"My recommendation is to listen to the vendor's recommended schedule of training and don't try to shortcut it," Nelson adds.
There's no argument from Anna Randall about the role of training in a successful EHR implementation. She worked with several EHRs and managed implementations at other practices before becoming practice administrator of Middle Georgia OB/GYN, in Warner Robins, Ga., seven years ago.
"The best investment you can make after determining what EMR to buy is the training hours," Randall says. "It will help you create a better form and learn the little tricks that make using the system much less time consuming for providers."
Recently, Middle Georgia OB/GYN opted to replace its EHR with one from a different company. Implementation of the new system went better than expected: The practice's two physicians didn't skip a beat, seeing their usual combined daily workload of 48 patients and entering every bit of necessary documentation into the record on that first day. Randall says Advance training made it possible for Middle Georgia OB/GYN to avoid the physician productivity dip so common in the first few days to months after a practice takes its EHR live.
Randall says that in the weeks leading up to the EHR go-live date, she created a group of administrative users and set up a separate training area for them to use a few hours a day. Next, the head of each department received a half-day of training. Then the physicians were trained one-on-one by the vendor.
Scoping out the training: a checklist
Picking an EHR is often easier than training staff to use it. So when you're shopping around for your EHR, Randall suggests asking a vendor the following questions about training:
• Will you give us a written estimate of the number of hours of training we will need?
• Will you observe a typical patient visit to determine the intensity of training we will need?
• Will you create a training-skills checklist designed specifically for our practice?
• Do you take into account each provider's previous computer experience?
• Do your training suggestions also account for our practice's size, specialty, and its existing information technology?
• Do we have choices in Web-based, onsite, and off-site training?
• Will you provide one-on-one training for the physicians, either via the Web or in person?
• Can you offer training (via Web or in person) during or after our office hours?
When calling other users who have installed the EHR, be sure to ask:
• How many providers were trained by the vendor?
• How many of your staff needed to be trained?
• What was your impression of the content of the training materials and the quality of the vendor's training, including the individuals conducting the training sessions?
• Was the Web-based training offered live or was it in the form of pre-recorded tutorials?
• What is the quality and flexibility of the training modules the vendor provides for the practice to train new employees?
Vendor support seems to the area of an EHR purchase that brings the most mystery and, sometimes, the greatest number of complaints. Tucker says support was an area of concern when her practice made the leap into an integrated EHR and practice management system.
"It's not just 'can I get a hold of somebody on the vendor's support line,' but will they know about our software and understand the types of things a medical practice will be asking them about," she says.
Nelson adds that technical support is important enough to include in a purchasing contract. Spell out the expected response times and, perhaps, penalties for poor or late response - such as discounts on technical support, staff training, or other considerations. An additional protection for the purchaser is for the contract to spell out how the penalties would escalate if the vendor's support remains less than promised.
"Support is really instrumental in what will make you happy as a customer," Nelson says. "Trying to gauge support is something I would be asking of the vendor's references, but also what I'd ask of the users I found through professional societies, online user forums, or other ways."
Another support snafu Nelson often sees is when hardware and software from different vendors fail to mesh as promised with the new system. While technology mismatches can be costly, a lot can be done in advance to prevent the finger pointing that slows down the search for solutions.
She suggests setting up a conference call with the EHR vendor, software and hardware suppliers, and your information technology support staff or contractors. Let them hammer out details, such as the right type of PCs, the proper wired or wireless network configuration and so on. Otherwise, the practice administrator is left playing middleman, she says.
"Before the purchase, you should be able to speak with the person who will be handling your support," Nelson says. "Ask questions that will give you a sense of what kind of people this vendor is hiring to support you."