3 Solutions to Improve EHR Training, Outcomes

When hospitals purchase expensive electronic health record systems, they are hoping to benefit from advanced features, which produce cost-savings, increased efficiency and patient care benefits. However, training sessions for complex EHR systems can be overwhelming and time consuming. According to Andres Jimenez, MD, CEO of ImplementHIT, many hospitals may not receive optimal outcomes from EHRs because hospital staff and physicians are not trained effectively. "One of the basic tenets of education is that individuals, especially adult learners, must find training immediately relevant need to be engaged in learning in order to retain information. With physicians, if the information is not relevant, it is not only harder for the individuals to learn, it will often completely disrupt learning, which reduces engagement and any possibility of meaningful learning from that point forward," says Dr. Jimenez. For healthcare, relevance applies to EHR training in both content and pace, at which intermediate and advanced topics are introduced. According to Dr. Jimenez, physicians and hospital staff need to undergo gradual EHR training that is set to their individual pace and tailored to their specialty and proficiency level. Not many EHR training sessions are individualized or specialized, which is causing problems for hospital EHR implementation.

Here, Dr. Jimenez discusses three major problems and solutions in EHR training.

1. Providing advanced training too early. Providing advanced training too early can overwhelm physicians and hospital staff, lowering their retention rates and rendering the majority of the training session almost useless. In many instances, physicians and clinical staff participate in long classroom-training sessions to learn about the hospital's new EHR system. During those long sessions, some of which can be 12 hours or more, they learn all facets of the EHR system — the basic, intermediate and advanced features. "When a physician sits down for 12 hours with a new system they won't use for another one to two weeks, he or she may not retain a majority of that information for when the system goes live. Learners often lack the ability to recall and apply such knowledge during the initial stressful days of implementation," says Dr. Jimenez.

Physicians do not need to learn the advanced capabilities of an EHR system during their first few weeks of training. Dr. Jimenez compares it to learning how to drive an automobile. "Think of the EHR like a Bentley. The driver must first learn how to control the vehicle, drive straight, yield to alerts like school zones and avoid any major accidents. These are the basics of driving. Similarly, the basics of an EHR might be entering the patient's medical history, writing a progress note, placing a simple medication order or understanding and adjusting the plan of care when an allergy or interaction alert pops up. Once you master the basics, you want to learn about the cruise control, heated seats and automatic parallel parking. These features are equivalent to order sets, health maintenance reminders and patient lists for targeted quality metrics in an EHR, says Dr. Jimenez. Since no EHR is sold or purchased solely for its basic functionality, some organizations may try to leap frog the basics to achieve advanced functionality as soon as possible. This may lead to a majority of users never making it past intermediate skills.

"Once you have driven 1000 miles, or cored for 100 to 200 patients with the new EHR, you can accumulate sufficient experiential knowledge on the EHR to eventually reach intermediate and advanced capabilities," says Dr. Jimenez.

Instead of comprehensive EHR training all at once, hospitals should train their employees in phases with the basic EHR capabilities first. A couple of phases may be necessary so advanced tasks can be introduced gradually. "Training individuals for the advanced features after the system goes live is more efficient. By focusing on the basics first, the hospital can reduce the overall amount of training needed prior to implementation, minimizing the loss of productivity pre-implementation. Using this training methodology, St. Vincent's Health, a 16 hospital network in central Indiana, reduced their onsite pre-implementation training by 50 percent by focusing on the basics, and moving targeted training materials online with a significant reduction in lost clinic time for providers," says Dr. Jimenez.

2. No personalized pace of training. When EHR training is not personalized to individual learning paces, problems with information overload and lack of retention worsen. Some physicians and hospital staff may master the basics in two weeks, whereas others may need a month. Training sessions should allow those that master concepts quickly to progress through the stages and learn the advanced capabilities at a faster pace. There is no benefit to requiring quick learners to wait on training. Additionally, the learners that take more time should be not be rushed into advanced capabilities before they are ready. If training sessions are only available before the system goes live with follow-up three to six months in, individuals may struggle. "Proper and effective training should be tailored to individual proficiencies as much as possible," says Dr. Jimenez.

A variety of session options will allow physicians and hospital staff to advance through training at an appropriate pace. For the first few months of EHR implementation, physicians and clinical staff should have freedom to attend training sessions that apply to their level of use. Many consulting companies offer a variety of training types such as classroom and online trainings to tailor learning environments and pace.

3. Lack of specialization in training. Every specialty and department in the hospital may use the EHR system differently, so training the physicians and hospital staff as one large group is not effective; the training should be as individualized as possible. "If you are a pediatrician and you receive the same training as a cardiologist or general surgeon, your learning potential is significantly impacted. Not only is the context different, but some EHR features might be basic for a cardiologist and should never be introduced to even an advanced pediatrician user. It goes back to the basic tenet of learning. Individuals need to be engaged to learn — it needs to be relevant. If physicians are not trained with relevancy to their specialties, they may not be as engaged," says Dr. Jimenez.

It is important to tailor the EHR training, especially the basic steps, to physician specialties and common tasks within the hospital. For example, the basic tasks in the EHR may be different for a pediatrician versus a cardiologist. The pediatrician may need to learn to order immunizations quickly because that is what they do every day, whereas ordering electrocardiograms would be more beneficial to a cardiologist. "Basics do not mean it is the easiest task but the one that is used every day. For the training to be effective and efficient, it needs to be tailored to what each specialty does most often," says Dr. Jimenez.

In order for a hospital to maximize training time, the training methodology should progress from basic to advanced over time and should be customized to individuals and medical specialties.

More Articles on EHR Implementation:

6 Best Practices for Implementing EMR, CPOE for Meaningful Use
How to Improve EHR Performance With Clinical Best Practices
5 Solutions to Problems Resulting From Improper HIT Implementation

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