notes unless there is something critical that happens. Unless there is a change with my patient that needs to be communicated or elaborated on, there is no reason to duplicate information that is in the flow sheets into a note. Your flow sheets can tell the patient’s story on their own. I chart by exception also.” Learn from Your Peers To prevent a backlog of EHR-optimization requests and increase nurse satisfaction with informatics, Amsterdam UMC developed an ongoing training program with the understanding that many nurse EHR requests and inefficiencies could be addressed with better training. In addition, their ticket triage and ambassador program ensure two-way communication between nurses and support resources. At Valley Children’s Hospital , nurse and IT teams focused on optimizing the most frequently used nurse flow sheets and ensured nurses on the task force received recognition from leadership. They also adapted and streamlined existing training and implemented lunch-and-learns led by nurses who are highly efficient at charting to help shift the culture to documentation by exception, dispelling the common sentiment that if it wasn’t documented, it didn’t happen. What Is the KLAS Arch Collaborative? The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, almost 300 healthcare organizations have surveyed their end users and over 440,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR.

Program Goals Create a large-scale EHR education program with limited time and staff Organization Outcomes 72nd percentile for provider satisfaction with virtual training Collaborative-Verified Best Practices Onboarding EHR Education Ongoing EHR Education Keys to Success Create a strategic partnership with uPerform to introduce learning on demand and computer-based training Create role-specific tip sheets and simulations to reduce the need for live training sessions while enhancing the accessibility of training materials Task curriculum review boards to revise and tailor training materials to be role specific and incorporate the “why” behind actions in the EHR Implement a Learning Pathways site, created by uPerform, that was featured as a link on the Epic F1 dashboard, ensuring quick navigation, flexible timing, and ease of access for learning during upgrades Look for opportunities for continuous EHR education improvement based on lessons learned from feedback and experience from prior upgrades What Aspirus Health and uPerform Did The Aspirus Health Technology Educators (TEDS) team recognized the need for scalable education due to challenges, such as limited resources and network constraints, that were exacerbated by the organization’s rapid expansion and the onset of COVID-19. Partnering with  uPerform paved the path forward to create and support a virtual education model. uPerform’s platform enabled Aspirus TEDS to create 575 tip sheets and simulations and improve access to and the breadth of training materials. A tight training timeline during the implementation of Beaker and Bugsy was alleviated by the creation of 11 workflow-specific training modules using uPerform, reducing the need for live training sessions for thousands of staff members. Survey analysis revealed increased preparedness from clinicians who engaged with the uPerform Learning Library. To enhance ongoing training, Aspirus focused on role-based training with an emphasis on the “why” behind actions in the EHR workflow. This led to improved user satisfaction. Additionally, challenges in communicating upgrade information across units and locations were addressed with the development of a Learning Pathways site that was featured as a link on the Epic F1 dashboard, resulting in a 3x increase in user engagement and effectiveness during upgrades. The organization’s training model is dynamic and adaptable, highlighting their commitment to individual impact and continuous training improvement. How Aspirus Health and uPerform Did It The Need for Virtual Education In 2019, Aspirus Health relied on a centralized training hub in Wausau that hindered onboarding and communication across 10 hospitals and 54 clinics, especially for remote locations that were difficult to access regularly. Substantial amounts of time were wasted because of the need to travel or to wait for a scheduled class time. The onset of COVID-19 prompted the organization to rapidly shift to computer-based training, which created a different set of challenges for various roles. The organization also announced the implementation of Epic in seven newly acquired hospitals and 21 clinics, which further intensified the situation. TEDS, the team responsible for training end users, supporting Epic applications, and developing training materials for all of Aspirus’ locations, consists of 15 members. The constraints of a limited training team paired with new sites that were not yet connected to the Aspirus network warranted innovative solutions, and the cost of a new tool was offset by the reduction in FTEs needed to support training. Implementing uPerform Aspirus used  Nordic to help with the virtual instructor-led training needed for the simultaneous Epic go-live at 7 hospitals and 21 clinics. The organization also partnered with uPerform to create a library of learning content to support clinicians after the big bang. During the first implementation phase, existing content was imported into the cloud-based uPerform Learning Library. This gave clinicians quick access to learning through Epic’s user menu. Over the six months post-go-live, 575 tip sheets and simulations were created using uPerform, enhancing the breadth of training materials. The application enabled the TEDS team to record screens and generate job aids, procedure guides, tip sheets, and workflow simulations. These simulations proved valuable for teaching new users efficiency tips and workflows. Survey results revealed that those who engaged with the Learning Library felt more prepared compared to those who did not. Improving Ongoing Training Aspirus Health also experienced challenges with ongoing training and clinician dissatisfaction with the effectiveness of classroom training. In response, Aspirus Health implemented curriculum review boards, tasked with creating and implementing role-based training and incorporating the “why” behind specific actions in the EHR workflow. Users, trainers, and organization leadership attribute the success of the training model to its focus on workflows, not just emphasizing functions and features but also elucidating the reasons behind specific actions. Training courses follow an instructional format, transitioning seamlessly into demonstrations and simulated training sessions, enabling users to observe, practice, and navigate through workflows in a controlled environment. This approach had a positive impact on user satisfaction and confidence, particularly in critical roles like nursing. One end user said, “It was convenient to learn at my own pace and have the chance to go back and watch something if I didn’t understand it the first time.” The organization faced additional challenges in effectively communicating upgrade information to end users, given issues like email neglect and reluctance to use the LMS. To address these issues, Aspirus collaborated with uPerform to develop a Learning Pathways site that was featured as a link on the Epic F1 dashboard for easy access by clinicians. Learning Pathways serves as a centralized hub for upgrade-related information. Role-specific buttons simplify navigation, catering to the diverse responsibilities of hospital nurses, for example. Users can access training materials, workflow demonstrations, and tip sheets, ensuring flexibility in learning. The site also links to external resources, such as an IT help portal. Additionally, uPerform’s Epic in-application help integration ensures the seamless incorporation of training into Epic workflows, reducing the need for users to leave the Epic system when they need help. The success of this approach is evident in the 3x increase in user engagement, as revealed in consumption spikes during upgrades, highlighting the effectiveness of the Learning Pathways strategy over previous methods. Lessons learned from past upgrades inform ongoing improvements for future implementations, showcasing a dynamic and adaptive training model. While preparing for the implementation of Beaker and Bugsy, the training team had a tight time frame to develop content. Despite the challenges, they created 11 workflow-specific training modules, reducing the need for live training sessions for 5,500 staff members. Despite the large scale of Aspirus’ training program, they keep in mind the impact training has on individual clinicians. Every statistic represents a real person whose life is affected by training initiatives, and the organization’s work to improve their training program has had a positive impact on individuals and the organization as a whole.

† Each individual clinician’s responses to the Arch Collaborative EHR Experience Survey regarding core factors such as the EHR’s efficiency, functionality, impact on care, and so on are aggregated into an overall Net EHR Experience Score (NEES), which represents a snapshot of the clinician’s overall satisfaction with the EHR environment at their organization. A NEES can range from -100 (all negative feedback) to 100 (all positive feedback). Top Methods for Improving EHR Satisfaction Based on the case studies included in this report, there are five main strategies healthcare organizations can implement to improve or achieve high clinician EHR satisfaction without using many additional resources: Arch Collaborative Case Study Index Make EHR education more accessible Strategy Cost Time to implement Organization performance Facilitate mentorship & collaboration among physicians No additional cost 0–6 months High performance Integrate clinical & documentation training No additional cost 0–6 months Improved performance Create a partnership between engaging trainers & knowledgeable staff One-time cost 0–6 months High performance Enable clinicians to access IT No additional cost 12–24 months Improved performance Communicate with clinicians more effectively Strategy Cost Time to implement Organization performance Use consistent communication to provide a predictable EHR experience One-time cost 0–6 months High performance Provide clinicians more visibility into behind-the-scenes EHR changes No additional cost 0–6 months High performance Optimize EHR communication for busy providers No additional cost 2+ years High performance Create a feedback loop to recognize & address provider challenges No additional cost 0–6 months Improved performance Empower clinicians to be involved in EHR governance Strategy Cost Time to implement Organization performance Capitalize on highly motivated volunteers No additional cost 2+ years High performance Systemize clinician EHR involvement No additional cost 0–6 months High performance Involve clinicians in EHR decision-making No additional cost 2+ years High performance Establish committees & advisory boards for EHR oversight No additional cost 0–6 months High performance Give clinicians an avenue to voice EHR needs No additional cost 0–6 months High performance Provide EHR support and improve EHR efficiency Strategy Cost Time to implement Organization performance Make EHR support accessible No additional cost 0–6 months High performance Facilitate peer EHR support No additional cost 0–6 months High performance Use EHR data to benchmark & improve performance No additional cost 0–6 months High performance Work closely with vendors to address challenges No additional cost 2+ years Improved performance Evaluate EHR enhancements based on patient care No additional cost 0–6 months High performance Embed clinician wellness into organizational culture Strategy Cost Time to implement Organization performance Promote clinician well-being No additional cost 0–6 months High performance Create a consistent approach to burnout across locations One-time cost 0–6 months High performance Foster work-life balance No additional cost 0–6 months High performance Focus on clinician autonomy to provide patient care No additional cost 0–6 months High performance Facilitate impactful communication One-time cost 0–6 months High performance Arch Collaborative Case Study Summaries The following Arch Collaborative case studies summaries provide a high-level look at healthcare organizations who implemented initiatives that helped achieve high or improved clinician EHR satisfaction. All featured initiatives had low costs and/or quick timelines, as self-reported by the involved organizations. For a more in-depth look at these organizations’ efforts, we encourage readers to go to the full case studies (linked in the header for each summary). Make EHR Education More Accessible Summaries listed alphabetically by organization name Facilitate Mentorship & Collaboration among Physicians Organization name:  Luminis Health Anne Arundel Medical Center (LHAAMC) Organization type:  Community hospital (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  86th percentile for provider agreement that EHR enables efficiency Project summary:  After new physicians receive specialty-specific onboarding training, LHAAMC proactively connects them with proficient physicians within their specialty so those proficient users can demonstrate effective use of EHR tools. This approach fosters collaboration, mentorship, and trust, and the proficient physicians feel valued without being financially compensated. Additionally, clinical leaders at LHAAMC dedicate administrative days to help colleagues navigate clinical workflows, including EHR integration. Integrate Clinical & Documentation Training Organization name:  Ohio State University Health Organization type:  Academic health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  21-percentile increase for nurse agreement that onboarding training is sufficient Project summary:  Wanting to create a more seamless transition for new nurses as they moved into their roles, Ohio State University Health revamped their onboarding program, dedicating a half-day block for nurses to complete EHR documentation modules during their first day of training. The training includes resources for honing clinical skills and thorough documentation to ensure nurses feel confident in their ability to document in the EHR before beginning clinical duties. Create a Partnership between Engaging Trainers & Knowledgeable Support Staff Organization name:  Sansum Clinic Organization type:  Academic health system (US) EHR vendor:  Epic Cost: One-time cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  98th percentile for provider satisfaction with initial training Project summary:  Sansum Clinic’s tailored their initial eight-hour EHR training to each individual’s role, utilizing the production environment to ensure relevance and practicality. Following that training, trainers provide up to two days of in-clinic, at-the-elbow support. This program uniquely emphasizes selecting trainers based on not only technical expertise but also their ability to engage and relate to the audience. Trainers and support staff collaborate closely, fostering relationships with clinicians and ensuring swift issue resolution. The organization’s overarching goal is to empower clinicians to concentrate on patient care by alleviating EHR-related frustrations through personalized training, ongoing support, and a culture of trust and collaboration. Enable Clinicians to Access IT Organization name:  University Hospitals of Morecambe Bay NHS Foundation Trust Organization type:  Academic medical center (UK) EHR vendor:  Dedalus Cost: No additional cost Time to implement:  13–24 months Outcome (Arch Collaborative metrics):  16% increase in nurse agreement that ongoing training is sufficient Project summary:  University Hospitals of Morecambe Bay introduced a new approach to deploying the EHR—locally termed as electronic patient record (EPR)—by implementing modular unit training for clinicians over several years. The organization established the I3 team (which stands for informatics, integration, and innovation) to provide at-the-elbow support and monitor training implementation. Additionally, Morecambe Bay integrated (1) a “quick log” button into their EPR, allowing users to easily report issues and receive support and (2) “Digital Design Authorities,” which consist of frontline workers who manage design decisions and provide valuable feedback. This approach builds trust among clinicians and has led to better adoption of new mandatory fields, ultimately improving clinician satisfaction and EPR proficiency. Communicate with Clinicians More Effectively Summaries listed alphabetically by organization name Provide Consistent Communication for a Predictable EHR Experience Organization name:  Compass Medical Organization type:  Ambulatory care group (US) EHR vendor:  eClinicalWorks Cost: One-time cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  99th percentile for agreement that IT leadership has implemented and supported the EHR well Project summary:  Compass Medical prioritizes building trust between clinical end users and IT through a structured, predictable process for EHR onboarding and change requests. Before seeing patients, newly hired providers go through orientation with IT to establish efficient workflows. Post-onboarding, communication with IT persists through a board of department representatives who manage EHR change requests. Clinicians follow a well-established process to propose changes. Compass Medical exercises caution in adopting EHR updates, ensuring changes positively impact the organization before implementation to maintain stable operations. Provide Clinicians More Visibility into Behind-the-Scenes EHR Changes Organization name:  Kaiser Permanente Northwest Organization type:  Academic health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  99th percentile for provider NEES Project summary:  Kaiser Permanente Northwest introduced a “Pyramid of Change” to guide clinicians, help them understand how EHR changes take place, and provide explanations on why some requests can’t be completed. With this program, clinicians can address their needs through a structured approach that includes end users, specialties, configuration levels, and system changes. Optimize EHR Communication for Busy Providers Organization name:  Sharp HealthCare Organization type:  Ambulatory care group (US) EHR vendor:  Altera Digital Health, Oracle Health Cost: No additional cost Time to implement:  2+ years Outcome (Arch Collaborative metrics):  94th percentile for agreement that providers have a voice in EHR changes Project summary:  Sharp HealthCare communicates through direct emails, monthly updates, and staff meetings. Providers can submit EHR change requests through various channels and are kept informed about the status of their suggestions through meticulous tracking. The Clinical Informatics Associates physician group plays a key role in reviewing system-wide changes and disseminating updates. Despite occasional hurdles with EHR vendor-related changes, the clinical informaticists persistently follow through until resolution, maintaining transparency through direct communication and regular updates at staff meetings. Create a Feedback Loop to Recognize & Address Provider Challenges Organization name:  SUNY Upstate Medical University Organization type:  Academic health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  18-point improvement in provider NEES Project summary:  SUNY Upstate Medical University’s approach to EHR changes involves a thorough review of Arch Collaborative survey data and provider commentary, leading to the implementation of tools in response to provider requests. The formation of a steering committee and the EPIC4Me initiative (which includes a practitioner advisory council and specialized Epic trainers) has fostered a collaborative environment. In response to provider feedback, SUNY also introduced the “We Heard You” email initiative to announce the launch of enhanced Epic functionality requested by providers who completed the Arch Collaborative survey. This was an additional venue for providers to know their suggestions were taken seriously. Empower Clinicians to Be Involved in EHR Governance Summaries listed alphabetically by organization name Capitalize on Highly Motivated Volunteers Organization name:  Memorial Health System Organization type:  Community health system (US) EHR vendor:  Oracle Health Cost: No additional cost Time to implement:  2+ years Outcome (Arch Collaborative metrics):  96th percentile for provider satisfaction with efficiency Project summary:  Memorial Health System created a physician IT advisory committee to make EHR-enhancement decisions, involving motivated volunteers who desire to improve the EHR. The committee serves as a focus group that thrives on a variety of perspectives to challenge ideas and drive progress. Their contributions have shaped decisions on EHR features, like templates and content organization. This committee exemplifies Memorial Health’s commitment to inclusive leadership and the value of listening to and implementing ideas from all levels of clinical staff. Systemize Clinician EHR Involvement Organization name:  Royal Children’s Hospital Organization type:  Children’s hospital (AU) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  98th percentile for agreement that the organization implemented, supports, and trains on EHR well Project summary:  The Royal Children’s Hospital implemented a clinician-centric approach to EHR governance, actively involving clinicians in EHR changes and optimizations. They established an online portal and help desk for end users to submit change requests. Requests are evaluated based on efficiency, safety, and patient-centric care criteria; then, they are forwarded to a working party of physician builders, who prioritize changes based on impact. This approach ensures that EHR changes align with the needs of clinical staff and enhance patient care. Involve Clinicians in EHR Decision-Making Organization name:  Sharp HealthCare Organization type:  Ambulatory care group (US) EHR vendor:  Altera Digital Health, Oracle Health Cost: No additional cost Time to implement:  2+ years Outcome (Arch Collaborative metrics):  99th percentile for agreement that providers can request EHR fixes Project summary:  Sharp HealthCare actively involves providers by using specialized provider work groups, which are led by clinical informaticists and physician champions. These work groups evaluate and address EHR requests using a standardized process. Establish Committees & Advisory Boards for EHR Oversight  Organization name:  TidalHealth Organization type:  Community hospital (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  95th percentile for nurse agreement that organization implemented, supports, and trains on EHR well Project summary:  TidalHealth formed a clinical informatics council, which includes frontline nurses, allied health professionals, and analysts. This council meets regularly to evaluate EHR design changes and assess nursing needs and skills. Annual competencies are determined based on member feedback; rounding (conducted by executive teams) allows diverse perspectives and feedback. The council members also serve as superusers and help disseminate information and encourage attendance at training sessions. Give Clinicians an Avenue to Voice EHR Needs Organization name:  WVU Medicine Organization type:  Academic health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  81st percentile for nurse EHR satisfaction Project summary:  WVU Medicine established an Interprofessional User Council that addresses workflow-related issues and invites clinicians who have submitted requests to present their proposals during monthly meetings. The council members vote on proposals, giving clinicians a say in the fate of their requests. Provide EHR Support & Improve Efficiency Summaries listed alphabetically by organization name Make EHR Support Accessible Organization name:  Gundersen Health System Organization type:  Community health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  87th percentile for provider agreement that their organization implemented, supports, and trains on EHR well Project summary:  Gundersen Health System established a dedicated extension, “5-Epic,” during their Epic EHR system go-live; this extension allowed clinicians to quickly contact an EHR trainer for support. Due to its success and frequent use during the initial go-live period, the service has been maintained. Clinicians learn about 5-Epic during their orientation, and it is also advertised on the Epic login page. The service, staffed by a full-time EHR trainer, is intended for additional training, not technical issues. The trainer is available to guide clinicians and remotely assist them until they are comfortable with the EHR functionality. Facilitate Peer EHR Support Organization name:  MetroHealth System Organization type:  Academic health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  95th percentile for provider NEES Project summary:  The MetroHealth System recognized that clinicians prefer learning about the EHR from peers, so the organization established a clinical informatics team of practicing clinicians to mentor their colleagues. The organization also allows clinicians to become Assistant Directors of Clinical Informatics, indicating their expertise in EHR knowledge. These individuals meet monthly to discuss EHR challenges, personalizations, and new features as well as to share knowledge with peers, improving efficiency and patient care. Use EHR Data to Benchmark & Improve Performance  Organization name:  St. Charles Health System Organization type:  Community health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  81st percentile for providers reporting less than five hours a week of at-home charting Project summary:  St. Charles Health System faced charting backlogs and sought to close patient charts within 72 hours. They transitioned from relying on Signal or PEP data for real-time tracking to extracting data directly from their EHR database. They generated reports (categorized by specialty) to monitor chart closure rates, and they also provided support to clinicians who were falling behind with charting. Work Closely with Vendors to Address Challenges Organization name:  Wahiawa Health Organization type:  Ambulatory care group (US) EHR vendor:  athenahealth Cost: No additional cost Time to implement:  2+ years Outcome (Arch Collaborative metrics):  15-point increase in NEES Project summary:  Wahiawa Health engages in open and honest communication with athenahealth, building trust and understanding. They have a shared language of EHR data points for benchmarking and tracking metrics. athenahealth’s customer success managers provide support and guidance, focusing on EHR metrics, schedule density, financial metrics, and change management principles. Wahiawa Health also developed an effective governance structure, hired an EHR specialist, and collaborated with athenahealth’s CSMs to tailor EHR training (which includes one-on-one coaching and subject matter expert training). Evaluate EHR Enhancements based on Patient Care Organization name:  Wellstar Health System Organization type:  Large health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  85th percentile for provider agreement that EHR enables efficiency Project summary:  Wellstar Health System established a standardized format for notes, processes, order sets, and documentation methods for each pediatric specialty. EHR enhancements are evaluated based on impact to patient care; clinician feedback is also considered during the decision-making process. Embed Clinician Wellness into Organizational Culture Summaries listed alphabetically by organization name Promote Clinician Well-Being Organization name:  Harbin Clinic Organization type:  Ambulatory care group (US) EHR vendor:  athenahealth Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  92nd percentile for likelihood that physicians will stay at the organization in next two years Project summary:  Harbin Clinic has successfully enhanced clinician wellness by fostering a sense of community and a culture of mutual support within the organization. They encourage clinician participation in EHR changes and celebrate team accomplishments. Additionally, Harbin Clinic organizes team events throughout the year, both within and outside of work, to build camaraderie and strengthen relationships among staff members. Create a Consistent Approach to Burnout across Locations Organization name:  Indiana Primary Health Care Association Organization type:  Ambulatory care group (US) EHR vendor:  Altera Digital Health, athenahealth, eClinicalWorks, Epic, NextGen Healthcare, other Cost: One-time cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  89th percentile for providers reporting no symptoms of burnout Project summary:  Indiana Primary Health Care Association (IPHCA) developed the Workforce Support Toolkit—a stress screening and resource guide—to address burnout among clinicians. The toolkit includes educational resources, assessments, and targeted strategies to reshape workplace culture, recognize burnout signs, and mitigate the impact of individual stressors. By providing personalized solutions and promoting interdisciplinary intervention, IPHCA aims to empower clinicians and organizations to improve their well-being and foster a culture of wellness. Foster Work-Life Balance Organization name:  Novant Health Organization type:  Large health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  94th percentile for provider trust in IT Project summary:  Novant Health focuses on fostering a culture of empathy and accountability, prioritizing physician wellness through initiatives that help providers maintain a balanced life. High provider trust in the organization’s IT is correlated with lower burnout rates. The organization also uses metrics that encourage well-being and hold providers accountable for their performance. They monitor these metrics and offer support to struggling providers, emphasizing the importance of achieving work-life balance. Focus on Clinician Autonomy to Provide Patient Care Organization name:  Wellstar Health System Organization type:  Large health system (US) EHR vendor:  Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  94th percentile for provider NEES Project summary:  Wellstar Health System motivates healthcare providers by demonstrating how the EHR system can help them improve patient care. The organization follows the principles of autonomy, mastery, and purpose to foster motivation. Autonomy is achieved by giving clinicians control over their work within standardized department-level order sets. Mastery involves continuous EHR education, enabling clinicians to improve their skills. Purpose is accomplished by aligning clinicians with EHR-driven outcomes (e.g., patient care improvements). Facilitate Impactful Communication Organization name:  Yuma Regional Medical Center Organization type:  Community hospital (US) EHR vendor:  eClinicalWorks, Epic Cost: No additional cost Time to implement:  0–6 months Outcome (Arch Collaborative metrics):  90th percentile for providers reporting no symptoms of burnout Project summary:  To address high burnout rates among their predominantly younger physicians, Yuma Regional Medical Center (YRMC) adopted a dyad leadership structure and paired medical directors with operational or nursing leaders to facilitate communication and bridge gaps. YRMC also improved onboarding processes by providing at-the-elbow support, streamlining workflows, and utilizing EHR initiatives to enhance efficiency. The organization focused on meaningful communication between physicians and technicians, training some physicians as certified Epic builders. YRMC’s chief wellness officer and organizational psychologist actively engage with clinicians to address burnout and promote well-being. This comprehensive approach has yielded significant improvements in morale and reduced burnout rates. What Is the KLAS Arch Collaborative?  The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, almost 300 healthcare organizations have surveyed their end users and over 440,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR.

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Key Findings See deeper insights on how to alleviate burnout Though burnout rates remain higher than pre-pandemic levels, they are beginning to stabilize for some and slightly decline overall Over the years, staffing shortages have been increasingly mentioned as a contributor to burnout, emerging as the top contributor to burnout in this report Those who are starting to feel burned out cite efficiency-related issues as reasons, while those who are completely burned out cite concerns related to the organization more broadly (e.g., lack of alignment from leadership) It is easier to prevent burnout by increasing EHR efficiency early on than it is to reduce burnout after it has already peaked Severity of clinician burnout and likelihood of leaving their organization are strongly correlated To alleviate burnout, both physicians and nurses want improved staffing and better alignment from leadership; physicians also want improved EHR efficiency, and nurses want better pay Burnout Rates for Physicians & Nurses Have Decreased since 2022; Prevalence of Burnout Differs across Organization Types The number of respondents reporting burnout (i.e., they chose one of the following responses: definitely burning out, symptoms of burnout won’t go away, or completely burned out) has slightly decreased since 2022. This is likely attributable to health systems implementing initiatives that combat burnout—for example, groups that foster community and belonging, efforts to reduce stigma around discussing burnout and mental health, and burnout reduction programs (led by chief wellness officers) that provide resources beyond what is provided by an EAP (employee assistance program). Still, burnout remains above pre-pandemic levels and is experienced by clinicians regardless of what EHR they use or what organization they work for. Across work environments, burnout is fairly consistent; however, it differs across organization types. Physicians and nurses working in community health systems are the most burned out, likely because these organizations experience higher turnover rates that result in increased workloads and less support (see the Yuma Regional Medical Center case study below to learn how one community health system is combating burnout). Clinicians at academic medical centers are the second-most burned out, as these organizations have more-complex workflows that decrease EHR efficiency and increase stress and after-hours documentation. Clinicians at FQHCs say their burnout is lower because of their intrinsic desire to help at-risk populations and their willingness to tackle uncomfortable situations. Clinicians at non-US health systems report the lowest burnout, saying regulatory pressures are less intense outside of the US. Physicians & Nurses Feel Overworked Due to Staffing Shortages & Inefficient Workflows In general, physicians and nurses feel they are overworked, and those experiencing symptoms of burnout report multiple contributors. Staffing shortages are the most-selected contributor for both physicians and nurses (particularly those at community health systems) and, over the past few years, have been cited increasingly more often as a contributor. Overall, top-mentioned contributors relate to either clinicians’ sense of belonging and appreciation—i.e., lack of teamwork and lack of shared values with leadership—or they relate to inefficiencies—i.e., EHR inhibiting efficiency and clinicians not having control over their workload. Furthermore, the contributors often perpetuate each other. When there aren’t enough staff members to support patients, physicians and nurses must shoulder a greater workload that can persist after hours, making it difficult to escape work stressors. Of note, the EHR is cited significantly less often than other burnout contributors. Physicians are more likely to mention it than nurses, especially since it can impede their efficiency. Still, the presence of an EHR doesn’t inherently lead to burnout and can even help mitigate burnout by improving efficiency and reducing duplicative work (view the Sutter Health case study and the Scripps Health case study for success stories). Burnout Contributors Shift Depending on Respondents’ Degree of Burnout; Organizations Can Prevent Severe Burnout by Improving EHR Efficiency & Reducing Workloads Physicians who are starting to feel burned out often cite no control over workload and a chaotic work environment as contributors. In contrast, those who are completely burned out cite no control over workload, lack of autonomy, and lack of shared values with leadership. Nurses who are starting to feel burned out most often cite staffing, while those who are completely burned out cite similar contributors to physicians who are completely burned out. Burnout contributors are easier to manage when physicians and nurses are experiencing early levels of burnout, rather than full burnout. To help alleviate clinician burnout in its early stages and improve EHR satisfaction, health systems can focus on improving efficiency—e.g., provide additional EHR education, support EHR personalizations, and decrease repetitive actions. Additionally, removing constant, daily irritants is an effective way to help both physicians and nurses feel more in control of their workload. Organizations frequently dismiss small concerns like these, encouraging users to find workarounds. But eventually, these irritants can build clinician’s frustration to an overwhelming point (click here to learn how Corewell Health—previously Spectrum Health—addressed this issue for their nurses). Organizations can prevent burnout and other challenges from worsening if they intervene early on, but addressing later-stage burnout is still feasible by realigning leadership’s values with clinicians’ and changing the organizational culture to be more inclusive and accepting of clinician feedback. Both physicians and nurses need evidence that the organization values their ideas. When addressing late-stage burnout, the leadership’s role is especially critical; if clinicians do not trust their leaders, solutions that worked before may no longer have the desired impact. In addition, previous KLAS research shows a correlation between strong IT delivery and reduced burnout. When clinicians perceive their IT team as partners who effectively reduce inefficiency, trust flourishes and burnout decreases (for more, see the Provider Burnout and the EHR Experience report and the Clinician Turnover and the EHR Experience report ).   Arch Collaborative Case Study: Yuma Regional Medical Center Yuma Regional Medical Center, a member of the Arch Collaborative, proactively created a psychologist-led program to address physician burnout. Their strategy includes ongoing monitoring and follow-up appointments, fostering a culture of open communication, and reducing stigma around burnout. For more details, click here . Arch Collaborative Case Study: SUNY Upstate Medical University SUNY Upstate Medical University, a member of the Arch Collaborative, had their chief wellness officer lead a training program (EPIC4Me) that reduced after-hours documentation by 10%. This has significantly boosted efficiency for clinicians, thus reducing burnout. For more details, click here . Severity of Clinician Burnout & Likelihood of Leaving the Organization Are Strongly Correlated Burnout can be costly for an organization. One study shows that burned-out physicians are less productive and that organizations can experience an $80,000 decrease in revenue for every physician who is burned out. Unsurprisingly, it is in every organization’s best interest to save on costs by increasing staff satisfaction and limiting turnover; however, physicians and nurses can only tolerate burnout up to a certain point before deciding to leave their organization. The greater their burnout, the more likely they are to leave their organization within the next two years (physicians who indicate they are very likely to leave their organization are 15 times more likely to actually leave). The resulting turnover can force even more work onto the overburdened staff who remain. However, experiencing burnout doesn’t mean a physician or nurse will immediately make plans to leave, so organizations can reduce staff turnover by addressing burnout in its earlier stages. To Alleviate Burnout, Both Physicians & Nurses Want Improved Staffing & Better Alignment from Leadership; Physicians Also Want Improved EHR Efficiency while Nurses Want Better Pay Both physicians and nurses say the number-one way to alleviate burnout is to improve staffing , which includes decreasing expected workloads and hiring more staff. Both groups are overwhelmed by their list of tasks and feel like they can’t accomplish everything due to increased patient panels, excessive bureaucratic tasks, inefficient workflows, and reduced staffing. As previously mentioned, many of these concerns relate to the inefficiencies that drive early burnout among physicians and nurses. The more clinicians work after hours, the greater their burnout becomes. It is important for leaders to listen to clinicians’ concerns; if no action is taken, burnout can worsen and prompt clinicians to look elsewhere for work. The second most-mentioned way to alleviate burnout for physicians and nurses is better-aligned leadership . Many respondents say they need their leadership team to listen to and acknowledge concerns, and some worry their leaders are starting to focus more on finances than on their staff or even their patients. Physicians and nurses are resilient and can work in challenging situations; however, when there is misalignment with leadership and when physicians/nurses no longer feel supported or valued, the resulting negative sentiments can quickly lead to burnout. The third most-mentioned way to alleviate burnout differs between physicians and nurses: physicians want improved EHR efficiency while nurses want better pay . Regarding EHR efficiency, physicians (and some nurses) report they are increasingly doing more work with fewer resources. If organizations are unable to hire more staff to distribute the workload, they can instead ensure clinicians receive ample EHR education and that their workflows are optimized. Regarding pay, nurses (and some physicians) indicate that increased pay would help retain staff. Many nurses who have worked at their organizations for a long time believe they are less valued than contracted or travel nurses, who—despite working only temporarily at the organization—receive greater pay. KLAS Reports That Can Help Improve EHR Efficiency & Reduce Early-Stage Burnout Reducing physician and nurse burnout in the early stages is critical, and the best way to intervene is by improving efficiency. View the following KLAS reports for more information: Self-Directed eLearning 2023 : Additional EHR education can greatly increase time savings. This report explains that clinicians can save up to 90 minutes per week for every hour they spend engaged in eLearning. Personalizing the EHR 2023 : This report shares that physicians who adopt personalization tools, particularly templates, are able to close their charts significantly faster than those who do not adopt these tools. Clinician EHR Efficiency Software and Services 2023 : Healthcare delivery organizations don’t need to solve inefficiencies on their own. This report validates various vendor and services firm offerings that can help organizations improve EHR efficiency. Improve Staffing ”Decrease the bureaucratic workload that comes with the pseudo patient safety and quality improvement training, and provide better staffing . The root problem isn’t lack of training, and that’s a good thing. Instead, the root problem is the lack of support and the added workload , like documentation time during daily work hours. The decision makers know what they should do, but they have an agenda that is different from the providers’ needs.” —Physician “ Appropriately staff the floors with both RNs and techs, and ensure we have proper resources available so that patients don’t take out their frustration on staff when certain procedures are only available at certain times. Things like that really help eliminate extra stressors on the job.” —Nurse Align Leadership with Physicians/Nurses “Listen to physicians and fulfill their needs. The lack of accountability from leadership is astounding. There is also a clear problem with transparency between the medical group, which is only interested in finances, and the institution that purportedly values high quality and complex care. Fix leadership and support physicians adequately .”  —Physician “ Take action when staff members speak up about problems in the office . I often think about leaving because there is no action and I feel as if my voice doesn’t matter. I feel like I work hard for others not to work at all. Often, I am assigned a task because other coworkers won’t complete theirs. There is no discipline for them, so I get stuck with the burnout.” —Nurse “The culture within my department has become increasingly toxic over the years. The clinical environment is becoming more chaotic, with more near-misses and less support staff, and the leadership is doing nothing to alleviate the situation. Despite being told repeatedly that clinics are not adequately staffed, the leadership does nothing to improve the situation .” —Physician Improve EHR Efficiency & Provide Better Pay Improve EHR Efficiency “My pain points are (1) the amount of work I take home and the amount of administrative work I do during non-clinical days, with the added bonus that all administrative work is uncompensated, (2) the out-of-control in-basket that I cannot keep up with, (3) poor access to my patients because my schedule is filled up with other people’s patients, and (4) the fact that the panel size is too large and still growing, resulting in us seeing an average of six to eight new patients per day.”  —Physician “I have help outside the organization and appreciate the support provided, but the constant push to do more with less is relentless, and the organization needs to figure out a way to make it stop . We can all clearly see the unsustainability, yet we blithely march on. We are supposed to increase production while being given additional tasks due to understaffing and without getting additional help, and we are supposed to work harder, be nicer, and make sure to avoid burnout. The organization simply must reduce overall workload on all participants.” —Physician Provide Better Pay “ Hire appropriate and well-trained staff, and pay staff whatever is appropriate for their level of knowledge and the patient care they provide . This organization pays travelers four times what in-house staff gets paid, and 90% of the time, we have to do a chunk of the travelers’ workload. There are few incentives to stay within this organization.” —Nurse “ Safe staffing needs to be a top priority, in addition to fair compensation for workload . The organization should hire more staff to be able to adequately care for patients.” —Nurse What Is the KLAS Arch Collaborative? The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, over 300 healthcare organizations have surveyed their end users and over 440,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR.

Program Goals To improve patient care by enhancing the user-friendliness of the EHR Organization Outcomes 99th percentile for physician agreement that the EHR enables efficiency 99th percentile for physician agreement that the EHR enables patient-centered care 100th percentile for physician agreement that the EHR is easy to learn Collaborative-Verified Best Practices Clinician Efficiency and Personalization Keys to Success Involve physicians in developing EHR enhancements Ensure the most commonly used functions are easy to access in the EHR Seek user feedback from multiple channels What Sírio-Libanês Hospital Did After their EHR implementation, Sírio-Libanês Hospital measured through an internal survey, and the data uncovered challenges with the initial EHR user experience linked to patient safety concerns. To address concerns and ensure that the EHR could better meet clinicians’ needs, the organization created a clinician portal that seamlessly integrates with the EHR, making important clinical functions more accessible. This collaborative development, which was done following agile methodologies, achieved success because physicians were actively involved and provided valuable feedback and suggestions. Over the years, the organization continuously upgraded both the EHR and the integrated clinician portal to meet evolving healthcare needs. Because the portal is directly integrated with the main EHR, physicians have swift access to clinical information, and the portal facilitates decision-making. Sírio-Libanês Hospital engaged multiple teams, including IT professionals, administrative personnel, and clinical teams to refine the EHR through a multidimensional feedback approach. Their tailored training process was designed for various departments and healthcare professionals, utilizing digital resources to address navigation and process challenges. This commitment to clinical system excellence has empowered the organization’s physicians to prioritize patient-centered care and has led to tangible improvements in patient outcomes. How Sírio-Libanês Hospital Did It

Program Goals Streamline workflows and reduce clicks to improve clinician efficiency Organization Outcomes 23 percentage point increase for provider agreement that the EHR enables efficiency and a 30 percentage point increase in agreement that the EHR enables high-quality care 11 percentage point increase in nurse agreement that the EHR enables efficiency and a 10 percentage point increase in agreement that the EHR enables high-quality care Collaborative-Verified Best Practices Shared Ownership and Governance Clinician Efficiency and Personalization Keys to Success Identify the workflows that need to be streamlined by tracking those with the most clicks Create an approval process that enables rapid implementation of changes Translate clicks saved into time and money saved to generate buy-in and keep clinicians and organization leaders engaged in workflow optimization What Scripps Health Did Scripps Health (Scripps) created a successful EHR optimization project that significantly reduced clicks for healthcare providers, saving time and improving the user experience. The project's success was due to engaged clinicians, a streamlined approval process, and a visual representation of saved clicks in the form of a "click wheel." Scripps’ commitment to ongoing optimization and efficiency improvements within the EHR system has resulted in substantial time and cost savings. How Scripps Health Did It

Program Goals Optimize the use of the EHR to improve the quality of patient care Organization Outcomes 96th percentile for provider agreement that the EHR enables quality care Collaborative-Verified Best Practices Shared Ownership and Governance Keys to Success Ensure patient data is accessible without unnecessary clutter that could impede efficiency Create a physician informatics team to optimize the EHR and streamline workflows What Essentia Health Did Essentia Health’s (Essentia) success in enabling quality care through EHR is driven by a combination of factors, including the effective utilization of BPAs, a commitment to EHR optimization, streamlined clinical workflows, strong physician and informatics engagement, and a culture that prioritizes patient care and quality. They have established committees to oversee the integration of clinical decision support tools and have a proactive approach to EHR improvement, guided by physician informatics experts and partnerships with nursing informatics teams. How Essentia Health Did It

Program Goals Address clinicians’ concerns regarding hardware, software, EHR documentation, and EHR education Organization Outcomes Nurses had a 24-point increase in their average Net EHR Experience Score Collaborative-Verified Best Practices Ongoing EHR Education Clinician Efficiency and Personalization Recognized Improvement Nursing EHR Success Keys to Success Simplify initial workflow training to focus on early documentation tasks and use workbooks for additional training needs Have facilitators on-site during self-guided training to answer new hires’ questions Optimize the most frequently used nurse flow sheets Ensure task force members receive recognition for their participation from organization leaders What Valley Children's Hospital Did Nurses at Valley Children’s Hospital (Valley Children’s) expressed concerns about EHR documentation and training. To address these concerns, the organization formed four task forces involving nursing leaders and bedside nurses. With strong support from nursing leadership, Valley Children’s revised initial training methods and reduced classroom training time. The organization also reduced documentation time by optimizing frequently used flow sheets, focusing on nursing areas that scored low in NEAT metrics, and reenforcing documentation by exception. Shifting the culture toward less documentation was challenging, but high-performing nurses assisted their peers during the transformation, especially with changes to flow-sheet layouts. A team approach and strong support from executives and nursing leaders were critical to success. How Valley Children's Hospital Did It

Program Goals Reduce clinician burnout related to documentation inefficiencies. Organization Outcomes Physicians using 3M™ M*Modal Fluency Direct at Baylor Scott & White Health have a Net EHR Experience Score (NEES) of 53.6, which is 7.3 points higher than the score of nonusers. Physicians using 3M™ M*Modal Fluency Direct at Baylor Scott & White Health report 14 percentage points higher agreement than nonusers that the electronic health record (EHR) enables quality care. Collaborative-Verified Best Practices Clinician Wellness and Reducing Burnout Recognized Improvement Keys to Success Involving the provider voice by getting input on changes and training around those changes. What Baylor Scott & White and 3M Did Baylor Scott & White Health initiated a medical group transformation project in 2022 to review all aspects of their organization and find ways to increase operational efficiencies on all levels. During the organization’s presentation at the KLAS Arch Collaborative Summit in 2023, Baylor Scott & White Health focused on one of the initiatives from the larger mission—to lower documentation burden among their providers. Baylor Scott & White Health has measured three times with the Arch Collaborative using the EHR experience survey since 2018, and they have seen continual improvement throughout the measurement period. Based on data captured from Epic, the average note length of Baylor Scott & White Health’s providers has more than tripled since 2009. Due to accumulating regulatory changes and clinicians who have grown accustomed to their existing ways of documenting, notes have continued to increase in length over time, which has caused patients to be confused in their reviews of the notes. Baylor Scott & White Health used two different approaches to reduce their providers’ documentation burden: re-ordering Assessment, Plan, Subjective, Objective (APSO) notes and increasing and optimizing their use of 3M™ M*Modal Fluency Direct. They got the idea of the APSO note approach from a UW Health webinar, where it was explained how UW Health initiated a project with their clinicians to flip the sequence of their note sections. This enabled UW Health’s physicians and patients to see the most crucial pieces of information at the top rather than having to scroll to the end of the notes to get to that information. After seeing what UW Health had done, the Baylor Scott & White Health team created an initiative to tackle note bloat (extraneous information commonly placed in notes that includes information contained elsewhere in the patient record) and utilized their results from the Arch Collaborative EHR experience survey to further expand the project. Note Bloat Initiative The primary goal of the note bloat initiative was to help providers to learn new documentation skills by acquiring more proficiency with the tools already available to them and to achieve higher performance standards. From the beginning, the team for the note bloat initiative involved representatives from across the organization, including individuals from the coding, compliance, and regulatory departments to ensure that any changes made wouldn’t negatively impact those downstream areas. The team designated 10–12 provider champions who represented each region of Baylor Scott & White Health and who helped develop the new note structure to pilot with primary care providers. The champions served as vocal cheerleaders for the project within their regions. The provider champions also helped gather user feedback so they could enhance the notes throughout the pilot period. During phase one of the project, Baylor Scott & White Health’s regional medical director led many town halls, delivering information and training on the use of this new APSO note type and soliciting from the 100 primary care providers piloting the project any feedback to further refine the process. One major cultural challenge the Baylor Scott & White Health team confronted as they sought to reduce the provider documentation burden was helping providers understand which pieces of information were no longer needed within each note; many aspects of their notes were already captured elsewhere in the EHR . As Baylor Scott & White Health piloted the APSO note initiative with primary care providers, they embedded a link in the EHR to track who was using the APSO notes and how the note structure was impacting their time spent documenting in the EHR. The pilot group of primary care providers was not mandated to use the APSO notes, but there were over 98,000 uses of the new APSO notes in primary care as of August 2023 . The organization is in the process of developing tracking tools that are inclusive to specialist uses of the APSO notes, so those numbers have not yet been reported. Prior to the APSO note initiative, Baylor Scott & White Health was in the 75th percentile of Epic users for note length; after the initiative, the organization is now below Epic’s average for note length. Baylor Scott & White Health has noted the following phase-one outcomes : 8 fewer minutes of pajama time per day per provider. 21% shorter progress notes on average for participating providers. 7% reduction in time in notes per note per provider. 34 fewer seconds spent in notes per provider per appointment. 2 fewer minutes spent in notes per provider per day (those who did not adopt the APSO notes into their workflows saw an increase of 4.5 minutes spent in notes per provider per day on average). 166.6 estimated minutes saved writing notes per provider per month. 16,327 estimated total provider minutes saved per month. 272.1 estimated total provider hours saved per month. Increasing use of 3M™ M*Modal Fluency Direct Baylor Scott & White Health recognized that a new note type alone wouldn’t achieve the desired results for end-user satisfaction or accomplish the mission to reduce the provider documentation burden. To this end, the organization collaborated with 3M to train their clinicians more deeply on how to optimally utilize 3M™ M*Modal Fluency Direct, a front-end speech recognition solution that was already available to their clinicians. 3M Fluency Direct was embedded within Baylor Scott & White Health’s EHR system, but too few providers were using it . 3M sent an in-house solution advisor whose sole role was to augment the adoption of 3M Fluency Direct and work closely with Baylor Scott & White Health’s Epic Efficiency Program (EEP) team members, a team of analyst trainers who work on EHR proficiency and efficiency skills with providers. 3M’s solution advisor and Baylor Scott & White Health’s EEP trainers conducted scheduled sessions with providers to assess their current workflows and to teach them how to best utilize 3M Fluency Direct. Baylor Scott & White Health’s EEP trainers consist of a team of seven employees designated to improve the work lives of providers at their health system by leveraging best-practice uses of Epic’s products. Interfacing with EEP leaders enabled 3M to scale education and training to optimize the use of technology across an organization of Baylor Scott & White Health’s size. This level of engagement was critical to the success of the 3M solution advisor charged with driving better adoption, EHR experiences, and clinician satisfaction. When the 3M solution advisor reviewed Baylor Scott & White Health’s data after the advisor’s visit and training sessions, Baylor Scott & White Health saw a significant increase in 3M Fluency Direct users and an increase in the volume of minutes per month of use. The 3M solution advisor credited the one-on-one sessions and word-of-mouth promotion as the reasons for higher adoption and usage of 3M Fluency Direct. KLAS’ Arch Collaborative conducted an analysis of providers using 3M Fluency Direct and of those not using it in Baylor Scott & White Health’s 2023 EHR experience survey. Those using 3M Fluency Direct achieved a higher overall NEES and reported decreased after-hours charting. The group leveraging 3M’s speech understanding solution also agreed more often (than those not using the 3M technology) that the EHR enabled the delivery of quality patient care. 3M has a well-defined path to incrementally delivering artificial intelligence–powered, innovative solutions with an eye for responsible change management, starting with real-time speech understanding to proactive computer-assisted physician documentation (CAPD) and conversational virtual assistant and ambient clinical documentation. With Baylor Scott & White Health, 3M accomplished the following key project deliverables: Redesigned governance of the deployment and optimization of 3M Fluency Direct, namely through engaging with EEP leaders. Deployed a prescriptive technology package. Planned the 3M Fluency Direct adoption expansion, strategic onboarding, and a scale-up plan alongside the EEP team’s educational efforts. Applied 3M Fluency Direct efficiencies to efforts around medical group documentation transformation. Physician endorsement of 3M Fluency Direct  One physician specifically enthused by their use of 3M Fluency Direct created a video of them completing a Medicare annual wellness note within 60 seconds using natural speech, demonstrating to their peers what could be achieved with 3M Fluency Direct. In the short video, the physician explained how they completed visit notes using Epic smart tools with 3M Fluency Direct and finished their notes within the same day of the visit. The physician covered four achievements through their process: Increased use of Epic smart tools to become more efficient with documentation. No violations of the “OHIO Principle” ( “only handle it once”), because the more a physician goes in and out of office visits without completing documentation, the longer it will take them to get it all done. Noticeable improvement in patient satisfaction since the physician was on time more often with their appointments. Increased personal EHR satisfaction by completing charts during the same day the visit occurred. During the video, the physician walked viewers through a real visit where the physician had pre-charted things and then, while in the room, completed their wrap-up documentation, decided on the correct billing codes, and placed information in the after-visit summary. The physician accomplished everything conversationally using 3M Fluency Direct. This enthused physician encouraged other interested providers to reach out to the right people at Baylor Scott & White Health to better understand what efficiencies are possible to improve their own documentation. Such endorsements by organizational and clinical leaders can help meaningfully drive interest among clinicians in the use of new and existing informatics solutions.

Program Goals Improve clinicians’ satisfaction with the EHR Have clinicians and departments buy in to the concept that they have responsibility for their EHR use and satisfaction Organization Outcomes 28-point improvement in Net EHR Experience Score 24-point improvement in agreement that the EHR enables efficiency 17-point improvement in agreement that the EHR is needed functionality Collaborative-Verified Best Practices Ongoing EHR Education Recognized Improvement Keys to Success Build a network of departmental support and provide clinicians with clear instructions on how to be successful with the EHR Invest in ongoing EHR education. Many issues that clinicians think might require a fix in the EHR can typically be resolved with more education What Amsterdam UMC Did After receiving their initial Arch Collaborative survey results in 2018, Amsterdam UMC chose to make significant adjustments to change the perception and utility of their EHR. They implemented three key programs to begin this transformation. First, they revamped their service ticket process to better meet the needs of clinicians regarding their EHR use. By triaging all incoming tickets, they determined integrality, clarity, and priority before sending the tickets to an application team to work on. Second, they changed strategies on their governance structure and positioned a strong CMIO, CNIO, and CSIO to work closely with Amsterdam UMC’s EHR department and to implement an ambassador program where every department was expected to provide a clinical ambassador who would spend approximately 10 hours per month in ambassador activities. Third, they created an ongoing, one-on-one EHR education program. How Amsterdam UMC Did It

Program Goals Improve clinicians’ satisfaction with the EHR Have clinicians and departments buy in to the concept that they have responsibility for their EHR use and satisfaction Organization Outcomes 28-point improvement in Net EHR Experience Score 24-point improvement in agreement that the EHR enables efficiency 17-point improvement in agreement that the EHR is needed functionality Collaborative-Verified Best Practices Ongoing EHR Education Recognized Improvement Keys to Success Build a network of departmental support and provide clinicians with clear instructions on how to be successful with the EHR Invest in ongoing EHR education. Many issues that clinicians think might require a fix in the EHR can typically be resolved with more education What Amsterdam UMC Did After receiving their initial Arch Collaborative survey results in 2018, Amsterdam UMC chose to make significant adjustments to change the perception and utility of their EHR. They implemented three key programs to begin this transformation. First, they revamped their service ticket process to better meet the needs of clinicians regarding their EHR use. By triaging all incoming tickets, they determined integrality, clarity, and priority before sending the tickets to an application team to work on. Second, they changed strategies on their governance structure and positioned a strong CMIO, CNIO, and CSIO to work closely with Amsterdam UMC’s EHR department and to implement an ambassador program where every department was expected to provide a clinical ambassador who would spend approximately 10 hours per month in ambassador activities. Third, they created an ongoing, one-on-one EHR education program. How Amsterdam UMC Did It