One of our more popular recent posts was published on EMR and HIPAA and was titled, “Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day.” When the post was shared on LinkedIn, it prompted a really insightful discussion on EMR training and Sutter’s approach to EHR implementation. A few of the comments were so good that I wanted to share them for more people to read and learn.
The first comment is from Scott Kennedy, an Epic Stork Trainer:
I was an Epic training consultant on the E. Bay Sutter EHR implementation and I can tell you first hand that Sutter Admin, and the Nurses are at odds. This unfortunate relationship made it difficult to train the staff. Epic itself is not to blame. Those who are using the Epic EHR are not as trained as they should be.
Sutter used an “in house” training team rather than bringing on a full consulting team with much more experience in training and educating end users. The “in house’ trainers included some nurses, RTs, and the like as well as a host of newly graduated college students who had less to no experience with conducting a formal training presentation on a multidisciplinary EHR.
Hiring and training “in house” is a great addition to bringing on an experienced, skilled, professional team of Epic credentialed trainers, like myself who do this as a profession all over the country.
We were also directed by Sutter EHR implementation Administration to “facilitate” rather than “train.” “Facilitate included passing out exercise booklets to the clinical end users and having them work on their own, rather than conducing concise, lectured, guided practice prior to each exercise. Hands on exercises are an essential part of the training, but should not be the complete focus of training.
The learner is left on their own to figure out the system, which is counter productive. That approach only builds anxiety, confusion and eventual resentment for the system and the administration who have chosen the EHR they are fumbling through.
I empathize with the clinical end users. There training experience could have been much more instrumental in getting them off on the right foot with their new EHR, had the training approach been more adult learning theory based rather than self-learning based.
I only wish I could come back to Sutter and retrain the nurses and other clinicians from the proven, consistent, progressive, successful adult learning approach, which enables and empowers the end user to grasp, comprehend and assimilate the EHR system into their daily shift work flow. That is not to say that there are not implementation bumps and optimization needs that have to be addressed, but they are far less impactful when the clinician is properly trained.
I am so sorry Sutter nurses and staff that I trained, but I was firmly told to “facilitate” your learning rather than “train” you. I tried to implement adult learning methodology, but was told by your EHR administration to “stop talking and let them do it on their own.”
Epic EHR is not to blame here. Epic is a sound, EHR system that is serving the needs of millions of patients and their care providers around the world, without incidents such as those being experienced at Sutter.
There is a right way to implement and train and a wrong way. Sorry Sutter EHR implementation administration, but “I told you so!”
I asked Scott Kennedy if he’d thought of leaving the project since it was being done the wrong way and he offered the following response:
@ John, yes I did come very close to leaving the project. As a matter of fact after I was verbally “scolded” for lecturing to much I phoned my recruiter and asked to be placed on another project, but then, after careful thought, I decided to stay on the project and attempt to train and support as much as I could. But it seems that my individual efforts were not enough to counter the original training “facilitation” focus.
To add insult to injury those of us trainers who were there for the Sutter E. Bay implementation were told not to return for the W. Bay implementation. The EHR administration wanted an entirely new outside consulting team.
I got a fellow colleague on the project, hoping that the E. Bay administration would have learned from and the current W. Bay implementation would be better. The training colleague I got on the W. Bay project shared with me that it was worse than the E. Bay implementation. They kept the experienced Epic trainers as support and utilized them as little as possible for actual front end training. So sad, really.
The EHR administration at Sutter tried to cut every financial corner possible and lost sight of the long run implications of improper front end training. Now they are paying the price.
Michael A. P., an EMR consultant offered this insight as well:
I’ve also had the misfortune of working with Sutter for a (thankfully) brief period. In their long history of attempting to implement Epic, they could be counted on to make the wrong decision in almost every situation. Their internal politics trump the advice they receive from vendors and highly experienced consultants. The result is an implementation that serves neither the patient or the users best interests.
Then, Ryan Thousand, an IT Architect at Athens Regional Medical Center, offered a broader view of what’s happening in health IT and EHR:
I hate to say it but most large healthcare organizations are getting like this as well…. There are WAY too many layers in these organizations and sometimes to get work done can mean 4 weeks of executive meetings and in the end no decision or 100% opposite of the recommended direction given. That being said, with the rapid change in healthcare and the mergers and acquisitions occurring right now, I fear the worries for Healthcare in general over the next couple of years. We cannot continue to try to meet mandates the government is making while still ensuring 100% utmost patient care; and in the end that is really all I care about.. the patient in the bed who is BENEFITING from my implementation. Change is always tough but done the right way with the right people (as you all stated above was not done correctly) we will continue to see great things happen on the HIT side. But unless Epic/Cerner all the big players in the markets as well as the local clinician and providers work together and decide the best outcomes for our patients, we will all one day suffer, as we will all one day be patients.
In all the years I’ve been writing about EMR and EHR, the biggest problem with most EMR implementations is lack of EHR training or poor EHR training. It’s really amazing the impact quality EHR training can have on an implementation. However, many organizations use that as a way to save money. If they could only see the long term costs of that choice.
John, I appreciate your article, but it would be nice if the comments were from both the vendor and the customer as the information shared is too one-sided.
I was not involved with Sutter’s EMR implantation training, but I can tell you from prior experience with EMR software vendors that their training content and subsequent transfer of learning for the customers has been seriously lacking. Vendor training is normally generic – it doesn’t take into account all the customization changes and workflows of the customer. Teaching generic screens and expecting the customers to be able to “figure out how the system works in their environment” has been what I’ve seen most from the vendor training.
I would be interested in viewing the Epic training given to Sutter, talking with both sides, and then making an objective analysis of what really went wrong with the training.
Jonena,
I’d love to hear Epic’s perspective as well. Too bad they don’t like to talk to the media. Although, that’s starting to change a little bit. Maybe I’ll run into them at a conference I go to this Fall and I can ask them as well.
Scott’s comments made me think of something. There’s a firm that hires groups of people around the country as trainers for such implementations. But from what I saw (when they asked me in to interview), they have enough ‘grownups’ in each roll-out to make sure any kiddies (IOTW recent school graduates) are properly trained to do their training. I can’t say how well the trainers get trained, but blogs suggest that the trainers keep coming back for more roll-outs and like working for that firm.
Hospitals do want to save money, and so do the consulting firms staffing these roll-outs. But I’m pretty sure that some do it a lot better then some others.
I think there is a lesson here.
The way to avoid disruptions/resistance/bad outcomes is to let organizations build, manage and own workflows at the functional unit level, with assistance from IT, or a Business Improvement specialist, an outside consultant, as needed, with vendor as your last choice.
Vendors typically don’t have on-staff process experts – they do what they do well (development software).
When was the last time a hospital signed up a software developer to perform a heart transplant?
This tells us the tool sets must be such that ordinary people can map processes themselves (much as they would using a piece of paper and pencil).
No real training needed for the basics. And, staff can revert to others for help in the area of decision box/rule set construction.
Now, the end result of this is the users will get the steps “right”, connected the right way, posting the right forms (their forms, not forms invented by, or dare we say “imposed” by outsiders).
And, if the User Interface consists of one screen, not some mind- boggling hierarchy of menus that you have to navigate up/down), staff is not likely to have a need for much training either in respect of day-to-day processing of instances derived from the mapped process templates.
The brick wall comes when the users say “we are too busy to map out our processes” (thank goodness they don’t say they are too busy to learn how to learn how to drive a new car they buy), but here, again, there is a solution and it’s called a “facilitator”.
I rarely see my clients complaining about their workflows (THEY have built these themselves and the workflows represent the way THEY like to go about their workdays).
I rarely hear about complaints relating to the forms they “have” to fill in (again, their forms).
And, as for the user interface, well, once you get down to ONE screen(a calendar on the right, a list of tasks you have to perform todayon the left), unless you need to look under the hood, things are about as easy as they can get.
Saying the biggest problem of an EMR is lack of training is like saying the biggest problem with leukemia is chemotherapy. The biggest problem is of course the leukemia itself, not the treatment.