Over the last ten years, I’ve experienced a wide variety of training designs for EMR implementations. Whether it’s training inpatient physicians, to front office and medical records clerks in an ambulatory setting, there are a few key factors that have stood out to be critical to a successful training program. Note that while most of this discussion is focused on the NextGen application, these recommendations can be applied to many different EMR applications in both inpatient and ambulatory settings.
Training By Job Role. While structuring your training sessions specific to job role may seem the obvious choice, sometimes mixed training sessions are the only option because of time restraints or staffing shortages. The time designated for end-user training is often some of the only time you have to focus on specific workflows with the end users. On the same note, there are functions within NextGen that cross roles, such as telephone calls and tasking. Unless you have intricate training scenarios developed, it could be beneficial to have a session designed just for these types of functions.
However you decide to structure your training, it’s important to avoid cross-training functions of the system that users will never have practical application for. One of the great yet overwhelming benefits of NextGen is that it can do so much, and it’s tempting to want to train users on every feature that can benefit them. That said, I see considerable benefit to training and bringing live different portions of an EMR at a time and not going with the big bang approach with your implementation.
Super Users. The question of “What is a Super User and how best to utilize them?” is as varied as the design of your training sessions. The Super Users should be your go-to and point contacts for the sites or departments. They also play a particularly helpful role during post Go-Live meetings in order to help end users learn the system and communicate their questions effectively. They should receive additional training to be able to support their staff and train new staff post Go-Live.
When it comes to designating Super Users, it’s not always as simple as selecting the most tech-savvy users or managers. While it is important that they are comfortable with the EMR system, it’s essential that they are approachable and perform well in stressful situations. A good Super User is usually a person that the staff already goes to for help and can well handle a high stress environment.
Training Design. Do you train in a classroom setting, or one on one? Do you run one 8hr session or eight one-hr sessions? Before I get into the details, I would like to share a quote I feel is very intricate in its simplicity:
"I see and I forget, I hear and I remember, I do and I understand." - Confucius
The practicality of this concept has been directly evident in my experience through the years. Not only do staff perform better during Go-Live after experiencing hands-on learning, they feel more confident and engaged in the entire process. I also have learned to incorporate the research of Edgar Dale and his ‘Cone of Learning’ in my training, which outlines in more detail the rate at which people learn and retain new skills.
Computer Literacy. With my first implementation experience, we went with the model of classroom training with a max of 10 providers per session. This was for an inpatient Cerner implementation rolled out to 7 large multi-specialty hospitals including 3,000+ providers. The biggest lesson learned there was not that classroom style training doesn’t work, but that training users in a classroom style where computer literacy skills are widely varied doesn’t work. When you have users that are proficient in basic/moderate computer skills sitting next to users that hardly understand the meaning of right-click or scrolling, you are doing a huge disservice to your users’ and trainer’s time. Try to get a overview of the users’ basic computer knowledge well before training sessions begin and either offer live sessions, web-based training, or other avenues to help those users become proficient in basic skills. Web-based tutorials combined with personalized assessment tests also give the users the privacy to complete training at their own pace.
Use-Case Examples. Instead of spending most of your training time lecture-style on the individual pieces of NextGen, mix that with real-life scenarios. Spend time demonstrating how to use the system, then transition to having the providers enter full visit notes of patients they saw the previous week into the system. The goal is to have the providers enter 30 full visits into the EMR prior to Go-Live. This gives the providers a multitude of advantages during both the training process and Go-Live, including:
1. A more realistic approach to how the providers will actually use the system once live.
2. Better opportunities for relevant questions during the training process that normally wouldn’t come up until during the Go-Live.
3. Repetition of the most common things they document vs. fully training part(s) of the application they will rarely use.
4. Promotes a higher rate of practicing outside of the training sessions because they quickly become more comfortable with the SOAP navigation.
5. Helps the training staff know what types of visits to expect during Go-Live.
Training Materials. Do you develop an entire training manual that is a full 100+ page document with screen shots on how to perform every function of the application? Do you create quick tips sheets that only include the steps necessary to perform basic functions? Do you only go with FAQs or skip the process fully? There are numerous approaches to creating effective training materials. NextGen offers up a multitude of vendor-created documents as I'm sure most EMR vendors do. FAQs, Quick Tip Sheets, and Detailed Documents are some of the more useful guides for end-users in that they are short, easy-to-reference summaries that take considerable less development and maintenance time than full-length resource manuals. They can be printed out on different colored paper to visually distinguish them, and kept right at the user’s stations.
FAQs are brief, high-level answers to common questions, often in bullet-point form.
Quick Tip Sheets are the basic steps of completing a certain function like Check-in, Entering an Order, Completing a Visit, Results Sign Off, etc. They should not include screen shots (small text-sized icons are permissible) and should be limited to 1-2 pages per topic.
Detailed Documents are topic-based and more descriptive than Quick Tip Sheets, and also include screen shots.
A few additional best practices to keep in mind:
1. An overhead projection can keep the class on track and help visual learners.
2. A training environment set up for users to log into during training is crucial for hands-on learning.
- It’s critical for this database environment to resemble your Production environment to keep training running smoothly and translate to successful transition at Go-Live..
3. A second trainer is recommended for sessions consisting of more than 4 providers.
We’ve reviewed many aspects of the training implementation process but when it comes down to it, with a high volume of onsite support staff during Go-Live, it’s possible to make most implementations look like a success. The ability to bring the providers to a point where they are truly prepared prior to the Go-Live date will not only increase provider satisfaction and patient care, but also allow you to pull reportable data out of your system at a more proficient rate.
For assistance planning and conducting your EMR training program, you can reach us at contactus@santarosaconsulting.com.
Kedra Jankowski Senior NextGen Consultant Santa Rosa Consulting, Inc.