While at the CHIME 2019 Fall Forum conference in Phoenix, AZ, I had a great chance to sit in on one of the CIO focus groups at the event hosted by Optimum Healthcare IT. The session discussed a wide variety of topics including EHR optimization, EHR training, and other related topics. While listening to these discussions, I was struck be a certain irony that seemed to be experienced by almost every CIO I met at the CHIME Fall Forum and this focus group in particular. The irony is illustrated in these two statements.
EHR Training Improves EHR Satisfaction
Physicians Don’t Want to Make Time for EHR Training
These are pretty broad generalizations, but the beauty of a generalization is that it’s generally true. For the first statement, this has really been proven out by the great EHR Satisfaction research that KLAS’s Arch Collaborative has done along with Heather Haugen’s research in the book Beyond Implementation. If you’re not doing enough EHR training, then fixing it will help with physician satisfaction. If you don’t have great EHR trainers, getting better trainers will help with EHR satisfaction.
Given this is the case, it’s amazing how much push back CIOs get when it comes to EHR training from physicians. The stories I’ve heard are wide and varied. Everything from physician’s refusing to do EHR training and hospitals hiring a scribe to do all the EHR work for them through physician’s leaving organizations because they don’t want to train on the EHR. While those are the extremes, the most common request I’ve seen is doctor’s asking for as little EHR training as possible.
Reminds me of the doctors who ask why their EHR isn’t as easy as their iPad or iTunes (ie. I shouldn’t need a lot of training). We’ve addressed this before, but you have to remember that an EHR is more like flying an airplane than it is playing some music. Would you want a pilot taking the “little as possible” approach to training on the software and systems they use?
Listening to CIOs the past year, I’ve heard a wide variety of efforts to overcome this conundrum. The most effective ones are literally getting EHR training added to the physicians contract or some other contractual obligation to participate. However, this isn’t possible for many organizations. Others are not providing an EHR login to a clinician until they’ve received the appropriate training. Many are masking the 2nd and 3rd level trainings by treating them more as a EHR trainer walk by that checks in on the clinicians, addresses any needs, and enrolls them in future training if there’s a specific need for more training. They basically hide the training from the physician to make it happen. It’s just amazing what lengths CIOs have had to go to ensure enough EHR training is happening in their organization. You’d think doctors would want this training since it will improve their lives. Luckily, CIOs now have the data available that illustrates this and can help them make the case. However, it’s still tough sledding.
I asked Kevin McNamara, MD MPH, a Practice Support Specialist at Optimum Healthcare IT, who facilitated the focus group mentioned above what he thought of this challenging situation. He took it another level and illustrated why quality EHR training and personalization not only improves EHR satisfaction, but has an impact on patient safety and the quality of care. Here’s what he shared:
For a physician, feeling safe with the tools of medicine is paramount to their success, and when considering the EHR, it is about more than the interface. Increasing evidence suggests that use of electronic health records (EHRs) can take up a significant amount of a physician’s workday, making it more difficult for them to do their jobs and contributing to professional burnout. Many point to poor technical usability as a root cause of these failings. But, wide variation exists within all EHR customer bases and evidence points to critical gaps in users understanding of how to use and optimize their EHR.
Multiple studies have indicated that users of the same EHR software can have significantly different safety performance and mortality outcomes. Less than 20% of all variation was explainable by the EHR in use, with over 50% of variation attributed at the Physician User level. Physicians who report poor training are over 3.5 times more likely to report that their EHR does not enable them to deliver quality care. The greatest opportunity for progressing the value of the EHR currently lies in improved user training and personalization. The challenge for many organizations is engaging their already overburdened Providers in participating and helping direct the team that shapes this EHR and their training into a successful solution.
No doubt EHR training isn’t the only thing plaguing EHR satisfaction. Personalization is another big element that improves EHR satisfaction. Effective leadership and governance is also a major contributing factor. Plus, I never want to leave the EHR vendors off the hook either. They could do better than what they’re doing today also. However, if you were going to start with one thing to improve clinician EHR satisfaction, I’d start with EHR training…even if clinicians will fight against it.