Training Your Medical Staff by Go-Live: 5 Tips From EMR-Experienced CIOs

The nightmare of arriving at go-live with a staff of untrained physicians is enough to make any hospital administrator shy away from EMR implementation. Bert Reese, chief information officer of Sentara Healthcare, has taken eight hospitals and almost 300 physicians live on Sentara eCare since 2004 and helped the hospital system achieve Level 7 certification from HIMSS. Mike Smith, chief information officer of Lee Memorial Health System in Fort Myers, Fla., has led his system through an EMR transition and plans to take the system's physician offices live on Epic in the coming months. They offer five training tips that can save your hospital time, money and stress during the implementation process.

1. Involve your medical staff in choosing your vendor and building your system. Don't just appoint figureheads to create the semblance of physician and staff participation, Mr. Reese says. "If they're not interested, they're not going to train," he says. When Sentara Healthcare decided to implement an EMR back in 2004, the health system took a team of 20 physicians to HIMSS to watch a series of demonstrations by the leading EMR vendors. Those physicians then participated in building clinical scenarios that the vendor finalists would demonstrate to Sentara. In order to improve institutional memory of those demonstrations, Sentara videotaped the presentations and mailed copies of the DVD to every member of the medical staff and solicited their feedback. "We were very collaborative with doctors in the system selection," Mr. Reese says. "We went all the way down to the primary care doctor, who wouldn't see the fruits of his feedback for three or four years."

Once Sentara had chosen a vendor, the administration created a physician advisory group. This is a common practice in EMR implementation, but Sentara decided to go a step further: They sought out the most respected clinical leaders and paid them to participate. "We wanted to let them know their work was serious," Mr. Reese says. The system also decided to train their clinical staff in IT, rather than hire IT personnel from outside the system. "Our thinking was: I cannot teach the IT person the critical thinking skills of a good nurse or doctor, but I can teach a nurse or doctor some basics of IT."

When you involve your medical staff in choosing and building the system, training will come more naturally, Mr. Reese says. Physicians were more likely to pay attention because they were learning from nurses they had seen on the floor. Medical staff was less likely to complain about the system's complexities because they had been involved in its creation.

2. Don't assume your physicians and staff members are completing the training on their own.
Even if you have supplied your physicians and other staff members with training environments in which to learn the system, don't assume they're actually using them. "In our case, we went to the executive committee of the physician group and put sanctions and requirements in place," he says. "We said, 'It's not optional, we're going to measure it, and if you don't participate in training, that will be considered misbehaving.'" He says there will always be people who resist training, but the bottom line is your hospital has likely spent millions of dollars on an EMR, and you can't let naysayers prevent you from accomplishing a successful implementation.

In order to find out if staff members are neglecting their training, you should measure the amount of time spent in training environments and how many charts your staff members have abstracted through your EMR, if possible. That shouldn't be difficult, Mr. Smith says. "It's less hard to see the measures and more hard to have the discipline to do something about it," he says. "You have to hold people accountable, and we had a couple of cases where we had to strongly deal with situations where folks weren't cooperating."

Mr. Reese echoes the point that it's easy to tell if medical staff members are completing the training. "Before you go live, you need to find out whether your medical staff is ready, and you don't want to ask them," he says. "Instead, look at the names of doctors who have been to training classes. Look at whether they've built their personal preference in the system. Look at how many doctors are practicing in the system."

3. Create a training environment that will make your physicians comfortable.
Physicians need a way to learn without feeling embarrassed, Mr. Smith says. "Their role is one of authority, and they're using to being the expert. This resets everybody to zero, and you've got to contemplate ways to address their learning difficulties if that becomes a sensitive issue." He says this problem can be addressed with one-on-one training or a mentoring session with someone the physician knows personally.

Mr. Reese says it helps to offer a variety of trainings to make sure you target the different learning styles of your medical staff. In retrospect, he says he would offer more computer-based training courses. When Sentara rolled out its first hospital, the system offered a lot of classroom training, but by the time the sixth hospital was ready to roll out, "word hadn't gotten around that CPT training worked for a lot of people," he says.

4. Plan to bring in a lot of man power. Mr. Smith echoes many other hospital administrators when he says on-site support is a big deal. Make room in your budget for support staff before, during and after go-live. "You've got to be prudent, and you can do things that reduce cost, but you've got to be sure to do what you have to do to produce a quality outcome," he says. "You don't want to save $10,000 over here and wind up torpedoing a $100,000 project." This means allocating money to pay for training staff — and potentially bring in more support if your medical staff is struggling post go-live. Especially if you're going live in several areas at once, "it takes a lot of man power to cover 24/7 on-site coverage for two or three weeks at a time," he says. "It's not a trivial process, and you have to also really train your hospital staff super users so they can provide support."

5. Recognize that training will continue after go-live.
Plan for lost productivity after your hospital goes live, Mr. Smith says, and let your physicians and staff members know that you recognize their difficulties. "Openly scale back their practice time, reduce their schedules and shift patients around," Mr. Smith says. "Make sure you have enough support staff at go-live and after go-live."

Mr. Reese says Sentara decided to take its physicians to around half their regular workload for two or three weeks. He says that while your processes might be jerky and slow during the transition period, your staff should be back to their normal patient load within a few weeks if they've been properly trained. "Everything slows down and then speeds back up," he says.

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