Training is Key! Secrets to Successful Advanced Training

I’ve been involved in clinical informatics for more than a dozen years, initially as EMR Director, Physician Designer for an eight-hospital academic medical system during EMR implementation, and more recently, as CMIO at a children’s hospital.

I think that it has only been in recent years that the informatics community has begun to realize the import of both initial and ongoing training. 

The EMR is professional-grade software that is built to help providers navigate the nearly endless intricacies of healthcare and clinical medicine.

In order to use the EMR effectively, efficiently, and even safely, our doctors, nurses and other members of the clinical care team need high-quality initial training as well as ongoing training and support.

This truth is also found in other industries where software is a key component of the profession’s practice. Many of my fellow CMIOs and I have learned this, and we are seeing this borne out in the Arch Collaborative’s findings.

Addressing the EMR’s Role in Provider Efficiency and Satisfaction with Training

As a CMIO, my team and I developed an “advanced provider training” program. I thought it would be helpful to share the specifics of this program. Here are a few key components:

• Specialty specific:

Training occurred at the specialty level. Cardiologists had class with other cardiologists, primary care providers with other primary care providers, and so on. The class content was specific to the specialty. 

The training was required. The time was planned far in advance so that patients didn’t need to be rescheduled. The training was also planned with the practice manager to minimize the patient impact.

The training model was tailored to the specialty. For example, some physicians had one-on-one training due to small size of their specialty, their learning style, or their discomfort with technology.

• Build changes:

Standard, relatively minor build cleanup was done as part of this endeavor. Cleanup included items like preference-list simplification and the addition of speed buttons.

• Production environment:

Some of the training occurred in the production environment so that personalization could be done during class.

• Physician champions:

This was one of our keys to success. A physician champion developed the content of the “advanced provider training” class in conjunction with our training team. In fact, we would describe the trainings as being “brought to you by Dr. _____.”

Only the providers truly know how their departments function, the pain points they face, and where they need assistance with improving efficiency. Some champions elected to participate in the training and even taught some sections of the classes. 

We found that the quality of the physician champion was related to the quality and impact of ‘Advanced Provider Training’

The Physician Response

Initially, leadership’s response to the proposed training program were less than encouraging. I remember one physician leader telling me, “We don’t need EMR training—we need someone to reduce clicks.” Another one said, “My doctors are smart. They know how to use the technology. They can tell you the 10 things that need to be fixed.”

We were not deterred. We smiled and moved forward with a pilot of the advanced provider training. After the initial round, the responses were quite positive! The physician who had been so insistent about reducing clicks later asked me, “When can you train this other group of doctors?”

The doctor who’d called for specific EMR fixes said, “This training is what we needed all along! Thank you for finally listening to us.”

I even started getting angry emails because I couldn’t accommodate trainings for certain specialties as quickly as the physicians wanted.

In addition, there were metrics – both subjective and objective – that showed that the APT (advanced provider training) classes had positive impact. Subjective metrics were based on a survey—overwhelmingly, providers rated the classes as worthwhile and helped them accomplish their work with less clicks, keystrokes etc.

On the objective front, we used data from the Provider Efficiency Profile provided by Epic. Due to the varied nature of provider’s work, we found that we often had to use different metrics (i.e. time spent in chart review or time spent placing orders) for different specialties.

In one specialty post-APT, the providers were spending almost a half hour less in chart review every day!

The overwhelming support from our providers was one of the most positive surprises of my career. Even I, one of the training program’s proponents, had never expected it to be such a huge hit.

Subsequently, our organization participated in the Arch Collaborative survey. Even though only a few of our specialties had gone through our new training program by then, we achieved the 84th percentile in EHR satisfaction. I attributed this to a culture change.

Our physicians were engaged in the learning process and knew that the organization had a process to help them.

Even More to Learn

Thus far, the results of the Arch Collaborative survey point to the importance of initial and ongoing training on the EMR. I suspect that high-value training (both initial and ongoing) can be done in many ways, but there are probably some key components that are linked to success.

I am hopeful that we will begin to tease out the key components to successful training via the Arch Collaborative.

The Arch Collaborative has also shown that an organization’s culture is paramount. I believe that further data and study in the Collaborative will reveal another secret to success: physician ownership of and engagement in the EMR.

How can healthcare organizations increase their physicians’ engagement? I look forward to addressing that question in an upcoming post.