Training is a critical aspect of EHR implementation that frequently takes a backseat to other considerations. Poor training is associated with failed implementations as reflected in low user adoption rates as well as incomplete use of EHR system functionalities. On the other hand, effective training has been shown to increase user productivity as well as to increase user satisfaction with the use of EHRs.
Training as an Ongoing Process
Training should be considered an ongoing process spanning the pre-implementation, go live and post-implementation phases of EHR adoption. Involvement of training personnel in the pre-implementation phase results in a curriculum closely tailored to workflow and establishes communication between trainers and developers. Periodic post-implementation training along with ongoing user support promotes increased efficiencies and increased adherence to best practices related to EHR use.
Cost and Time Considerations
Underestimation of the cost and time required for training is a common mistake that leads to sub-optimal EHR implementations. Both the direct costs of training, such as the cost of training materials, as well as indirect costs, such as the anticipated decrease in patient volumes during training, must be taken into consideration. In a similar vein, adequate time should be provided for employees to attend training sessions and extra time allocated while personnel adapt to new workflows. Organizational commitment to prioritize and support training will ensure the success of the training program.
Design and Implementation
Regardless of the phase of EHR adoption or the scope of the project – training needs to be approached in a systematic fashion. Borrowing from Dowd, the steps in executing a training program are: needs analysis, program design, program development, program implementation and program evaluation.
- Needs Analysis. Defines the scope of the project: Who needs to be trained? What content or skills need to be imparted? Are there any potential impediments to content assimilation? What is the timeframe? What are the budgetary constraints? Who is the training team?
- Program Design. Provides the plan for program delivery:
- Content Development - Define learning objectives matched to each particular user’s needs. Utilize best practices in adult learning.
- Content Dissemination - assess available resources, utilize multiple training/learning approaches i.e., in-person didactic sessions, webinars, simulations, at-elbow support, super-user support.
- Timeline Development – insure necessary content delivery occurs in close proximity to need.
- Program Development. Develop and refine the content and delivery methods:
- Material Development – customize existing resources from vendors, HIT societies & peers along with original development.
- Personnel Training – super-user training, at-elbow support training.
- Implementation. Execution:
- Dry run and fine-tuning.
- Compliance documentation.
- Evaluation. Assessment:
- Trainee Satisfaction - self-questionnaire.
- Trainee competency – testing.
- McAlearney et al. (2012) The role of cognitive and learning theories in supporting successful EHR system implementation training: A qualitative study
- A Novel Approach to Supporting Relationship-Centered Care Through Electronic Health Record Ergonomic Training in Preclerkship Medical Education
- Nurses Readiness and Electronic Health Records
- Simulated Electronic Health Record (Sim-EHR) Curriculum: Teaching EHR Skills and Use of the EHR for Disease Management and Prevention
Duggan, Christina Mayer. "Designing effective training." Journal of AHIMA 76 (2005).
Lowes, Robert. "EMR success: Training is the key." Med Econ 81.11 (2004).
McAlearney, Ann Scheck, et al. "The Role of Cognitive and Learning Theories in Supporting Successful EHR System Implementation Training A Qualitative Study." Medical Care Research and Review 69.3 (2012): 294-315.
Submitted by (H. Graziano)