EHR training is biggest predictor of user satisfaction, experts say

A better clinician experience makes for higher-quality patient care, according to a new report from KLAS' Arch Collaborative, which makes the case for bigger investment in end-user education.
By Mike Miliard
03:56 PM

A new study published in the Journal of Clinical Informatics takes aim at the notion that lackluster user experience is an essential part of electronic health record usage.

Instead, it emphasizes the importance of thoughtful education and training processes, sensitive to the unique needs of physicians and nurses, to enabling increased EHR satisfaction.

The study, from KLAS' Arch Collaborative, which comprises academics, providers and other informatics experts, polled more than 72,000 clinicians at more than 150 hospitals and health systems nationwide.

"Despite decades of effort and billions of dollars of investment, the EHR has not lived up to its potential to improve care, reduce costs, or revolutionize the experience for caregivers," researchers write. "Many people point to poor technical usability as a root cause of these failings."

After speaking to those tens of thousands of clinicians – which included nurses, residents and other providers – the Arch Collaborative researchers found "critical gaps in users' understanding of how to optimize their EHR."

Their takeaway? "We as an industry have an opportunity to improve EHR adoption by investing in EHR learning and personalization support for caregivers. If health care organizations offered higher-quality educational opportunities for their care providers – and if providers were expected to develop greater mastery of EHR functionality – many of the current EHR challenges would be ameliorated."

The reason the very same EHR system can lead to different user experiences – and different patient outcomes – depending where it's deployed boils down much more to how it's used, than how the software is designed, said researchers in the JCI study.

"Less than 20 percent of all variation was explainable by the EHR in use, with over 50 percent of variation explained at the physician user level," they noted. "This variation at a user level in every software customer base indicates that no current enterprise software solution (as every major U.S. commercial EHR software solution was measured) has been identified that is so user friendly that it removes individual user variation in experience."

That means that hospitals and health systems that want to improve user experience – and by extension, hopefully, improve outcomes – need to think less about software usability per se, and more about "factors unique to individual physician users."

Translation: Training is key.

And that's why providers need to give more consideration to standards and strategies when developing their EHR education programs. And they shouldn't give them short shrift.

The survey showed "significant jumps in users' overall satisfaction with the EHR experience occur for every additional hour of initial EHR education they receive," according to the report. "Organizations requiring less than 4 hours of education for new providers appear to be creating a frustrating experience for their clinicians."

As for other suggestions, the Arch Collaborative experts said health systems should support efforts and tools to enable EHR personalization whenever possible, especially since clinicians are used to that level of customization on all of their consumer electronics, and generally invest more in EHR training across the board – especially since add-on functionality such as clinical decision support modules will get more nuanced and complex in the years ahead.


Suboptimal UX for EHRs isn't the main cause of the physician burnout epidemic, but it's surely one of the biggest exacerbating factors. So any effort to improve end-user satisfaction is worthwhile if a hospital hopes to do right by its clinicians and patients.

Another Arch Collaborative report on usability spotlighted the importance of strategies both localized (software customization) and enterprise-wide (larger cultural changes at healthcare organizations) to enabling better a better EHR experience for physicians and nurses.

"In the Arch Collaborative large dataset, the single greatest predictor of user experience is not which EHR a provider uses nor what percent of an organization's operating budget is spent on information technology, but how users rate the quality of the EHR-specific training they received," said researchers.

"For a physician, feeling safe with the tools of medicine is about more than just the user interface," according to the report. "Physicians who report poor training are over 3.5 times more likely to report that their EHR does not enable them to deliver quality care.

"While user interface matters, practice does also," researchers added. "A scalpel is a tool that has a very simple interface and use, but using it with confidence and safety requires knowledge of anatomy and surgical techniques coupled with practice to use it skillfully. In other industries, it is well recognized that education and training are of paramount importance to the successful use of professional-grade software. We need to recognize that this also holds true for EHRs and the practice of medicine."

Digital Transformation in Healthcare

In May, we'll talk to experts and professionals on the front lines about what's really happening today with the digital transformation in healthcare and what hospital executives need to be doing right now.

Twitter: @MikeMiliardHITN
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