Michaels & Associates

 

Due to ARRA legislation, healthcare organizations are asked to comply with government mandates and implement health information technology. HIT includes such things as:

• Computerized physician order entry
  
• Computerized documentation of patient biometric information
  
• Electronic delivery of diagnostic test results
  
• Computerized documentation of physician, nursing and allied health patient care plans and notes
  
• Evidence-based guidance
  

The scope of HIT requires that all health care workers must be trained to use the computer system.

Although many resources are focused on defining such things as meaningful use of health information technology, levels of adoption, and software selection, little attention has been focused on the training and support of the health care workers who ultimately use health information technology on a daily basis.

The Current State of the Industry

Health care as an industry is a latecomer to the computer age, and many nurses and physicians are novice computer users. They are faced with the challenges of learning basic computer operation and the introduction of computer technology into the daily work of patient care. These challenges precipitate changes in workflow and data entry processes that can impact the delivery of patient care.

Components of Effective Training

It is essential that health care staff are properly trained and prepared to use health information technology, and health care organizations must create effective and flexible training through a variety of delivery methods such as online courses, instructor-led training and hands-on practice. Training must also focus on the key concepts and processes, and it should be chunked into flexible learning modules that can be reused to meet the needs of the many different roles involved in the delivery of patient care.

Example of Chunking Training for Flexibility and Reusability

Training Modules	Learner Roles
	Physician	Nurse	Social Worker	Nursing Assistant
How to enter vital signs		X		X
How to view vital signs	X			X
How to enter an order	X	X
How to view an order		X	X

Because EMR software is constantly changing with upgrades and new functionality, training must keep up with the change. Learning modules must be designed so they can be quickly and easily updated to reflect changes in software or processes and can be utilized for ongoing employee training long after the initial implementation training.

Implementation of effective, successful HIT training requires several components:

• A development team with an in-depth knowledge of the processes and practices associated with the delivery of patient care and a detailed understanding of computer technology and the possibilities and limitations of an EMR system
  
• Expertise in and application of adult learning theory and instructional design principles
  
• A focus on the end users, the targets of change, and their concerns and needs
  
• A dedication to creating conditions for success during this time of extreme organizational change
  

There are few experts within the health care industry who possess this combination of skills to design effective training.

The Clinical Specialist

Historically, training within health care has focused on the validation and advancement of clinical skills, a task most often performed by clinical experts such as registered nurses trained as clinical nurse specialists. Although clinical nurse specialists are experts in the processes and practices of the delivery of health care, the training of computer technology is typically not within the scope of expertise for these professionals.

The Information Technology Solution

A new breed of health care professionals has arisen in response to the growing need for HIT implementation expertise. These professionals include nursing informaticists, medical informaticists, and other licensed health care professionals who focus on the integration of technology with the delivery of health care. The design and delivery of HIT training is often delegated to the informaticist, who possesses an in-depth knowledge of patient care delivery processes as well as an understanding of health information technology. Missing from the equation, however, is the expertise in adult learning, instructional design, and change management.

The Software Vendor Solution

In response to the lack of effective training solutions, many vendors of electronic medical records systems offer prefabricated or customized training to a health care organization. Although a software vendor is an expert in the functionality and processes associated with their particular EMR system, the vendor is often unfamiliar with the unique culture and processes of each health care organization. Oftentimes the result is training that teaches health care staff how the software works, but not how to use the software in their daily work.

The Instructional Design Solution

Infrequently seen in health care but utilized by many other industries, the instructional designer is trained to tap the knowledge of subject matter experts in order to design and deliver effective training. Instructional designers for an initiative as large and complex as EMR implementation typically work in a team to provide consultation services and training solutions. They can collaborate closely with subject matter experts in all areas to perform tasks such as:

• Clarify organizational goals and objectives.
  
• Identify the target training population: their characteristics, current processes, and needs.
  
• Analyze the level of performance to be attained as a result of the training.
  
• Determine strategies for transferring learned skills into the workplace.
  
• Identify learning objectives for the training program.
  
• Design and develop a flexible, comprehensive training program that meets the needs of learners, is instructionally sound, creates conditions for success, and meets the business needs of the health care organization.
  
• Implement the training solution along with complementary communications to prepare learners for success.
  
• Evaluate the success of the training program.
  

There are few experts within the health care industry who possess this combination of skills to design effective training.

Benefits of an Instructional Design Solution

The delivery of training to patient care staff is a large expense for an organization, triggering increased payroll costs during the training and implementation period. Although hiring instructional designers to manage the training is also an investment, it is often more economical than using the internal resources because:

• The internal resources are usually fully booked with work. Stretching internal resources can be detrimental to morale, but hiring additional permanent employees can be expensive and time consuming. Instructional design consultants are fully engaged in the learning project and feel the urgency of deadlines.
  
• Successful instructional design consultants have proven track records, protocols, methodologies, and efficiencies that reduce development time and money.
  
• Instructional designers are skilled at learning new technologies and business processes and can quickly assimilate into the organization's environment. This acceleration provides an excellent return on investment.
  
• Consultants schedule their work around the subject matter experts' commitments, maximizing their time and reducing their time away from their other priorities.
  

Conclusion

A critical component in the successful implementation of health information technology is training. However, very limited attention and resources have been dedicated toward helping novice users in the industry gain the necessary skills to be successful with the technology. HIT process, practice, integration and functionality experts have historically been tasked with creating training, but they lack the essential expertise to create instructionally sound, effective solutions. By completing the existing team of experts with experienced instructional design consultants, health care organizations can achieve optimal ROI and deliver EMR system training that meets the needs of the staff and the business objectives of the organization.