EHR/HIT Training-MyThoughts

These are some of my thought about EHR Training. I recently went through clinician specific training to use the EHR being installed in the hospital where I work. I wrote about my experience, which was not very satisfactory. I've had some time to process my impressions and hopefully will put together some useful conclusion in this post.


The training for physicians where I work consisted of two 4-5 hour classroom sessions. The training primarily was a lecture/demonstration format, although participants were assigned some exercises. Printed training aids were limited, poorly edited, had some confusing errors, and were only provided at the time of training, not before. Navigation instructions to accomplish basic tasks were few and often did not follow clinical workflows. My biggest complaint is that the training had few permanent artifacts that could be reviewed later. The sessions were repetitive for the trainers, who became very familiar with the system by conducting numerous classes, but not for the future users who had only one chance to learn information critical to their livelihood and the safety of patients. The result is that the trainers became excellent super-users to help clinicians after go-live but the clinicians were poorly prepared to use the system. This form of training was expensive for the institution because of the need for a large number of trainers and specialized classroom space required for the sessions. The pace was often determined by the trainers rather than the students and could not easily accommodate those with different levels of computer skills. My experience was that when I got stuck at some phase, often I missed a big chunk of training as the class moved ahead without me. Several of the clinicians received pages and phone calls during the classes that either took them out of the sessions or were distracting to other attendees. I'll say it again, there were almost no permanent guides to refer to later during go-live.

I envision a different approach. First and foremost, training should recognize and follow the workflows encountered in real clinical practice. This means that curriculum developers need to have a strong and broad-based clinical background. Next, as a clinician, I want to have the control to learn at my own pace, at a time I find convenient. I would like to be able to review training materials as many times as it takes to learn how perform essential tasks. Furthermore, training that is based on a set of training artifacts can be reused to train new staff members without the need for the institution or vendor to maintain and support a large staff of permanent trainers. Self-directed learning suits the needs of busy clinicians better than the options we were provided. I learned these lessons first hand in my graduate program for a master's degree in medical informatics.


One of the challenges of taking an online degree was the need to learn and rapidly master a variety of new computer applications. Here is a short list of the some of the applications we used at Northwestern when I was a student: WebEx, Backboard, Visio, Microsoft Word, Microsoft Excel, TreeAge, Microsoft Access, Microsoft PowerPoint, Microsoft SQL, Adobe Connect Pro, SimulConsult, and EndNote. One of the more difficult academic assignments was to create a database in Access from a schema we were given, in little over a week. I'd had no prior exposure to MS Access. The teaching assistant for the class created a WebEx recording and demonstrated each of the required tasks in a session that took her only about 45 minutes. I watched the recording a few times. I then broke out the tasks I needed to accomplish and created an index using the time code for the WebEx recording that correlated with the tasks. I used the indexed times to review relevant portions of the session until I could accomplish the tasks myself. This made it relatively easy to complete the assignment even though the software program was completely new to me. It turns out that this was one of the most valuable lessons learned in the graduate program.


The approach I recommend is applicable to many adult learning needs. First, you need to realize that not everyone is a good teacher. To create useful educational materials requires a team of skilled individuals. Curriculum development is a specialized skill set that is an essential element. Once a curriculum has been developed then a scripted teaching plan must be formally written out, much like a screenplay for a TV show or a movie. Those with creative skills to actualize the plan are needed next. This requires skill with special software that that has the ability to record screen movements, webcam output, capture voice over, and insert presentation graphics. Such software is readily available. Some sites even offer many functions at no cost. Indexing capability within the software is a must to make the materials accessible and user- friendly. Additional skills with video and audio editing are helpful as is the ability to utilize web resources such as video streaming optimization, etc. The final product can be distributed as free content on the Web (YouTube, for example), can be sold commercially as a training aid, or be made available over an organization's private Intranet. Realistic training exercises could be developed. Computerized scoring is an available tool.


I realize there are many approaches to teaching EHR use. The technology I have recommended is available now to enable user-friendly training that respects the learning needs and time restrictions of modern clinicians. Taking this approach can also limit training costs and improve the quality of EHR instruction for the sponsoring institution or vendor.