EMR training

Training clinicians to effectively utilize all the features of an electronic medical record system (EMR) is difficult. Various methods include: classroom sessions, computer-based training modules, and one-on-one training. There is no clear cut best solution to this problem. Physicians are usually not willing to take classes outside of their usual work schedule. Physicians tend not to retain classroom training or understand the significance of what they are taught until they have a chance to try it out.

Physician Help Desks

A "physician help desk hotline" operates differently than a regular help desk line. First, a physician help desk line always gets a human being, never a bot or voice mailbox. Second, the "service level" for the help desk personnel is immediate. When it rings, the responders answer STAT.

The challenges of optimizing first call resolution is at 60%. There is also physician resistance because they neither want to troubleshoot with the Help Desk staff, nor be provided a post-call follow up if the issue cannot be resolved immediately.

People also often create a special team specifically dedicated to providing more direct, face-to-face issue resolution for physicians....which may be analogous to the solution you're considering. What my docs would LOVE is to always have someone "right there" when they have a problem, i.e. someone sitting on every unit just waiting to help. But obviously this is not realistic (except possibly for some areas like Radiology.)

Post-live Physician Training & Support

"Super users" are clinical staff who are experts at using the electronic system and can help their colleagues in an ongoing way. Super users can teach the physicians more advanced techniques ("tips, tricks, etc"). The immediate, one-to-one assistance of super users works better than vendor resources for post go-live support. Housestaff pick things up very quickly!

Training Barriers

In order to have a successful implementation of the EMR program within a clinical setting, there are several barriers that surround training of the providers that must be addressed during the implementation development and process.

• Training and productivity impact
• Lack of uniform standards
• Access to technical support
• Lack of computer skills

It has been studied that 77.5% of providers in Rohde Island who responded to a survey regarding successful implementation, said that Training and productivity impact was the largest perceived barrier. Lack of computer skills had the lowest perceived barrier percentage of 34.4%. The above issues should be communicated from the beginning of the implementation process with providers and other medical staff users of how these perceived barriers will be overcome.

Make the training relevant

In addition to the above training mentioned above: classroom sessions, computer-based training modules, and one-on-one training, training styles need to be determined by the type of provider being trained, experience and also technical skills. Not everyone learns in the same manner, some providers will be fine with a classroom setting style of instruction, but most, because of the impact that the EMR software and CPOE has on the provider and how they provide care. It is best to look at “a day in the life” style of training or simulation training. Normally providers only want the information that they need, their time is valuable, and showing that as a trainer you understand that will go a long way. Training on the functionality of the EMR software, will go in one ear and out the other. Training needs to be developed around the workflow that will best help the provider maneuver throughout the EMR program to most easily do the things they need to do. Surgeons must understand their surgery work flow of pre-op orders, peri-op orders, rounding and discharge, within the system. Giving them the tools and simulation training based on that will increase confidence.

Personal Tip for Go-Live Provider Training and the Epic system

The Epic Inpatient system allows providers to take order sets that were developed within the system and “personalize” them. This is a great tool for a system that is built, tested and used. Do not teach providers and surgeons to “personalize” the order sets until the Go-Live phase of the system is complete. As changes are made during the Go-Live phase to the order sets, the providers saved work will become irrelevant, and will need to be deleted and manually re-saved, as the Epic system does not recognize what was there and what has changed. The provider will have to start from scratch. If large order sets are used, this could cause major frustrations for the providers.

References

1. Beyond the focus group: understanding physicians’ barriers to electronic medical records. Yan H, Gardner R, Baier R. Jt Comm J Qual Patient Saf, 2012 Apr; 38(4); 184-191
2. The advantages of simulation training. Haugen H. Health Mgmt Tech, 2012 Apr; 18

Additional resources

1. Landauer, T. K. (1995). The Trouble with Computers; Usefulness, Usability, and Productivity. Cambridge, MA; London, England, The MIT Press.
2. Karat, C.-M. (1994). A business case approach to usability. Cost-Justifying Usability. R. Bias and D. Mayhew. New York, Academic Press: 45-70.
3. Chapanis, A. (1991). The business case for human factors in informatics. Human Factors for Informatics Usability. Shackel, Brian and Richardson. Cambridge, U.K., Cambridge University: 39-71.
4. Zhang (1999). Usability Problems with electronic medical record. AMIA Fall Conference, Washington, DC.

Update Submitted by Sandersen