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EMR User Certifications: Does it Really Measure Adoption?

May 19, 2011
by Pete Rivera
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When it comes to EMR adoption you have a few different levels of expertise to consider

In the early stages of EMR adoption, most organizations were happy if their providers just attended the EMR kick-off meeting. After all, most providers hated the idea of having to shift from a comfortable paper world to an electronic screen. The EMR felt like an intrusion into the provider patient encounter session. Thankfully we are passed that mindset (I hope).

Now we have a national effort underway to deploy EMR’s to most providers. Each EMR user has different talents when it comes to working in an electronic environment. It may be a factor of age, technology phobia, previous experiences with computers, or just the fact that they really never had a need to use computers. So when it comes to EMR adoption you have a few different levels of expertise to consider. Here are some of the different technology styles that I have seen across users:

1. Totally connected. Carries an iPhone and has a unique ringtone for each caller. Syncs their phone with their car via Bluetooth. Has an App on the phone for everything they do. Buys the first version of any new technology that comes out. Probably uses social media. Not only wanted the EMR, but is frustrated that it is not doing everything they wanted it to do!

2. Trust but verify. Will wait until everyone tries it first before they pass judgment. They are very concerned that it will fail and they will have to revert back to what they were doing. Has a computer at home and uses email. Don’t waste your time showing them the EMR features unless you are someone that has been using it to do the same thing they will…in the same specialty.

3. This too shall pass. Believes that they can accomplish much more in less time with less technology. Perceives the EMR as requiring too much clerical skills that they don’t have or don’t want to learn. Is waiting for the ability to just talk to the thing (EMR) and tell it what to do. The computer at home is something their kids use and the last thing they want to use at the end of the day. The only way they will use an EMR is if someone is going to walk them through it...every day.

Organizations have developed their own carrots and sticks to get providers to use the EMR. One important factor is to have a consistent certification process that measures proficiency in using the application. This provides a benchmark of how well the features and functions are displayed within the application and what level of expertise you are dealing with across the organization. You cannot always assume that the users just don’t “get it,” especially if the testing deficiency is consistent across all users. You may have to spend more time with the users who think “this too shall pass,” but the advantage is that you identify them early and allocate your resources accordingly.

Training and certification exams are often on the tail end of the project and it is a check in the block before go-live. It really needs to be something that senior leadership views as part of the go/no-go decision. You cannot just build it and assume they will come.



From a curriculum development standpoint, I like to approach this from a baseline skills perspective required for the user and Risk Mitigation for the organization. Although I have not seen Taxonomy skill sets, I believe that some effort has been made to address the secondary use of data and taxonomy related to security categories.
For me the baseline skill sets are driven by the category of users I outlined. Working from this and similar models, you establish your curriculum enabling objectives (what you hope to derive from the user at the end of the training session) and set goals such as:

1. Log-in and navigation.
2. Look up and verification of identity.
3. Workflow entries based on Roles and Rights.
4. Messaging and CPOE.
5. Review of results, imaging and scanned documents.
6. Sign off and referrals.

The other part of the training are those issues that tie back to your organizational policy and procedures. I look at these as Policy statements that are created to mitigate risk. The policy drives the procedure and the procedure is the baseline for the curriculum. Once the user completes the training and certifies that they have achieved a level of comprehension (final exam), you then can hold them accountable for policy compliance. Some of these Policy issues include:

1. Downtime procedures-recovering from a downtime and capturing information.
2. EMR Roles and Security Rights.
3. VIP flags and auditing.
4. Matching Criteria for Interfaces.
5. Verifying Identity when patient is present when reviewing results.
6. Scanned Documents.
7. Termination of Access-Employee terminations.
8. Change Management
9. Patient Requests for printed notes and electronic files

These of course are a sample representation.

Nice analysis and recommendation.
Have you seen a EMR utilization taxonomy that you recommend organizations using for for tracking and management? In the consumer eHealth space, one taxonomy separates six abilities (remembering, understanding, applying, analyzing, evaluating, and creating) and six dimensions of literacy (computer, information, media, numeracy, science and health). Can you share your ability framework for EMRs?

Thanks Pete. That's a very helpful planning framework.

Pete Rivera

Director Informatics, Hayes Management Consulting

Pete Rivera