Since the COVID-19 pandemic, healthcare organizations have shared concerns with KLAS about how difficult EHR implementations have become in this new age of hybrid work models, staffing shortages, and tight budgets. KLAS’ vendor performance data supports these organizations’ concerns—customer satisfaction with implementations has declined consistently since the pandemic. Furthermore, Arch Collaborative data highlights that there is a need for improvement around the human elements of implementations.
After organizations asked KLAS for best practices, we realized we needed a comprehensive resource that identifies common pitfalls, shares lessons learned, and ultimately helps organizations achieve long-term success with their EHR. Thus, the EHR Implementations 2025 report came to be. Our goal was to illustrate the current state of implementations and highlight that organizations can be successful as long as they focus on and invest in the human elements. The report’s information is valuable not only for organizations implementing an EHR but also for health systems that have acquired other organizations and are onboarding those clinicians to the EHR.
The State of EHR Implementations
EHR implementations have never been easy, as they are a large financial and operational undertaking. They involve thousands of hours of meetings, decisions, and governance councils, and an implementation can significantly impact how a health system delivers patient care.
KLAS data shows that implementations can be successful, but many have missed the mark since the pandemic as the industry has worked to adjust to the numerous challenges that have remained since 2022. EHR implementations have consistently been one of the weakest elements of the EHR experience for recently live organizations, and challenges have become more pronounced since the pandemic.
Just 38% of organizations report that their post-pandemic implementations hit the mark, while 62% said that their implementations either missed the mark significantly or had areas for needed improvement. The key takeaway here is that organizations really have to put in the effort to make a difference. Some organizations have the perception that they just need to go live on an EHR and that things will improve with time. However, the research in the report indicates organizations should do everything possible up front to get things right because when implementations miss the mark, recovery can be a difficult and lengthy process.
The Importance of Change Management & Training
We want to emphasize the importance of prioritizing the human elements of an implementation—change management and training are critical to success and are often where implementations fall short.
Many organizations make plans to address change management but realize their efforts were too late or had an overly narrow scope. Some focused too much on functionality training without addressing the mind-set and process changes critical to adoption. A common misstep is thinking that training is a complete change management strategy, but it needs to account for so much more. Mind-set and process changes need to be addressed first—creating a desire to change—before the training and knowledge pieces come into play. Those mind-set changes need to be driven by effective communication from department leaders to help clinicians understand “the why” of the implementation and what they should expect coming out of it.
Additionally, training is often the first thing to be cut from budgets—organizations plan to do it later, or they think they can get by with limited training resources for a shorter amount of time. However, data from the Arch Collaborative shows how training can significantly impact clinician EHR satisfaction. Based on end-user feedback, clinicians should receive three to six hours of initial training on their EHR.
Nurses’ Experience vs. Physicians’ Experience
One thing that surprised us was the stark difference between nurses’ and physicians’ implementation experiences. Nurses often feel left behind, which is concerning due to nurse shortages and their critical role in patient care. Physicians tend to be more satisfied because health systems prioritize their experience. As an industry, we need to address the poor experiences of nurses to ensure they receive adequate training and support. That said, both physicians and nurses acknowledge a need for better training during their implementation—just 43% of physicians and 33% of nurses feel that their initial EHR training was sufficient.
“The training for the superusers and staff was too short and incomplete. Many superusers were still not comfortable using the system when it was implemented, and many of the support staff, who were supposed to be the go-to people for the superusers, knew even less than the superusers, and were not helpful or able to answer questions.” —Nurse
Is It All Doom and Gloom?
This report doesn’t paint a pretty picture of the state of EHR implementations, but that doesn’t mean organizations are doomed to fail. The report covers multiple case studies of organizations that have bucked the downward trend, detailing how they achieved positive outcomes. Additionally, the report covers strategic priorities recommended by interviewed organizations—each priority focuses on a human element of an implementation:
- Regular, transparent communication between the healthcare organization, EHR vendor, and implementation partner to ensure continual alignment and accountability
- A constant focus on change management execution
- Strong governance structures that promote effective communication between leaders and end users
- Deep investment in workflow-specific training that accounts for the entire patient journey
Looking forward, KLAS intends to keep conducting research around the human elements of implementations to provide more detailed guidance to healthcare organizations.
Successful implementations are achievable. Implementation challenges won’t disappear in the next few years, but we are optimistic that with better data and investments, organizations can realize improved outcomes. Read the full report to determine your organization’s next steps.
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