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Once implemented, EHRs don't run automatically. You have to train staff prior to and after integrating a new system to ensure a smooth transition.
Usability seems to be one of the consistent shortcomings of many EHR systems. Growing dissatisfaction with EHRs can also be traced back to poor training of practice staff members.
Mary Griskewicz, senior director of healthcare information systems for the Health Information and Management Systems Society, said work flow is still a challenge in many practices.
"I asked Dr. David Hunt from the Office of the National Coordinator [for HealthIT] recently, 'What is the number one issue you are hearing from physicians about the current EHRs?' And he said usability," Griskewicz said. "They're not meeting the needs of clinicians or the work flow and a lot of the products were built without the clinician in mind. Particularly for the physician and end-user, the work flow needs to be more agile for them so that they will use the technology to help them. And so it doesn't take them 20 minutes longer when they're seeing patients."
While practices have little control over solving the work flow problems inherent to their EHR system, they do have control over whether staff members are using the system to the best of their abilities.
Much of that boils down to how the EHR implementation and training process is approached.
Trenor Williams, managing partner of consulting and management at The Advisory Board Company, said he believes that leading with technology as the solution will be doomed for failure.
"I strongly believe that the keys are delivering better care and managing patients better, and then [asking] how does the technology support those two goals," Williams said. "Because that's what resonates with staff, nurses, and doctors."
CONTINUING EDUCATION REQUIRED
Williams warned that any EHR system is a continual learning process.
"There's no way that I'm going to learn everything about the EHR and put every activity in correctly before we go live," he said. "So, there has to be an ongoing learning process and evaluation of how individuals are using the system ..."
While it might seem like a "baby step" evolution of learning, Williams said ongoing training helps physicians learn a little bit more about how to use the EHR during specific situations and continually get better.
Another fact that can determine whether staff and physicians receive the appropriate training is whether training costs are factored in post-implementation. According to a November 2014 Agency for Healthcare Research and Quality study, a five-physician practice would typically spend $162,000 to implement an EHR and $85,000 in first year maintenance costs.
"Any time taken away from seeing patients costs physicians money," Griskewicz said. "So there are the actual upfront costs of what they need to do [for implementation], but then there's the backend costs and everybody forgets about that. So the total cost is much higher than putting in the software."
To get staff and physicians on board with ongoing training, some practices may want to consider offering incentive-based training for staff members.
"Sometimes the vendor will give Web-based training for some of the modules and of course they're reinforced by the practice manager or the super user- they'll do things like give [staff members] extended time or change their schedule, and they'll do lunch-and-learn," Griskewicz said. "I've seen them do all kinds of things. Just offer little incentives to keep the morale up because it takes them longer to do their jobs."
Make sure to provide frequent measurement and feedback to demonstrate value and sustain progress throughout the EHR implementation and adoption process, said
Bill Fera, principal in the Americas Advisory Health Care sector for Ernst & Young.
"As with all quality improvement projects, results have to be tracked to ensure that desired outcomes are being achieved," he said.