Ask any physician who has implemented an EMR whether he or she could benefit from additional training and you are likely to get an affirmative response. Training is usually viewed by medical practitioners as an expense rather than an investment. Since most consumer electronics are easy to use, it leads one to believe that EMRs can be learned intuitively and with a minimum of training. After all, when did you last read the manual for your latest smartphone? You just picked it up and it worked. What you could not use immediately you learned over time through a slow process of diffusion, or because your teenage son or daughter provided a tutorial.
Why is training so important? And can you forecast your training needs so that the costs become more predictable and you are able to build them into your practice budget?
The following diagram represents the level of effort that is required when transitioning through the various stages of EMR adoption and use.
- In the pre-EMR phase, paper processes are used dominantly. Little effort is required to use long tried and tested methods for documentation, orders and prescriptions.
- Readiness preparation results in an intense burst of effort for a period of time until the practice is ready for implementation.
- The implementation phase is one in which there is the greatest disruption to the practice. New systems are installed, old workflow is re-engineered to accommodate the EMR, and for a period of 6–12 weeks there is an intense effort with a loss of productivity as practice members learn how to use the technology.
- From that point onwards, the practice is dependent on the EMR and information technology in order to deliver care... indefinitely. Each time a new feature is introduced, or a practice begins to use a specific capability of the EMR, more training is required.
Training can be provided in a number of ways:
- Formal training — bringing in a vendor to provide advanced training on new features or to optimize use of existing features.
- Super users who are trained to provide support and assistance to clinicians and staff through on-site expertise.
- Small group learning — getting together with peers in order to share tips and learn from others.
- Online learning modules provided by the vendor or through online training sessions and webinars.
Ensure that someone in your practice is required to review new features when your EMR system is updated. The EMR vendor usually provides advance notice of any needed upgrade and will publish a list of updates and enhancements. If possible, this individual should have some clinical experience in order to provide appropriate updates to other members of the practice with respect to features that are going to be of greatest value. If you are using an ASP- or Cloud-based EMR system, updates can be more complex to monitor, as the EMR may be regularly updated without a report every time a small enhancement is made.
If you have super users in your practice, make sure that they attend vendor training sessions on a regular basis and are given adequate time to improve and maintain their EMR skills. This expertise will provide invaluable onsite knowledge in the event that someone from your practice needs assistance.
Finally, make sure that you have a process for training new clinicians and staff. Staff and clinician turnover is an inevitable part of running a practice; however, many practices fail to train new staff members to use the EMR and assume that these individuals will gradually figure it out. This approach can be costly and time consuming, particularly when data is incorrectly stored in the wrong section of an EMR. A 30-minute guerrilla program can be developed to provide basic EMR orientation, but these individuals all require some form of ongoing training to ensure they are utilizing the EMR correctly.
If you have any additional experiences or insights regarding training that you would like to share, click on the “Comments” link below.