“Tell me and I forget. Teach me and I remember. Involve me and I learn.” — Benjamin Franklin
Investing in your staff is key to any successful organization. Having the wherewithal to be able to train a group of people, some willing and some unwilling, can be a daunting task. Yet, no matter how difficult to manage or how time-involving training is, it is an essential part of both a successful EHR go-live and maintenance of a system. No matter how technologically advanced the new EHR system may be, if an organization slacks on the training, it will never see the full return on investment of the cost of the system.
From years of implementation experience, I have compiled the five best practice methods to enable an organization to reach its maximal return on investment and user satisfaction with an EHR system.
EHR superuser training
A superuser doesn’t need to be the most technically savvy user, but they need to be able to be teachable and to transfer that learned knowledge to the other staff. These users should be the first to experience a new system. Oftentimes, some of these staff members would have been involved in the selection process. They are the organization’s first-line users and defenders of the new EHR functionality, and the ones that others turn to when they need help. Therefore, they are called super. For best results, there should be, at minimum, one superuser per specialty per every 15 users. At the time of go-live, these superusers need to be relieved of all their routine duties and focus on assisting the staff with the EHR adoption during the go-live dates.
EHR User Acceptance Testing (UAT)
It may say testing, but this is also a training method, and it should involve those already trained as superusers. UAT is time utilized as a field training exercise for your newly trained and specialty experienced superusers to test the system for proper process workflow in all fields of expertise. A testing script should be utilized for each process workflow and there should be room on that script for comments from the testers on improvements that need to be made prior to staff training. Each moment the superusers work on the testing scripts is a training exercise in navigating the system and making them comfortable with teaching their peers at the next venture.
EHR End User Training (EUT): The see, touch, and repeat approach
Training can be performed in many forms. As an organization, a decision on which format of training works best must be decided upon and then kept consistent. Methods of training could be in person, virtual, or online. The key to successful training, no matter which plan an organization chooses, is to involve the "see, touch, and repeat" approach to learning. Trainees should see the system in action, touch the keyboards or tablets and follow along with the instructor or through a written scenario, and repeat the processes multiple times at their own leisure in a testing environment. Implementing this method allows all generations of users in the organization to be properly trained on the new EHR.
In-person classes should be:
- Separated by specialty or process
- Involve manageable group sizes (one user per computer)
- Include a brief overview of the EHR
- Include a demonstration of the process workflow in action
- Be followed by the user repeating the process on their own device
If there are more than two hours of content to train on, the recommendation is to divide the training into smaller durations to maximize the effects of learning.
Virtual classes involve an instructor performing the same steps as in-person training, but the end user attends from their office or a designated learning area. These can be pre-recorded and the EUT can occur during the optimal time for the user to have complete devotion to the training. In these instances, logins to the testing/training site need to be given out in a separate communication, and these logins should be single-user available, as to avoid complications from locked accounts if many end users are training at the same time. A trainer needs to have availability for questions if this process is utilized.
Online classes involve pre-recorded demonstrations that are included with process workflow scenarios. In these, the end user goes to a training site and watches sections of demonstrations one at a time. At the end of each section, the user may rewatch the online demonstration as many times as they need to, but there must be a self-paced scenario that the user follows along to perform the touch and repeat portion of the learning. Additionally, there needs to be contact information for a trainer should there be issues or questions. Many organizations utilizing this method of training allow the end user access to these training videos for refreshers once the EHR implementation has occurred.
EHR Just In Time (JIT) and At the Elbow (ATE) training
The JIT/ATE training is essential during and post go-live. Once an organization implements the EHR, there is always going to be someone who did not complete the training. That is where the superusers become involved and train these individuals in their time of need. These short, microburst, JIT trainings may involve a superuser hovering nearby the new user as they navigate through a documentation for the very first time. ATE training involves a superuser reaching out to a user who has had training but may have forgotten steps involved to complete the documentation. These are the times that those superusers show how super they are.
Post implementation of the EHR, as the superusers resume their normal duties, there will still be a need for JIT/ATE training, and their expertise will be sought out after by their peers, further assisting in a successful adoption of an EHR. In addition to the superusers, if available, a dedicated informatics employee should be making frequent rounding, looking out for those who may be struggling with the EHR documentation processes and workflows, and performing JIT/ATE training at these discovered instances.
EHR training refreshers and audits
“There are no shortcuts to any place worth going.” – Beverly Sills
This final stage of training is continuous. Once you have an EHR, there will always be a need for training. No matter how successful your training may have been, habits and shortcuts to documenting in an EHR are bound to occur, and then spread throughout the organization. For the most part, these shortcuts result in mis-documentation; audits must be performed to determine how detrimental to proper documentation they are. Once the issues have been identified, the organization must determine how to correct the issue. Sometimes this involves going directly to the end user whose documentation is at subpar levels and performing JIT/ATE training. If it is widespread, a refresher course for all end users may be required to correct the issues. Sometimes a communication of corrective action may work in substitution for JIT/ATE training.
“Don’t decrease the goal. Increase the effort.” — Tom Coleman
Regardless of the effort, all end users should have a contact to reach out to for assistance post EHR go-live and the ability to access a training site as needed. New hire training sessions should continue to be optimizable on documentation.
BerryDunn’s team of consultants is happy to assist you with creating a Request for Proposal, selecting the right EHR vendor for your organization, developing communication, change management, training plans, and project management for the system implementation.