“Buy a cake and throw a kickoff party,” says Dr. Rishi Agrawal, a pediatric hospitalist at La Rabida Children's Hospital in Chicago. Sound a bit flippant? Not really. Agrawal is trying to drive home the message that technology adoption should be a high priority for an organization, treated with “the same level of engagement as a move or expansion. Ask for everyone’s patience and convey to everyone that this is a high priority for your organization.”
Doctors – and their staff – could benefit from more training on EHRs, according to a recent survey by AmericanEHR Partners. Physicians who received at least three to five days of training reported the highest levels of satisfaction with their electronic health record systems, but most of the surveyed physicians received much typically three or fewer days of orientation. “This survey data strongly suggests that many physicians may be receiving an inadequate amount of initial training on how to use their EHR,” says Dr. Alan Brookstone of Cientis, an international developer of web-based tools for healthcare technologies. With regard for Meanful Use features, such as formulary checking, at least one week of training is needed to show significant improvement in use for clinicians.
One of the biggest obstacles in physician training on EHRs is information overload, says Dr. Robert M. Turner, a family medicine specialist and co-managing physician of clinical information technology at the Kelsey-Seybold Clinic, a large multispecialty clinic system in Houston. “In the EMR there are usually several ways to do anything and each individual must find the way that works best for them. We have certain favored work-flows and not all workflows work equally well for all physicians.”
When moving from paper charts (which 80% of physicians still use) to a digital format, Turner says clinicians need to understand that the electronic medical record is a tool. “It allows for a large amount of data about a patient to be kept in one easily-accessible place so that it is all at our fingertips in the exam room. The challenge is effectively mining the data which is useful, perhaps critical, to caring for the patient out of the larger data which are available.” Adopting a technology system to the flow of information in a practice, whether clinical, social, and billing is crucial. One vendor mapped out over 120 EHR workflow considerations to factor in, ranging from connectivity to internal messaging.
Agrawal, who is also a physician member of the Metro Chicago health information exchange council, one of the largest in the nation, said that physicians often expect more from EHRs than the software can deliver.
“Managing expectations and getting physicians to adapt to the particulars of the software can be a challenge,” says Agrawal, who added too many lectures and verbal explanations are impractical, for both scheduling and attention-span. Rather, the best training for electronic medical records is a combination of e-learning where a doctor has multiple short, task-based lessons in combination with live, hands-on training with an instructor who can help the new user to figure out what's truly important. Oh – and “rudimentary typing skills would be helpful,” adds Turner of Kelsey-Seybold Clinic.
