Wednesday, November 14, 2012

What are the Key EHR Training Strategies?

Too many practices are struggling with performance and productivity issues in the use of their EHRs.  In many cases, the real problem is the strategy and process around the training of staff and physicians.  Failure to focus the training strategy on your practice and not the EHR product can lead to a variety of problems that will damage your efforts for years to come.

Most EHR vendors offer standard training programs that teach practices to operate the EHR.  However, most EHR vendors do not address how to use the software in the practice.  For example, staff may learn how to enter a message, but managing messages and assigning work is just as much a part of the training strategy as how to send a message and update the status. 

Vendor training materials present general information on the use of the EHR, but typically fail to address:

Area of medicine considerations – Each specialty and area of medicine has different issues and challenges.  For example, processing outgoing referrals are critical for primary care practices, but may be insignificant for a specialty practice.  Certain specialties will want to include specific information on managing orders for internal diagnostic services and surgery scheduling.

Practice specifics – Office setup, staff composition and offered services will affect how your use the EHR and the responsibilities of doctors and staff in maintaining the patient records.  For example, some practices use the nurse to educate patients on disease issues, while other practices may rely on videos and printed materials.  Practices with technicians, and mid-level providers need to use the EHR within a collaborative care model.

Failure to address either of these issues may undermine the patient record as providers and staff members develop their own EHR coping strategies.  Indeed, coping strategies will vary within the practice since a standard was never designed as a basis for EHR use and training.  For example, if some people document certain items in a clinical note, while other staff members document that same issue in a clinical message, practice management will be hard pressed to keep track of practice operations.
More problematic is the inconsistencies in the patient record produced by a variety of techniques.  For example, how will the practice be able to verify review of incoming documents if some doctors note findings on the document before scanning while other doctors document their comments in the EHR after the document has been scanned?  How will physician and clinical staff be able to tell what the status of the patient is and maintain the accuracy of the patient record?

The key training issue is to design training materials and strategies that reflect the redesign of practice operations and processes from a paper focused strategy to an EHR enabled one.  Failing to consider the impacts on office flow and patient service will undermine the use of the EHR and limit EHR based improvements to the practice regardless of how great the EHR may be.  Failure to develop training materials and programs to establish appropriate EHR use in a practice will prevent capitalizing on the EHR investment.  In the worst cases, poor training may create problems which destabilize patient records.  For example, inconsistent use of messages and notes could prevent doctors from reviewing the context of patient interactions.

The key to training is insuring that the practice has developed training materials that reflect and establish standards for practice EHR use.  In other words, practice training materials do not focus on the particular screen or function (like most vendor documentation), but rather the clinical or operational process.  For example, many EHRs accept patient orders to reflect the care plan of the doctor.  The practice focused training materials would include the use of the order feature by the referral staff, surgery scheduling and lab staff.

In order to develop the operational basis for training users, the practice should evaluate how the EHR features will be used in the practice and develop a procedure outline by process.  The procedure outline will be the basis for the training materials and segments.  For example, an outline of EHR issues at the front desk may include verifying patient entry of history of present illness information into the patient portal, scanning clinical paperwork delivered by the patient, and triggering notification to the clinic staff that the patient has arrived.  An outline of a nurse’s role may include vetting information from the patient, establishing baseline information in the EHR for the patient, processing procedure and diagnostic orders from the physician, and processing consent forms for in-office procedures.

The training process should be supported with the following:

Training Materials - Training materials should include screen shots of the relevant EHR feature as well as practice specific instruction on using the feature.  For example, the materials may include screen shots of the order screen, lab flow sheet, and findings interpretation for the in-house lab as well as instructions on how to highlight abnormal results and exchanging messages on test issues with doctors and staff.  The training materials for physicians and clinical staff would include screen shots of the lab results and instructions on recording interpretations and assessments of labs.

Online Training Sessions – Online meeting tools offer a cost effective way (for any size practice) to record training programs that can be viewed by users when needed.  The key benefit to recorded training is that the practice can discuss the specifics of how the practice uses the EHR while presenting the EHR in use.  There are a number of cost effect web conferencing services that can be used to record these sessions and make them available to practice staff on demand.  The sessions should be 10 to 20 minutes and target a specific aspect of the EHR.  The recording should include appropriate references to practice workflow and operations.  For example, an ophthalmic practice may record information on scheduling and coordinating differences between elective and medically necessary procedures.

Training Classes – The training materials are used to structure classes targeted to various roles.  Classes should be used for training staff after they have completed the practice’s online training sessions.  The 60 to 90 minute sessions should be focused on selected roles in the organization.  For example, you may have a class for administrative EHR issues that covers front desk and billing issues.  A separate class for clinical support staff may target nurses, and MAs while another class addresses EHR use for diagnostic testing staff and lab employees.  Staff and doctors should practice using the EHR on a daily basis after training leading up to EHR Go Live for their area or office.

One on One Training – Super users are an excellent resource to provide one on one training to staff and doctors.  One on one training may be necessary to address an evolving problem or deviation from standard EHR use as well as training users on refinements to EHR use or handling of new situations.

Integrating practice specific issues with the EHR training strategy will help your practice more effectively use their EHR.  Such an approach to EHR training is necessary to insure that the EHR is used to address the specific care and services provided by the practice without suffering with EHR distortions and problems from a more general training and EHR use approach.

For more solutions to a wide range of EHR Implementation issues, click here.

For help developing your training program that focuses on what you need to know and not extraneous information that will confuse staff and doctors, contact Sterling Solutions at (800)967-3028 or click here.


  1. Great post. I am writing a paper about EHR Vendors and I have been doing a lot of research, that is how I came across your post. I am so glad I did because this is the most informational post I have read. Thanks so much for sharing Ron, this is very helpful.

  2. Thank you for sharing. There are a variety of different EHR testing services including Functional and Interoperability testing, which are needed. Other services such as security testing may also be required.