HIT Think

Why EHR training can make or break an implementation

Technical training for an EHR go-live is often hectic, arduous and occurs at the very end of implementation—when end-user nerves are most frazzled, IT expenses are highest and, often, the build is not complete.

Yet much of an organization’s success with their EHR hinges upon the effectiveness of system training. A decade of EHR implementations have taught me one thing—training never stops, it just changes form.

Initial technical training for an EHR must shift to ongoing, long-term education. Having a steady training team in place ensures coverage for day-to-day questions, new-hire training, remedial education and EHR updates. However, for long-term EHR training teams to be effective, executive management must keep three important points in mind:

  • Technical training is very different than long-term education: a different skill set is needed
  • Training is not complete after initial EHR training: like the build team, the training team requires a long-term investment
  • Training occurs in a variety of forms: no single approach works for all learners

As a former EHR user (including Epic, Cerner, Next Gen and more), instructional designer, training manager and now a training advisor over the past dozen years, I’ve collected the following best practices for a successful long-term technical training program.

Offer the best of both
Every person learns differently. Therefore, every EHR user has a preferred method of retaining information. Classroom training and eLearning should both be provided to reach multiple and divergent groups of end users.

For users already familiar with the EHR, interactive eLearning sessions can be easily implemented in lieu of classroom training. Courses should be short, interactive and challenging to keep end users engaged. To help users retain information learned during an online session, the following are recommended:

  • Gated exercises: include built-in exercises to prevent advancing without completing an action
  • Timing: ensure hands-on practice the same day or during the next shift to reduce learning loss

In addition, build and maintain a long-term EHR training classroom(s) within the facility. They can be used for new hires as well as seasoned users during remedial training, EHR system updates and upgrades. Limit classes to about four hours maximum, and stick to the basics of navigation, terminology and one or two main workflows for new users.

Integrate training
By incorporating EHR training into other established onboarding processes, organizations offer expanded learning opportunities—especially for new employees.

Nurse trainers, for example, can incorporate EHR instruction into their initial skill validation onboarding week for new clinical hires. For every skill they perform, the newly hired nursing professional should also find the corresponding order and document the procedure in the EHR.

Preceptors can also support both initial and long-term EHR education. By working side by side with the trainee, preceptorship occurs in the department by repeatedly completing a task. Shadowing and performing the work alongside a preceptor cements system learning for the employee. Great preceptors personify four qualities:

  • Experience within the department: offer expertise, removed from current duties
  • Cultural knowledge: embody the organization’s culture, serve as cheerleaders for the EHR
  • Patience to answer the same question multiple times: remain calm, even when others are distracted
  • Good listening skills: stay close to trainee and be attentive; end users often struggle in silence

Rightsize your team
The number of EHR long-term trainers varies according to the organization’s size and breadth of the application. A single trainer may be able to handle all training without the support of additional educators. However, best practice is to have at least one additional trainer always available to cover vacations, assist with remedial training during upgrades and other times. Trainers should also be cross-trained so the entire team is versatile in related applications—with a maximum of three areas of focus per trainer.

From a workflow perspective, coordinating and delivering monthly update training accounts for about 10 percent of an EHR trainer’s time. If one-on-one sessions are needed with an end user, another 20 percent of a trainer’s hours will be required. And while new hires account for about 30 percent to 50 percent of a trainer’s time, there will always be specific departments and individuals that require extra help and instruction.

The challenges of maintaining EHR software efficiency across hundreds of departments and thousands of end users are well known. In fact, at a recent EHR vendor’s user group meeting, sessions dedicated to long-term training were among the best attended. Steady, recurring education schedules along with a flexible variety of training options are the key to ensuring an efficient long-term training team.

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