There’s more than one way to improve clinician acceptance and success with using clinical records systems, and simply throwing more online or formal training classes at them may actually lessen the chances for success.
Individualized training tailored to clinician needs, technical aptitude, learning styles and work situations is essential to get nurses and physicians to become enthusiastic users of clinical systems.
That was the common theme at several sessions Wednesday at the first-ever KLAS Arch Collaborative Learning Summit in Salt Lake City. KLAS developed the event to build off its survey methodology to find organizations that had high clinician acceptance and positive opinions of electronic medical records systems, and then had them present best practices for gaining clinician support.
In many cases, achieving success involved rethinking or discarding common beliefs of how best to train users with information systems.
For example, NorthShore University HealthSystem originally sought to school new physician users on its Epic electronic health records system by providing 16 hours of classroom training. After pushback, it was cut to 12 hours. Now, it’s zero, says Janis Ennis, a lead EHR trainer for the integrated delivery system.
Instead, new users get four to six hours of online training, and on their first day of work at NorthShore, they’re met by their own trainer—in their first two weeks at the organization, they have three days of contact with the trainer and a lighter schedule for treating patients to enable them to acclimate to the records system.
Physicians that come to NorthShore with previous experience using an Epic EHR can build off their previous knowledge, but still have to pass a competency test before they’re allowed to treat patients with the EHR, says Kristin Seubold, the system’s director of application services.
For nurses, training on NorthShore’s clinical records systems was redesigned about two years ago to “make sure we were meeting all of their needs,” said Seubold, who notes that the IDS has slightly more than 27 full-time equivalent employees providing training. Each nurse goes through an orientation to the records system, meeting with a preceptor within the first six weeks of coming to NorthShore, and setting them up with their toolbar, flowsheets and more.
NorthShore offers more than initial training. It aims to improve physicians’ ability to use the records system efficiently. It has an overarching program called, “Home for Dinner,” which is designed to streamline the system to reduce needless keystrokes and clicks, while optimizing individual physicians’ ability to use the system quickly. The name of the program ties that technical success with the message that the integrated delivery system places importance on achieving work-life balance for physicians, says Mark Neaman, executive chairman of the board of directors for the system, who discussed the program at closing remarks of the Learning Summit.
The program will pair clinicians who are excelling at using the system efficiently, according to usage metrics, with physicians who are “silent strugglers,” those with the lowest usage scores who may know the basics of how to use the records system but don’t use it efficiently.
According to data gathered through the KLAS Arch Collaborative, 85 percent of NorthShore physicians express satisfaction with its records system, and 91 percent are satisfied with the training they’ve received. Metrics are even higher for nursing staff, with 99 percent stating satisfaction with the records system, and 98 having a favorable view of the training they’ve received.
Clinician support for electronic health records systems and other new forms of technology also can come from efforts to engage them in new ways, says Rachel Dunscombe, Director of Digital for the Salford Royal Group of the National Health Service in Britain.
She convinced the Trust operating one of the hospitals in the Trust to provide significant floor space in a high-traffic area of the facility to enable clinicians to come and meet with IT staff, look at new technology and share comments or concerns. In this “experience center,” clinicians feel free to come in to demo technology, look at prototypes and get questions answered.
“Anyone can come in—it’s like a genius pop-in bar, an open-door space that’s friendly,” Dunscombe says. “We’ve seen some correlation between having this available and acceptance for the EHR—it’s the single most successful thing we’ve done.”
The Salford Royal user training staff also takes an aggressive stance with outreach, she adds. “My training team is bigger than most in the UK; 50 percent are clinicians, and the majority are nurses. They go out and do outreach; they ask people how they’re doing, and they have an intuition around those who are struggling.”
Still, success isn’t universal, Dunscombe notes. “Typically, doctors who have been practicing more than 25 years are the most resistant to training,” she says. Personal assistance in training “can make the difference between a successful EHR deployment and failure. With e-learning, we just went too far down that road. We’re striking more of a balance now—it’s all about the human factors of learning—we have to build individuals’ learning styles into our training.”
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