October 23, 2013
Part III: Neglecting All Facets of TrainingHere is the third installment of WRS Health’s 10-part series dedicated to Dr. Lawrence Gordon’s recent white paper, “10 Implementation Mistakes to Avoid: Why Practices Fail.” Each segment of the series examines one of the 10 most common implementation mistakes by medical practices when implementing electronic health record (EHR) systems.
MISTAKE #3: NEGLECTING ALL FACETS OF TRAININGMany physicians neglect to commit the necessary time for EHR setup and training. Lack of training is detrimental to EHR implementation. You must recognize that change is stressful and there may be resentment to change because of a lack of knowledge about the system and the changes it will inevitably bring to everyone. In “Adoption of Electronic Medical Records in Family Practice: The Providers’ Perspective” Amanda Terry, PhD discovered that reluctance and resistance to change affects the transition process. In the study, Terry singles out one participant who says, “Initially, a couple of the doctors were eager to try new things out, but the rest of us were a little reluctant. I don’t even know if reluctant is it, but maybe just a little bit intimidated thinking how are we going to integrate this into our lives.”
- Proper training of physicians and staff is essential for using software systems correctly. It can also help explore reasons for currently inefficient processes, reveal what is possible and expose weaknesses in employee training, skill sets or experience that need to be addressed.
- Don’t assume that because you know your practice, the new EHR software is obvious to your staff. What may appear obvious to the physician or owner of the practice, isn’t always clear to the staff. In the “Adoption of EMRs in Family Practice” study, participants described the overall response of their practice site to the EHR. The author reports, “Initially, most practices had a negative reaction to the introduction of the EHR. Feelings of frustration were described by many participants due to little knowledge of the EHR software combined with issues related to the hardware setup. One participant described the reaction to the Electronic Health Record as… ‘kind of frustrating at first to get everything sorted out.’ The software is a tool and there is an implicit process coupled to that tool that will lead to workflow efficiencies if it is used correctly. The experience of Grace Vanderkuyl, Office Manager of an internal medicine practice, Unique Healthcare of Orlando, underscores the importance of being mindful of the entire practice’s workflow efficiencies. “Every time we had an EHR representative come by, or we went online, we would do test runs and try the systems out. We wanted a Cloud-based system that was user-friendly for all of us. This was very important because there are different users, and we are also a teaching facility with interns. We wanted the system to be compatible so that we could use it for different things,” says Vanderkuyl.
- Training takes time and it may be expensive, so there may be a temptation to learn to use it on your own. Frequently, lack of training turns out to be costlier to the practice, due to costs associated with lost opportunities for efficiency. You lose the time that you could have been operating at a higher level. Inefficiency is very costly because your office and staff are not operating at peak efficiency.
- A crucial investment that practices frequently pass over or opt out of is the training of first time EHR system users or new systems. When a practice starts to utilize a Cloud EHR system there is an abundance of anxiety and fear. The job that physician and office staffers were doing instinctively for years is transformed into what at first seems like daunting and tedious tasks. What once was routinely accomplished on paper without much thought to technological aspects, can now only be accessed with clicks and typing on a computer and learning what resembles a foreign code.
- New users, many of whom lack high tech computer skills, have the added burden of learning to use a new software system while simultaneously dealing with a heavy patient load in a very fast paced and high pressured work environment.
- Allocate funds for training. Dr. Maki Rheaume, owner of Kuraoka Clinic, which operates in Atlanta, GA and Columbus, OH couldn’t agree more about the benefits of allocating funds for training. In addition to watching online webinars, Dr. Rheaume purchased a training package from her Cloud EHR company. “I set up the time and went through everything with the software company’s team. It was well worth the money. Everyone should do training, especially if they never used an Electronic Health Record. Even if the one-on-one training is optional, physicians should do it, otherwise you end up spending more time (learning the system). A doctor can generate more business. I think you should spend more on training and conserve your time (for patients),” advises Dr. Rheaume.
- Training prior to using a new EHR and support during the first few days and weeks are paramount for success. There are many useful training approaches. It is important to provide hands on support. Barbara Buckley, NP at Comprehensive Women’s Healthcare, an OB/GYN practice in Grapevine, Texas says that when it came to implementing their cloud-based EHR they did not encounter any barriers training its staff and patients because they provided continued support. “We made a lot of handouts for patients. We did a screen shot of what it would look like once they logged in. We showed them where to put their user name and password and showed them what the screen would look like when they are logged in. We showed them, ‘Here’s where your test results will be.’ I also made business cards with instructions on the ins and outs of how to navigate the Cloud-based system and I displayed charts in every room. Patients are very visual,” Buckley explains.
- Don’t follow your impulse to “learn it on our own.” This is frequently costlier to a practice since you lose the time that you could have been operating at a higher level.
- Don’t forego one-on-one training. Being trained by clinical and billing experts is an excellent investment in your practice’s EHR adoption success and long term use.
- Take advantage of a wide range of training methods. Well-designed, computer training modules and webinars that can be accessed by the entire staff at any time ensures that even the busiest employee or physicians can receive instruction when they desire. They can reference these modules as questions and issues arise.
- Provide ongoing training. Remember that many employees may only remember a small amount of what they learn in training that is conducted prior to going live. Training and support on the go-live date are essential and they should also be available and continued for the first few weeks. As the staff becomes more knowledgeable, they can be trained further to learn how to use all of the system’s capabilities and features to enhance workflows and processes along the way.
- Help users feel comfortable with the system to help alleviate the stress that they feel while still performing the duties that are expected of them.