EHR Follow through

Multi-Step Training Increases the Value of Your EHR System.

“Set it and forget it,” the “Ultima Thule” of workflows. It reminds me of a coffee mug my offspring bought me for Father’s Day years back. One side of the mug said: “I love computers”. The other side of the mug said: “I can watch them do my work all day”.

Quite often the a new electronic health medical record (EHR) is sold with the promise it will improve the efficiency in which a medical team will deliver quality health care. The majority of practitioner’s do not find new EHR’s meet their expectations in the short term.1

To solve this problem, EHR system implementation would be more effective if it was handled in a multi-step approach.

1. The initial installation and basic training for the new system: get it up and running, and go live. 

2. Once the system is in place and the basics are routine, a secondary round of training and support is essential.  This training would focus on developing effective  and more efficient workflows. It would focus on a higher level of usage where experienced users can dive deeper into the features of the EHR system.

Moving to an EHR, whether it’s the initial move from paper or a switch to a new system, is a stress to a medical practice. It’s a stress to the individuals of the medical practice. It entails learning something new, in addition to performing the duties and tasks with the highest level of accuracy. It means a move from a system they have developed, refined and maybe “tweaked” to their workflow. A new EHR takes a set of tools that are integral to a medical practice and changes them dramatically.

Training is essential to learning any new skill or using any new tool. The scope and method of training varies but often it’s a a group setting with a large ratio of students to instructors. Quite often “super users” are identified to extend this training.2 Super users hopefully provide a supplement to the instructors, grasping concepts quickier and helping explain them to others.

As with any skill or technique, there were be three varying levels of aptitude.

• The great majority of users will fall in the middle of the spectrum in adapting to the new system. They will learn a workflow and never vary from it.
• There will be a group, that despite instruction, will struggle with any workflow.
• The other end of the spectrum are those who are usually selected as the above mentioned “super users”. They will learn new workflows easily and quite often modify them to make them more efficient.

Just as the skill in illustrating or sketching, some people can sit down with a pencil and paper and generate magnificent work. Most people with some training can produce average drawings and then finally there’s a group that can never move beyond simple figures.

Earlier it was noted that many practitioners where not satisfied with newer systems. Logically, we can conclude they WERE satisfied with their previous system. Why was there a change in the level of satisfaction? These systems were mature. The systems had tweaked and tailored to their workflow. They were beyond the initial period of just learning to tread water with the system.

This brings me back to the point of this article. Most vendor’s support after the initial training period is one of just solving problems or fixing issues. Practices are left to themselves and their “super users” to improve or modify their workflows. With the advent of Meaningful Use, practices have installed EHR’s just to avoid penalties. The ancillary promise is you’ll provide better, more efficient care for your patient. The later promise isn’t always realized.

Vendors can take simple steps to help improve workflows, which adds to the value of their software and help end users achieve the ancillary promise of better and more efficient care. This secondary level of training – to modify and improve workflows – should be built into the cost of the program, or at least provide it as an addon that they require or highly recommend.  Users will be more familiar with the software making it easy for them to make suggestions and ask questions to meet this end.

Meaningful Use was intended for computer systems and technology to add and improve patient care. Follow-up training could be a simple and very effective way to obtain this goal.

1. Edsall, R. L., & Adler, K. G. (2008). User satisfaction with EHRs: report of a survey of 422 family physicians. Practice, 215, 657-7010.

2. Gray, T. P. (2011). Upgrading to Epic’10 at Oregon Health and Science University: monitoring and assessing the electronic health record update process.