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How to Design, Implement EHR Use Training Courses
Providers and healthcare researchers across the country are trying to combat clinician burnout with a variety of EHR use training courses.
With full EHR adoption nearly widespread, the future generation of clinicians need extensive EHR use training courses and health IT knowledge at an earlier stage in medical education to boost health IT education.
Sufficient EHR training may be the key to improving EHR user satisfaction rates, according to a KLAS Arch Collaborative survey.
“We as an industry have an opportunity to improve EHR adoption by investing in EHR learning and personalization support for caregivers,” wrote the study authors.
“If health care organizations offered higher-quality educational opportunities for their care providers — and if providers were expected to develop greater mastery of EHR functionality — many of the current EHR challenges would be ameliorated.”
The researchers suggested industry stakeholders implement standards to ensure clinicians across health systems receive high-quality EHR training and at least four hours of EHR training to boost user satisfaction.
“Organizations requiring less than 4 hours of education for new providers appear to be creating a frustrating experience for their clinicians,” wrote KLAS. “These organizations have lower training satisfaction, lower self-reported proficiency, and are less likely to report that their EHR enables them to deliver quality care.”
High-quality training and a strong relationship between the organization and the EHR vendor could also improve the EHR training experience. Organizations that train clinicians on EHR usability could boost confidence and satisfaction.
EHR Training Early in Medical Education
EHR training at the residency level can boost a clinician’s knowledge, confidence, and writing of progress notes, according to a study published in the Association of American Medical Colleges’ MedEdPortal.
Organizations that invest in EHR training may ease EHR usability, potentially reducing the chances of clinician burnout in the future.
For example, researchers at the University of Wisconsin School of Medicine and Public Health developed the Progress Note Assessment and Plan Evaluation (PNAPE) tool to aid its medical residents in EHR documentation. PNAPE helped evaluate inpatient EHR progress notes on a 20-item checklist.
The research team leveraged the PNAPE tool and constructed a workshop to improve resident knowledge, attitude, and confidence in writing progress notes. The workshop included a pre-workshop questionnaire, a large-group discussion, introduction to the PNAPE tool, individual and small-group work using the tool, and a post-workshop questionnaire.
Although residents said they grasped the purpose and critical parts of progress notes, they were still unsure how to construct notes and why each note included specific patient information.
Following the workshop, residents boosted their knowledge of progress notes and improved their responses from 78 percent to 91 percent. These responses improved in 15 out of the 20 items on the PNAPE list and five of those items had a significant increase.
“My progress notes are more organized, focused, succinct, readable, and useful after implementing your guidelines and using the templates,” said an anonymous resident. “They also take less time to write when I know exactly what five or so things to include in an assessment, which is notable given that I'm on [a service] with so many complex patients.”
Beginning the EHR training process with fledgling clinicians is a step in the right direction. In 2021, Regenstrief Institute and its partners developed a teaching electronic medical record (tEMR) system that utilized de-identified patient data to improve EHR training and teach medical students how to use health IT.
“Many students enter medical school with EHR experience,” explained an anonymous curricular leader whose institution implemented tEMR. “Unfortunately, much of this previous EHR experience is not useful for physician training as these previous roles (eg, scribe) yield EHR experiences different than a physician’s role.”
tEMR is an optimized version of one of the first EHR systems, Regenstrief’s Gopher. Researchers said tEMR users could simulate every EHR task available through a commercial EHR, such as order-entry, clinical note writing, and data review.
tEMR users gained a realistic virtual patient care experience, Regenstrief noted. The EHR platform also enabled collaboration between medical students and individuals working in disparate locations working at the same or different times.
Although Regenstrief and its partners intended to train future clinicians on the tEMR system, the group also aimed to design tools that medical students, educators, clinicians, and administrators can leverage to influence how health IT should be used in healthcare, the study authors wrote.
Over the past eight years, nearly 12,000 students and 12 academic healthcare institutions have adopted the Regenstrief tEMR system.
“With the exponential growth of health-related data and the impact of health information technology (HIT) on work-life balance, it is critical for students to get early EHR skills practice and understand how EHRs work,” the study authors wrote.
Investing in EHR training could make the user more skilled at navigating the EHR, learning the platform’s intricacies, and potentially reducing the chances of clinician burnout in the future.
SUPERUSER EHR TRAINING
Identifying and training super users and clinical leaders will create a core of knowledgeable staff members who align with the organization’s goals and EHR system requirements, according to the Office of the National Coordinator of Health IT (ONC).
Most super users should have clinical experience and health systems should train super users on all EHR functions to fully comprehend the workflow, ONC recommended.
Training a superuser is crucial to streamlining the optimization process throughout the organization, and the user should be able to provide both clinical and technical perspectives. These users can also provide in-depth analysis of the EHR workflow and the system’s configuration to meet the organization’s goals and client base.
Not only is a clinician super user critical for user satisfaction, but many EHR vendors discount potential maintenance fees if the organization has a certified superuser or trainer on-site.
Throughout the years, clinicians at Rush University Medical Center felt immense clinician burden due to a lack of EHR training and constant EHR optimizations.
Rush conducted its first KLAS Arch Collaborative survey in 2017 to gauge clinician satisfaction. This survey identified several critical EHR usability issues that Rush clinicians and end-users consistently encountered.
That survey revealed that the source of EHR issues at Rush were not uncommon than those in the general healthcare community. Most of the problems related to a lack of specialty health IT personalization and training.
“We were in the middle of the pack of that initial survey and it seemed like the healthcare organizations that were supporting their providers in unique ways were utilizing various models,” Jordan Dale, MD, Rush’s acting CMIO, said in an interview with EHRIntelligence. “That's when we committed to having a dedicated team that was primarily focused on provider satisfaction and how it relates to our electronic health record.”
To combat those issues, Dale developed the Provider Optimization and Experience Team (POET).
POET includes seven total individuals who hold a clinical license to fully understand clinical language or have extensive experience or training at the clinical level, such as five to ten years of go-live and optimization support. POET members aim to go beyond initial training and also focus on optimization and support, Dale added.
“I have a medical degree and did my clinical rotations in the United States,” Wasim Attar, MD, Rush POET said to EHRIntelligence. “IT is a hobby of mine, and then I had a background in clinical informatics. When I work with providers, I focus on finding solutions, discovering workarounds, and trying to avoid delaying the individual’s workflow or negatively affecting patient care.”
After implementing POET in 2017, Rush administered a second survey and the hospital said it saw tremendous results.
Rush clinician EHR satisfaction scores significantly improved and Rush ranked near the top compared to its provider counterparts.
Rush clinicians have reduced documentation time by 30 to 35 percent since the POET launch, and Dale said clinicians had increased satisfaction knowing a health IT optimization wouldn’t negatively impact performance.
“I think it's critically important to focus on the post-initial training personalization and optimization phase,” Dale recommended to other health systems. “If an individual only spends a short amount of added time to feel safe and acclimated to a new vehicle, then the person won’t be able to maximize performance or comfort until she spends increased dedicated time on optimization to feel comfortable about that workflow.”
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