Variation in EMR Satisfaction Offers Clues for Ways to Improve

By Taylor Davis, KLAS

For two years, I lived in a country of poverty where all people struggled to live from day to day. The middle class as we know it did not exist. In fact, there wasn’t income inequality as we think of it for people, besides those who ran the cartels. After spending two years in that area, I realized that while I could be poor anywhere, I would prefer to be poor in a country with variation. It is differences that allow change to occur.

Variation is an indication of opportunity.

Since the launch of the Arch Collaborative over 14 months ago, KLAS has worked with more than 80 provider organizations to measure clinician satisfaction at these organizations. The ultimate goal of this effort lies in solving the IT aspect of physician burnout. Before embarking on this journey, we considered: Could it be possible that satisfaction is uniformly low across all organizations?

We had many reasons to assume that clinician satisfaction could be uniformly low:

  • The EMR has been the Trojan Horse for regulated documentation.
  • The EMR will never be as fast as paper.
  • Medicine has had to change with the EMR, and it will never go back to the way it was. Clinicians who liked the old ways will never be completely happy.

What did we find? Variation. Incredible variation. Hopeful, optimistic variation! Some organizations were up to 70 percent dissatisfied, and others had satisfaction as high as 90 percent. 

I think many in the industry will be more surprised by the 90 percent satisfaction rate than by the 70 percent dissatisfaction. That leads us to the next big question: Where did the positive variation come from?

I’ll let the physicians tell the story. These are actual quotes from end users:

  • “There are many advantages of the EMR. The main one in our specialty is the ability to see all entries for a chronic-disease patient in all facilities and the community. [The EMR g]reatly improves care coordination.”
  • “Having learned to navigate through [my EMR], I like it very much.”
  • “[This EMR] has been integral to improving my work-life balance. I think that people who have always had it do not know how lucky they are.”

Alternatively, here are some comments from clinicians with less-than-stellar views of the EMR:

  • “If there has ever been a profession at the mercy of IT designers, it is medicine.”
  • “The profound disruption caused by the introduction of this terrible EMR cannot be overstated. It is the signature disaster of my career in medicine.”
  • “I think we have to decide whether healthcare is going to be primarily patient driven or micromanaged from the top. I hope the former wins out.”

Those bleak sentiments from the second group of EMR users in some ways remind me of my two years among a poverty-stricken people a half a world away. I see a lot of the same feelings of hopelessness and resignation with “the way things are.”

Thankfully, like a bolt of lightning, the highly satisfied users have given us a flash of light and a glimpse of what could be for all EMR users. In short, physicians and clinicians at these organizations have deeply learned their EMRs, are capitalizing off of the strengths of their EMRs, have set up their EMRs to meet specific needs, and feel that they are part of great teams making their EMRs work.

The variation in experience means that we, as stakeholders in healthcare, have a lot to learn from the most successful organizations.

Ultimately, this variation is the hope that we all need to investigate. Top organizations need to better understand why their users are more successful so that they can continue to build on their success. Lower-performing organizations, for the first time, can see a road map to change.

We all have a lot of learning to do. But we know who to learn from, and more importantly . . . we have hope.

More AEHIA News Volume 2, No. 1: