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Meaningful Training

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To get a staff ready for EMR, timing matters, and so does who is designated to handle the knowledge transfer.

Some day, the healthcare sector may come to realize the promise of electronic medical records, with their improved information flow, better health outcomes, and reduced medical errors.

In the coming months and years, HR executives at hospitals all over the nation will have to cope with a training, budgeting, and scheduling nightmare as they prepare staff—the largest cost driver in most hospitals—for one of the biggest transitions of their professional careers.

There is a lot of work to be done. At the end of 2009, less than 1% of U.S. hospitals had achieved the highest Stage 7 compliance with the EMR adoption model put out by the Healthcare Information and Management Systems Society, while 11.5% of hospitals were at Stage 0.

Edna Boone, senior director of healthcare information systems at HIMSS, says there is no definitive answer for budgeting training and scheduling costs. "I hate to say it depends, but it depends," Boone says. "You have to know your organization. Look at the readiness as well as the staff experience with health IT and the specific vendor product suite at the institution."

There are some general guidelines that can vary tremendously depending on the EMR experience of the physician or clinician being trained.

"A safe range is four to eight hours of computer and bedside training for [computer physician order entry]," Boone says. "For nursing and physician documentation, we see between four and six hours for those with system experience jumping to six to eight hours for those without system experience. For both CPOE and documentation, these numbers may decrease slightly, if the organization has developed templates and standardized order sets."

Roland Garcia, senior vice president and CIO at Baptist Health in Jacksonville, FL, said the five-hospital health system schedules for nurses 16 hours of training—most of it away from the bedside—during an initial implementation of EMR. "Not all of that is done two days in a row, because you can only absorb so much," Garcia says.

If 16 hours of training for nurses sounds expensive and disruptive, that's because it is.

"As you might imagine, if I have to pull 100 nurses off the floor, certainly there are costs associated with that," Garcia says. "You have to plan that well in advance because schedules are typically done six to eight weeks beforehand on the floor."

And once you make a schedule, keep it. "If you're targeted to go live and make this switch on July 1, and you train several hundred if not thousands of folks, you don't want to miss that date," he says.

As important as the "who" and "what" of EMR training is the "when" to train. "If you are training me today and two months from now is when I am going to use this technology, chances are I am not going to retain it," Garcia says. "For the most part you want to be relevant in terms of timing and manage that."

Keith L. Stein, MD, senior vice president for medical affairs and CMO at Baptist Health, says making the digital transformation is particularly disruptive "because it's hard to do incrementally."

"Training is something we focus a lot on but it is of modest value," Stein says. "On the day you have to use it is the day where all of a sudden it becomes very real. No matter how realistic we try to make the training, it is not real until it's real, when you are at the bedside and you have to use it."

Stein says hospitals can incentivize physicians and clinicians to learn the EMR more quickly—and thus cut down on scheduling and labor costs—by promoting niche functions within their systems that can be customized to ease workloads.

"For example, writing orders in the digital world is facilitated by predefined order sets that have been agreed upon in advance," Stein says. "It might be a list of 20 things I might do when a patient has these circumstances. If physicians can predefine that order set and we develop that for them in the digital world, then rather than having to reproduce that line by line with every patient, they draw it out of the library in the digital environment and make the individual adjustments they need to."

Stein says identifying the so-called "super users"—the physicians and clinicians who have a facility with computer systems—is also critical way enhance training and reduce training costs.

"Peers are the best source of help," Stein says. "Bringing in someone with fancy certifications and high-tech wizardry is often not quite as effective as having a colleague standing next to you and saying, 'I understand what you are trying to do. I had the same problem myself. Let me show you how I do this.'"

John Commins

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