Adverse EHR Implementation Sentiments Can Linger One to a Year Post-Launch

EHR implementation challenges can significantly derail provider satisfaction, according to a KLAS report that found that nearly 50 percent of respondents opened up about room for improvement.

Provider organizations also mentioned that EHR user satisfaction levels were worsened by misaligned expectations between organizations and vendors, often underestimating the required time and effort for successful implementation. In the Landmark Insights report, KLAS interviewed 180 respondents from 113 different organizations, discussing common difficulties encountered during EHR implementation.

Overall, the top implementation challenges include training quality and time with 30 responses, rigid timelines with 24, and ongoing insufficient vendor communication, receiving 18 responses. Some respondents reported that established timelines are often unrealistic or inflexible, leading to concerns when unexpected implementation delays arise. As a result of these delays, organizations may need to allocate additional resources or shorten another project phase, such as training, to remain on schedule.

“As an implementation progresses, misaligned expectations between the provider organization and the vendor can frequently lead to problems as well as lower provider satisfaction,” the KLAS researchers said.

“Because vendors are still securing a bid when explaining the required investment to the customer, provider organizations planning to implement cannot always take the expectations vendors set at face value. Respondent feedback indicates that going into a project, provider organizations almost always underestimate the time and effort implementation requires; they also often feel that vendors undersell the time needed for implementation in order to win the contract.”

The mixed bag of expectations throughout the implementation stages mirrors provider satisfaction scores. During the pre-implementation phase, 83.3 percent of organizations were satisfied with their respective EHR vendors. However, this number dropped to 79.2 percent during implementation and further declined to 74.4 percent after implementation, with expected long-lasting sentiments.

Specifically, the training phase can significantly influence implementation outcomes. When done correctly, EHR training positively impacts the process, but if mishandled, training can lead to negative sentiments lasting up to a year after going live.

KLAS has repeatedly emphasized that high-quality EHR training and clinician-led governance structures are essential for enhancing user satisfaction. Nonetheless, poor EHR experiences can lead to employee turnover. A previous KLAS report highlighted the costs associated with EHR dissatisfaction, ranging from $93,000 to $170,000 per organization per year for nurses and $319,000 to $1.3 million for physicians.

Various issues can contribute to dissatisfaction, such as underestimating the learning curve or inadequate staffing. Respondents of this most recent KLAS study reported that these factors often cause organizations to struggle to comprehend the additional workload that implementation imposes on employees.

KLAS highlighted that solutions to training challenges do exist. When asked about preventing implementation challenges, provider organizations frequently cited better vendor preparation.

 “Most staff members are not familiar with the implementation process, and the discrepancy between how a project is sold and what happens during the implementation decreases satisfaction,” researchers wrote. “Vendors need to be more up front and detailed about the extensive workflow required for projects.”

In general, organizations want more guidance when preparing for EHR implementation projects.

Respondents are concerned that EHR vendors tend to accommodate their desires instead of thoroughly examining the organizational need and providing tailored solutions for existing problems. Numerous respondents wished their vendor had invested more time in understanding their operations before planning and designing the implementation.

During the configuration and building phase, these respondents encountered knowledge gaps, which resulted in reduced confidence in the vendor and diminished satisfaction.

On the other hand, provider organizations that reported satisfaction with their EHR implementation had implemented change management plans before commencing any of the implementation processes.

“Working with one or two vendor teams during implementation can quickly lead to a chaotic operation if project roles, responsibilities, and milestones are not clearly defined and understood by all stakeholders.”

“While the provider leadership team is responsible for establishing and administering a change management plan, the strength of that plan—and consequently the success of the implementation—highly correlates with how involved the vendor is. Most vendors suggest best practices for developing an implementation plan, but provider organizations want their vendor to be a partner who will actively help create a plan that best meets their organization’s needs.”

According to the survey results, respondents who implemented strong change management plans early on reported higher levels of satisfaction with their vendor upon project completion. They also reported a stronger sense of ownership over post-implementation projects resulting in greater user adoption.

Meanwhile, dissatisfied provider organizations mainly reported a disconnect from their vendor and uncertainty about EHR roadmaps, resulting in reduced confidence in the project. These respondents also frequently cited missing functionality or system bugs that hindered EHR usability and effectiveness.

Effective change management remains a prevalent challenge for provider organizations implementing solutions, and it is one of the areas with the lowest satisfaction among survey participants. Even the most satisfied respondents admitted to struggling with facilitating clinician adoption of new processes after implementation.

“Interviewed organizations say that insufficient training in change management plans can contribute to low adoption rates, as users can’t fully engage with the new solution unless they feel comfortable with it.”

“Provider organizations sometimes try to save costs by choosing less-involved training plans; however, knowing how much training staff members will realistically need before the transition is paramount for a successful go-live. Respondents that invest in longer, more in-depth training from the beginning are more likely to have higher adoption rates.”