Local Investment in Training Drives Electronic Health Record User Satisfaction
22. Oktober 2018
31. März 2019
15. Mai 2019 (online)
Background and Significance
Despite decades of effort and billions of dollars of investment, the electronic health record (EHR) has not lived up to its potential to improve care, reduce costs, or revolutionize the experience for caregivers. Many people point to poor technical usability as a root cause of these failings. To find solutions to these challenges, the Arch Collaborative organizations (signed below) are working together to jointly study the feedback of their EHR users. After collecting responses from over 72,000 physicians, nurses, advanced practice professionals, and residents across 156 provider organizations, we are identifying key opportunities to derive greater value from the EHR investments that our organizations have collectively made (See details of survey methods in the [supplementary Material], available in the online version).
The extensive feedback from tens of thousands of users reveals critical gaps in users' understanding of how to optimize their EHR. Therefore, 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.
We came to this conclusion after discovering the wide variation in EHR experience that exists within all EHR customer bases (see [Table 1]). This variation cannot be ignored as it is not caused by differences in regulatory burden or programing design. We express concern that user competency often does not receive the strong focus it needs. These findings do not negate the need for EHR developers to continue to improve their user interfaces to be more intuitive, nor do they negate the critical need to reexamine the current regulatory and billing requirements that drive so much of the clinical documentation burden faced by providers today, but we believe that a greater focus on education and training is the overlooked opportunity that could enable EHR technology to drive substantial gains in the quadruple aim. 
Abbreviation: EHR, electronic health record.
Protection of Human and Animal Subjects
This study is considered exempt from the Institutional Review Board review as defined by 45 CFR 46.101(b).
* The list of Arch Collaborative members appears in [Supplementary Material] (available in the online version).
- 1 Soumerai SB, Mahjumdar SR. 2009. A bad $50 billion bet. Washington, DC: The Washington Post;
- 2 Rosenbaum L. Transitional chaos or enduring harm? The EHR and the disruption of medicine. N Engl J Med 2015; 373 (17) 1585-1588
- 3 Sittig DF, Belmont E, Singh H. Improving the safety of health information technology requires shared responsibility: it is time we all step up. Healthc (Amst) 2018; 6 (01) 7-12
- 4 Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27 (03) 759-769
- 5 Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12 (06) 573-576
- 6 Metzger J, Welebob E, Bates DW, Lipsitz S, Classen DC. Mixed results in the safety performance of computerized physician order entry. Health Aff (Millwood) 2010; 29 (04) 655-663
- 7 Chaparro JD, Classen DC, Danforth M, Stockwell DC, Longhurst CA. National trends in safety performance of electronic health record systems in children's hospitals. J Am Med Inform Assoc 2017; 24 (02) 268-274
- 8 Han YY, Carcillo JA, Venkataraman ST. , et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-1512
- 9 Longhurst CA, Parast L, Sandborg CI. , et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics 2010; 126 (01) 14-21
- 10 Stevens LA, Pantaleoni JL, Longhurst CA. The value of clinical teachers for EMR implementations and conversions. Appl Clin Inform 2015; 6 (01) 75-79
- 11 Pantaleoni JL, Stevens LA, Mailes ES, Goad BA, Longhurst CA. Successful physician training program for large scale EMR implementation. Appl Clin Inform 2015; 6 (01) 80-95
- 12 Stroup K, Sanders B, Bernstein B, Scherzer L, Pachter LM. A new EHR training curriculum and assessment for pediatric residents. Appl Clin Inform 2017; 8 (04) 994-1002
- 13 Pereira AG, Kim M, Seywerd M, Nesbitt B, Pitt MB. ; Minnesota Epic101 Collaborative. Collaborating for competency-A model for single electronic health record onboarding for medical students rotating among separate health systems. Appl Clin Inform 2018; 9 (01) 199-204
- 14 Stevens LA, DiAngi YT, Schremp JD. , et al. Designing an individualized EHR learning plan for providers. Appl Clin Inform 2017; 8 (03) 924-935
- 15 Elkin PL. Human factors engineering in HI: so what? who cares? and what's in it for you?. Healthc Inform Res 2012; 18 (04) 237-241