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EHR Russian Roulette

March 1, 2013
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There are many reasons users change EHR’s. Some are forced to change because the organization has grown beyond the capabilities of the product. Others change when they transition employers. Either way, you’re never sure what you are going to get when you pull that trigger.

Not all EHR’s are the same. I am not just talking about the “look and feel,” I mean the core application is drastically different. Some were developed by data base analysts locked in a room, then tweaked to fit clinical informatics. Other EHR’s were developed by clinicians and then tweaked to fit data architectures, while others grew from a niche’ clinical application. Either way, they all have their own personalities, quirks and silver bullets.

Finding the bullet in the chamber:

I don’t have time; EHR training is often divided into Clinicians and Staff. The staff receives one or two days of training. The clinicians receive half or full day of training. “They don’t have time to sit in a classroom.”

I need to see patients; Frustration builds when clinicians are asked to learn new software when they really want to just see patients.  You have a few show-up for part of the training and they just don’t have time for the rest.I used an EHR before; Some EHR physician champions find themselves lost when they transition to a new EHR. They expect the new EHR to behave the same, and mock the nuances of the one they are trying to learn. This not only affects individual productivity, but permeates the moral of other clinicians. One thing to remember is that the best EHR is the one that you used at your last organization or the one you just purchased and have not used yet.  

I just need someone to do the documentation for me; Nothing like admitting defeat and handing someone a crutch. It reminds me of the first transition to computers. “What do you mean I have to type my own memos?”

Just give me Dragon, I’ll be fine; I am a big fan of Dragon. Speech recognition and natural language processing. It is where we all need to be headed. However, you still need to train users how to navigate and park the data in such a way that it can be "data mined" later. Once you have someone parking data in a free form text page, then you have to reverse engineer how to get reportable clinical quality measures.

I had a physician mention that he struggled with the EHR training. He went home and tried the demos remotely and after a few glasses of Jameson he finally got it! I guess once the frustration and aggravation was set aside, he was able to focus on the flow.

Adult learning is a science, not an art. Yet we tend to overlook the issues associated with clinicians trying to learn a new pathway to document clinical encounters. In a way, they are often asked to forget what was drilled into them in Med School and now follow a formula that the organization believes yields better clinical outcomes.  This needs to be done in order to advance the stage of clinical documentation and analytics, however how the training takes place is often haphazard.  

What is missing is a comprehensive way to deal with adult learning. We tend to focus on workflows, accommodate productivity requirements, engage IT specialist…but we don’t engage people trained in the science of Adult Learning. You have to provide Computer Based Training, Classroom, Lab, Remote, and combination of Hands-On and Real world examples. We cannot develop training programs with a “one size fits all” mentality. It has to be multiple solutions to fit the multiple clinician personalities, as well as the single physician with multiple personalities. It has to be different tools to fit the different training requirements. We also have to factor in the nuances of the EHR application and determine the right tool for each student. Otherwise, you’re just spinning the revolver's cylinder.