CC BY-NC-ND 4.0 · Appl Clin Inform 2019; 10(02): 331-335
DOI: 10.1055/s-0039-1688753
Invited Editorial
Georg Thieme Verlag KG Stuttgart · New York

Local Investment in Training Drives Electronic Health Record User Satisfaction

Christopher A. Longhurst
1   University of California San Diego Health, La Jolla, California, United States
Taylor Davis
2   KLAS Enterprises LLC, Orem, Utah, United States
Amy Maneker
3   Akron, Ohio, United States
H. C. Eschenroeder Jr
4   OrthoVirginia, Lynchburg, Virginia, United States
Rachel Dunscombe
5   National Health System, London, United Kingdom
George Reynolds
6   Omaha, Nebraska, United States
Brian Clay
1   University of California San Diego Health, La Jolla, California, United States
Thomas Moran
7   Northwestern Medicine, Chicago, Illinois, United States
David B. Graham
8   Springfield, Illinois, United States
Shannon M. Dean
9   University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Julia Adler-Milstein
10   University of California San Francisco Center for Clinical Informatics and Improvement Research, San Francisco, California, United States
on behalf of the Arch Collaborative › Author Affiliations
Further Information

Publication History

22 October 2018

31 March 2019

Publication Date:
15 May 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.[1] Many people point to poor technical usability as a root cause of these failings.[2] 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.[3]

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.[4] [5]

Table 1

Variation in experience by EHR

Number of organizations with vendor deployed (and >10 surveys collected)

Lowest organization net EHR experience score

Highest organization net EHR experience score

Vendor 1




Vendor 2




Vendor 3




Vendor 4




Vendor 5




Vendor 6




Vendor 7




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).

Supplementary Material