Successful Physician Training Program for Large Scale EHR Implementation

80
© Schattauer 2015
Successful Physician Training
Program for Large Scale EMR
Implementation
J.L. Pantaleoni1,2; L.A. Stevens1,2; E.S. Mailes2; B.A. Goad2; C.A. Longhurst1,2
1Department of Pediatrics, Stanford University School of Medicine, Stanford, California;
2Department of Clinical Informatics, Stanford Children’s Health, Palo Alto, California
Keywords
Physician, education, electronic medical records
Summary
End-user training is an essential element of electronic medical record (EMR) implementation and
frequently suffers from minimal institutional investment. In addition, discussion of successful EMR
training programs for physicians is limited in the literature.The authors describe a successful phys-
ician-training program at Stanford Children’s Health as part of a large scale EMR implementation.
Evaluations of classroom training, obtained at the conclusion of each class, revealed high physician
satisfaction with the program. Free-text comments from learners focused on duration and timing of
training, the learning environment, quality of the instructors, and specificity of training to their role
or department. Based upon participant feedback and institutional experience, best practice recom-
mendations, including physician engagement, curricular design, and assessment of proficiency and
recognition, are suggested for future provider EMR training programs.The authors strongly recom-
mend the creation of coursework to group providers by common workflow.
Correspondence to:
Julie L. Pantaleoni, MD
Department of Pediatrics
Stanford University School of Medicine
Stanford, California
Email: julie.pantaleoni@stanford.edu
Appl Clin Inform 2015; 6: 80–95
http://dx.doi.org/10.4338/ACI-2014-09-CR-0076
received: September 28, 2014
accepted: January 1, 2015
published: February 11, 2015
Citation: Pantaleoni JL, Stevens LA, Mailes ES, Goad
BA, Longhurst CA. Successful physician training pro-
gram for large scale EMR implementation.Appl Clin
Inf 2015; 6: 80–95
http://dx.doi.org/10.4338/ACI-2014-09-CR-0076
Case Report
J.L. Pantaleoni et al.: Successful Physician Training Program for Large Scale EMR Imple-
mentation

81
© Schattauer 2015
1. Background
Deliberate and comprehensive end-user training is essential for the implementation, actualization,
and end-user satisfaction with an organization’s chosen electronic medical record (EMR) [1-7].
Given the variety of roles and specialized workflows performed by medical staff, physicians com-
prise a unique group of end-users for whom distinct recommendations are essential. However, there
are few guidelines in the literature addressing the development and implementation of an EMR
training program for physicians. Rockswold et al, found that 43% of clinician users rated initial
training as “less than adequate,” 94.6% of respondents thought their ability to use the EMR could be
improved, and the authors called for the closer study of both training content and delivery [8]. A re-
view of the literature reveals general training strategies for all employees [9], recommendations for
nursing populations [10], post-implementation training [11], training within the broader context of
a successful EMR implementation [3, 6, 12, 13], and training as a barrier to EMR adoption [14, 15].
To our knowledge, this is the first manuscript to describe the focused development and implemen-
tation of a successful physician training program in preparation for a large scale EMR implemen-
tation.
2. Case Report
This case report outlines a training program developed at Stanford Children’s Health (SCH). SCH
includes Lucile Packard Children’s Hospital (LPCH), the major teaching hospital for pediatric and
obstetric care for Stanford University, as well as about 100 network physicians in a medical foun-
dation. As of 2014, LPCH has 311 beds, approximately 1,250 faculty and advanced practice pro-
viders (APPs), and approximately 1,000 rotating fellows and residents. The EMR implementation at
SCH was a transition from one commercially available EMR system to another. The legacy system
included computerized physician order entry (CPOE) and online clinical documentation in the in-
patient setting with partial adoption of online clinical documentation and no CPOE in the out-
patient setting [16-19]. The newly procured software system was already in place at the physically
adjacent but financially and operationally independent adult hospital Stanford Health Care for over
five years at the time of implementation [20].
2.1 Training Program Scope and Structure
The scope of the project was to train all SCH credentialed providers to use the new EMR for their re-
spective workflows; including faculty, community physicians, APPs, fellows, and residents. The
training team consisted of eight instructional designers (IDs) who were each responsible for the
training content, training environment creation, and education of the end-user trainers for their
given application (e.g. ambulatory, inpatient, radiology etc.). The IDs also worked closely with the
appropriate application team to understand the technical development of each workflow and to pro-
vide usability feedback from a learner’s perspective. The team also consisted of a training manager
(BG), training coordinator and, uniquely, a physician lead (JP) with 50–75% salary support for the
duration of the implementation, who oversaw all provider education and communication. The
physician lead worked closely with the training manager and IDs to determine the structure, con-
tent, and logistics of provider training. Training team roles and responsibilities are further outlined
in Table 1.
2.2 Curricular Development
The training team created provider tracks based upon role and common workflows, e.g. inpatient
provider only, ambulatory provider only, obstetric provider, and combined inpatient and ambula-
tory provider. Tracks consisted of 1–2 instructor-led training classes (5 hours each) and basic
e-learning (1 hour total). Eight courses were eligible for continuing medical education (CME) credit,
ranging from 4.25 to 5.25 AMA PRA Category 1 Credit(s)TM credits based upon the class duration.
Provider courses, class duration and CME information are presented in Table 2.
Case Report
mentation

82
© Schattauer 2015
Based upon provider surveys, approximately 20% of providers (particularly trainees who rotate
through the adult hospital) had experience using the new software at other institutions; therefore,
accelerated coursework was created for certain provider tracks. The accelerated coursework was 2.5
hours in duration with an emphasis on the features and workflows specific to SCH, assuming com-
petence with the core software features. To qualify for accelerated coursework, providers identified
themselves via a brief online survey asking them to attest to duration and location of usage and par-
ticipation in previous training. The attestation survey was available for two months, with a deadline
of 6 weeks prior to the start of training registration ( Figure 1). The accelerated coursework did not
qualify for CME credit, as the learning objectives could not be accomplished in the shortened time-
frame. It was also determined that CME training for the full course incentivized those providers
who were torn between participating in the accelerated and standard coursework. In addition, par-
ticipation in the accelerated track exempted providers from completion of the associated e-learning
which reviewed the software basics.
In response to feedback from hospital departmental and division leaders, residents and fellows
who were based at the adjacent adult hospital, and deemed proficient with a different institution-
specific version of the same software, satisfied their training requirement with e-learning only. This
was the only group that did not have a classroom-training requirement. Given their extensive ex-
perience with the new EMR, limited clinical time spent at SCH, and demanding clinical schedules,
clinical leadership of the implementation project agreed that e-learning was the most appropriate
strategy for these learners. The training team created a specific set of e-learning modules for this
population, which totaled approximately 1 hour in duration.
2.3 Course Assignment & Registration
The training team assigned providers the appropriate coursework via an institutional learning man-
agement system (LMS). This LMS was already in place for existing institutional training purposes
and was leveraged for training registration and e-learning delivery. Providers who attested to exten-
sive experience with the EMR were assigned accelerated coursework; others were assigned course-
work based upon on their specialty (Pediatrics, OBGYN, Anesthesia, Radiology) and workflow (In-
patient, Ambulatory). For example, a Pediatric Surgeon would be assigned Pediatric Surgical Pro-
vider (5 hours) and Ambulatory Provider (5 hours). The physician lead for the training team ident-
ified the appropriate coursework for each division based upon general knowledge of specialty work-
flow and based upon communication with each department/division representatives. Training regis-
tration began 4 months prior to beginning of the training period. Providers logged into the LMS to
select a class date and time during the training period for each classroom activity to which they were
assigned. Classroom training was offered Monday through Saturday from 7AM to 7PM on a variety
of days each week, with both morning and afternoon classes to accommodate a wide range of clini-
cal schedules. Although providers were encouraged to register by the beginning of the training peri-
od, registration remained open throughout the training period for rescheduling purposes. The
training manager produced weekly registration reports to determine unregistered providers. The
physician lead distributed the lists to department chairs and division chiefs via email to ensure that
all providers register for training.
2.4 Classroom Training
End-user training took place over an 8-week period in the two months prior to go-live. Classroom
training was conducted in the skyboxes of the Stanford University football stadium. This was a non-
traditional training venue; however, it was close in proximity to SCH, large enough to accommodate
clinical end-user training, and featured an abundance of parking and public transportation options.
This location created a fun and inspirational learning environment with space for all classrooms, a
helpdesk, and indoor and outdoor space for dining (see photos supplement). Breakfast, lunch,
snacks and beverages were provided daily to all participants.
Fifteen distinct provider courses were taught with a total of 215 classroom sessions offered to pro-
viders. The program consisted of 18 trainers for provider coursework, including two faculty phys-
icians, six medical students from Stanford University School of Medicine and four IDs from the
Case Report
mentation

83
© Schattauer 2015
training team. The remaining trainers were hired outside of Stanford Children’s Health. These “ex-
ternal” trainers were consultants who had experience teaching the software at other institutions.
They joined the project 6 weeks prior to the start of classroom training, during which time they re-
ceived instruction on adult learning theory, learned the SCH-specific workflows and software cus-
tomization, finalized the curriculum, and prepared for classroom sessions [21].
The curricular content for each class was structured in a case-based fashion, highlighting the core
clinical workflow elements and identifying changes from the prior system ( Table 3). The curricu-
lum was presented to the learners via slide presentations and paper supplemental materials. Each
classroom was outfitted with one desktop computer and 24-inch monitor per student, as well as two
large screens at the front of the classroom, one for the slide presentation, the other to demonstrate
the instructor’s actions in real-time within the training environment. After a brief introduction to
the course objectives, outline, and classroom ground rules, learners were instructed to log into the
training environment at their computer terminal. The learners followed along with the instructor
walking through each step of the workflow – described verbally, displayed in a written stepwise
fashion via PowerPoint, and demonstrated in real-time in the instructor’s training environment. The
curriculum was instructor-led, punctuated by independent exercises during which students com-
pleted a workflow based upon written instructions.
Provider classrooms had a range of 6 to 18 students with a super-user to end-user ratio of 1 to 6.
Classroom support super-users consisted of faculty, fellows, residents, and medical students from
Stanford University, who staffed 100% of all provider classes. In total, approximately 1,220 providers
were trained in the classroom, including 550 faculty, 250 community physicians, 160 Advanced
Practice Providers (APPs), 100 fellows and 160 residents. E-learning only was assigned to approxi-
mately 750 Stanford University-based residents and fellows.
At the conclusion of each class, participants completed an evaluation of the course and a
multiple-choice proficiency exam. Upon completion of these tasks, the participants logged into the
production environment to test their login credentials and set basic preferences prior to go-live, such
as patient list formation, order favorites and note template favorites. Members of the Information
Services (IS) security team staffed a helpdesk at the training location during training hours to help
with login issues in the production environment. There was also a general helpdesk set up for par-
ticipants who had further questions outside of classroom hours.
2.5 Provider Preference Labs
Two weeks prior to go-live, provider preference labs were held Monday through Friday from 11AM
to 7PM. Staffed by credentialed trainers and classroom support super-users, these drop-in labs
allowed providers to get more practice using the system, set preferences, learn more about mobile
device and remote access, and to ask questions. Over 175 providers took advantage of this opportun-
ity. Although no formal survey was administered, anecdotal comments regarding the preference lab
sessions revealed that providers felt the sessions provided more time to:
1. practice using the new system,
2. create favorites and user-specific customizations and
3. gain the confidence they felt necessary to get through their first workday using the software.
3. Results
All training participants were asked to complete a 10 question evaluative survey upon completion of
their course. The training manager developed the survey, which the training team utilized to evalu-
ate every classroom session during the training period. In the survey, providers assessed their overall
experience, including: trainer preparedness, course design, handouts, and the learner’s overall readi-
ness to use the system, as a 1 (Poor), 2 (Fair), 3 (Good) or 4 (Excellent). Out of a total of 1,218 pro-
viders who attended classroom training, 1,013 completed all survey questions with an 83% response
rate. Mean responses ranged from 3.27 to 3.87 on the 4-point scale ( Table 4). Evaluation of the in-
structor’s mastery of the subject demonstrated the highest score with an average of 3.87. Evaluation
of the provider’s comfort level with using the system demonstrated the lowest score, which an aver-
Case Report
mentation

84
© Schattauer 2015
age of 3.27. The survey allowed participants to provide additional comments. 433 additional com-
ments were recorded and overall themes were created from repeat comments. These general themes
and example comments are presented in Table 5.
4. Discussion
Physician training is an essential element of EMR actualization; however, there are few concrete rec-
ommendations in the literature regarding the development of such a program [3, 6, 8-13]. At Stan-
ford Children’s Health, an EMR training program for physicians was developed and implemented
prior to a large scale EMR implementation which was considered successful based upon learner
evaluation data and feedback from departmental and institutional leadership. Key factors in the suc-
cess of this training program included a well-staffed training team, a dedicated physician champion,
thoughtful curricular design, an accessible and comfortable training location and physician recogni-
tion for participation in training. Based upon participant feedback and institutional experience, we
have compiled best practice recommendations for future physician training programs.
4.1 Physician Engagement/Communication
Our first recommendation is to engage the medical staff in the target organizational change. This is
important whether the change entails a large-scale EMR go-live or smaller functionality rollout,
both of which require some form of end-user training. One of the best ways to achieve this engage-
ment is to include key physicians to inform the software configuration, testing, and training process,
and also serve as liaisons for communication changes to the medical staff. These “physician cham-
pions” are usually funded via a reduction in their clinical time, which can vary from 10–50% full
time equivalents (FTE). A total of 22 physician champions were funded for the described project and
expected to participate as super-users for classroom support, provider preference labs, and go-live
support, among other responsibilities. The success of the training program was also attributed to a
dedicated physician lead for training, separate from the role of the Chief Medical Information Of-
ficer. This physician provided essential review of clinical context (training patients, training scenar-
ios) and knowledge of institutional workflows (e.g. number of distinct provider workflows, how to
group providers in class). In addition, the physician lead was involved in the design and delivery of
training communication for both hospital and medical staff leadership. It is important that the phys-
ician in this role have an interest in education or curricular design, institutional knowledge, and
good communication skills.
Communication focused on the new EMR training requirements are of particular importance, as
attending training sessions may represent the end-user’s first interaction with the new system.
Therefore, the timing, duration and structure of the EMR training should be communicated in ad-
vance to the medical staff. For large-scale go-lives, such messages may start up to one year in ad-
vance and progress to include incrementally more information as the change approaches. Appropri-
ate forums for presentations include hospital, division and departmental meetings. Written com-
munications can be delivered via medical staff newsletters, email and website postings.
4.2 Timing
For larger scale go-lives, training classes should be offered 2 to 8 weeks prior to the change. Training
which occurs greater than 8 weeks in advance will likely not be remembered by the end-user. How-
ever, this must be balanced with allowing enough time to schedule all courses necessary for a large
medical staff. Furthermore, a one-to-two week hiatus prior to go-live is recommended for emergent
rescheduling/make-up sessions, remediation, personalization and use of a practice domain.
4.3 Learning Environment
Classroom training should occur in a location as close to a provider’s clinical practice setting as pos-
sible. This proximity allows ease of class scheduling and helps to ensure that providers will arrive on
Case Report
mentation

85
© Schattauer 2015
time. If the training is not within walking distance, parking and transportation options should be
available and ideally without cost. Complimentary meals, snacks and beverages are important to
consider, especially for classes greater than two hours in duration. The learning environment should
be as conducive to training as possible with consideration given to screen size, ergonomics of work-
stations, room temperature and external noise reduction.
4.4 Curricular Design Considerations
4.4.1 Learner Groups
As with any type of curricular development, it is important to know your learner [22]. The training
leadership should consider the number of distinct workflows in the population, in order to deter-
mine when learners can be grouped together and where the workflow is unique enough to create a
different class or track. Classes applicable to a greater breadth of learners can be offered more fre-
quently to accommodate the variable schedules of providers. In addition, repetition of a more gen-
eral class will allow the trainers to master the delivery of content, improving quality and consistency
of core concept delivery during classroom events. Frequently end-users will request classroom train-
ing for their division/department exclusively, which may be warranted when the workflow or patient
population is highly specialized or unique, but may not always be feasible. Overall, we strongly rec-
ommend that coursework should be designed to group learners by common workflow. By clustering
medical staff based upon their workflows, it is also easier to maintain physician engagement. For
example, those who spend most of their day in the operating room may not be as engaged in class-
room training which emphasizes admission, rounding, consultation, and discharge of medical pa-
tients.
4.4.2 Ensuring Clinical Relevance
One additional way to enhance engagement is to create practice patients for the EMR training do-
main, which have a variety of diagnoses, mirroring those seen by medical staff throughout the insti-
tution. The curriculum should then be delivered through the lens of relevant practice patients, with
scenarios that will mimic the learner’s workflow. For example, if surgeons are grouped together for
classroom training, the curriculum can emphasize pre-operative preparation, booking the operating
room, procedure documentation, and post-operative care of a practice patient with a surgical diag-
nosis such as appendicitis. Although not all learners will perform appendectomies, common surgi-
cal workflow is still emphasized. For further instruction or practice, learners can conclude the
session by working through an independent exercise with a practice patient and scenario consistent
with their sub-specialty practice. A sample outline of the Inpatient Medical Provider coursework is
displayed in Table 3.
4.4.3 Content Delivery Considerations
Next, the previous EMR experience of the end-users should be considered in order to determine the
appropriate duration and delivery of content. The two major types of training utilized for physicians
are classroom-based instructor-led training (ILT) and online e-learning. The balance between class-
room and e-learning is highly specific to the institution, the EMR, and the desire of the medical
staff. E-learning is helpful for basic review of the structure and function of the EMR, whereas com-
plex concepts, multi-step workflows and specialty-specific information are best taught in the class-
room. Furthermore, the classroom can be the best place to maintain interaction/enthusiasm, pro-
vide individualized assistance, assess competency and create a remediation plan if needed. More
often, a training program will consist primarily of classroom training, with a few e-learning modules
that review either basic concepts for a general audience or highly specialized concepts that are appli-
cable to a small group of users.
4.4.4 Enforcing Training Requirement
Another decision to be made by an organization is whether or not the physician training should be
required prior to obtaining security access to the new EMR. The benefits of a requirement include
consistency of end-user knowledge base and the reinforcement that the proper training is required
to achieve desired efficiency and patient safety.
Case Report
mentation

86
© Schattauer 2015
4.4.5 Applying Adult Learning Theory
Coursework should be based upon adult learning theory and resonate with multiple learning styles.
Therefore, whichever classification scheme of learning styles the organization chooses to adopt,
careful planning must be incorporated so that all types of learners are reached. The program de-
scribed above included interactive use of the system, visual cues on classroom monitors and printed
handouts, and verbal instructions.
4.5 Instructor Selection
It is important to select course instructors who not only have a mastery of the software, but who are
engaging professionals trained in the above mentioned adult learning theory and classroom man-
agement. Additionally, we found that utilizing instructors with a clinical background was particu-
larly well-received by the learners due to their understanding of the larger clinical context [21].
4.6 Assessment of Proficiency
There are two general forms of proficiency assessment: exam-based and demonstration-based.
Exam-based assessment, such as multiple-choice questions, can be graded quickly but may not pro-
vide an accurate assessment of the end-user’s knowledge. Demonstration-based assessment requires
1:1 proctoring as the end-user demonstrates specific tasks to the examiner. This format requires
more time and staff for administration; however, it may provide a more accurate assessment of
proficiency and allow for immediate remediation. The program described above utilized an exam-
based assessment but had super-users circulating to room to grade exams on the spot and provide
remediation/assistance as needed.
4.7 Recognition
As medical staff training will likely take place during a physician’s non-clinical time, and other fi-
nancial incentives may not be feasible, recognition of the time spent training can be awarded via
CME credits. The training program described above qualified 4.25 credits per 5 hours session, for a
maximum of 14.0 AMA PRA Category 1 Credit(s)TM designated by Stanford University School of
Medicine.
4.8 Other Considerations and Future Directions
The training program described above was considered successful based upon provider and institu-
tional feedback at the conclusion of the training period. However, it is important to continually as-
sess the efficacy of initial training, as well to address ongoing training needs, after initial system im-
plementation. Data that could be analyzed to this end could include post go-live training surveys,
delinquent physician documentation, incident reports, patient safety indicators and system change
requests. Our institution has begun to analyze these factors and to offer efficiency sessions for pro-
viders to improve their use of the system. These metrics are not available for inclusion in this case
report, but could be a future addition to the literature. In addition, this case report represents one in-
stitution’s experience with provider training which may limit our ability to predict success in other
settings. Lastly, some may argue that with more intuitive software design, the need for provider
training should be minimal. Although we agree that it is important to improve software usability, the
complexity of clinical workflow and risks to patient safety are too substantial to eliminate provider
training programs altogether.
5. Conclusion
End-user training for physicians and other medical providers must be deliberate and comprehensive
to ensure successful implementation, actualization, end-user satisfaction and appropriate usage of
Case Report
mentation

87
© Schattauer 2015
the EMR. Failure to do so may result in patient safety, quality, and efficiency issues, as well as phys-
ician dissatisfaction. Important aspects to consider are physician engagement, timing, curricular de-
sign, assessment of proficiency, and recognition.
Conflict of Interest
The authors have no conflict of interest to report.
Human Subjects Protection
The Stanford University Institutional Review Board (IRB) determined this project to be exempt
from further review as this activity did not meet the definition of research.
Acknowledgements
The authors would like to acknowledge Vickey Weir, BSN, MPA and Warren Chandler, for their
support of the physician training program. Supplemetary photos: permissions obtained prior to
publication.
Case Report
mentation

88
© Schattauer 2015

Fig.1ProviderTrainingTimeline
Case Report
mentation

89
© Schattauer 2015
Table 1 Training Team Roles and Responsibilities
Role
Training Manager
Physician Lead for
Provider Education
Training Coordinator
Instructional Designers for
Provider Courses (8):
•Ambulatory – 2
•Inpatient – 1
•Obstetrics – 1
•Anesthesia – 1
•Radiology – 1
•Oncology – 1
•Transplant – 1
End-user Trainers:
•IDs
•External trainers
•Medical students
Responsibilities
•Hires and manages IDs, training coordinator, end-user trainers and classroom
super-users
•Manages training timeline and budget
•Communicates with project and hospital leadership
•Oversees training environment development
•Coordinates training material creation and standardization
•Creates LMS reports
•On-site management during training period
•Works closely with training manager and IDs to:
– Create an overall structure of provider coursework (standard v. accelerated
track, number of hours, number of courses, provider groupings)
– Assign coursework to provider groups
– Create clinically relevant training patients and scenarios
– Review all provider training content (PowerPoint, e-learning, supplemental ma-
terials)
•Designs and delivers training communication to medical and hospital staff leader-
ship
•Manages training involvement of other EMR physician leads and physician class-
room super-users
•Serves as course director for CME activities
•Manages LMS
•Creates master course schedule
•Manages scheduling of end-user trainers and classroom super-users
•Manages all training location logistics (classroom set-up, hardware, food etc.)
•Available to providers by phone, email and in person for training questions and
problem-solving
•Integrate/communicate with application teams to translate software features and
workflow into training material
•Create/maintain all training content
– PowerPoint slides
– E-learning
– Supplemental materials
•Build/test/maintain training environments
•Educate/supervise end-user trainers
•Conduct classroom training
•Conduct classroom training
Case Report
mentation

90
© Schattauer 2015
Table 2 List of Provider Courses
Course
Inpatient Medical Provider
Inpatient Medical Consultant*
Inpatient Surgical Provider
Ambulatory Provider
Ambulatory Psychiatry Provider
Ambulatory Oncology Provider
Inpatient OB Provider
Ambulatory OB Provider
Anesthesia Provider
Pediatric Resident*
inpatient and ambulatory content
Obstetric Resident*
inpatient and ambulatory content
Anesthesia Resident*
Accelerated Ambulatory Provider*^
Accelerated Inpatient Medical Provider*^
Accelerated Inpatient Surgical Provider*^
*not CME eligible; ^no e-learning assigned
Classroom Hours
5
2.5
5
5
5
5
5
5
6
5
5
3
2.5
2.5
2.5
Case Report
mentation

91
© Schattauer 2015
Table 3 Sample Course Outline: Inpatient Medical Provider
Workflow
Admission
Rounding
Transfer
Bedside Procedure
Discharge
Consultation
Operating Room (OR)
Procedure
End of Day Activities
User Preferences
Clinical Scenario
11 year-old female with pneumonia admitted to
Pediatric Wards from Urgent Care Clinic.
Patient develops pleural effusion and has more re-
spiratory distress requiring chest tube placement.
Patient condition worsens before surgeons arrive
and requires transfer to Pediatric Intensive Care Unit
(PICU)
Chest tube placed in PICU
A few days later, patient recovers and is ready for
discharge.
17 year-old female post-op spinal fusion, Ortho
team requests consult for pain, nutrition, anemia.
14 year-old female admitted to PICU and needs
bronchoscopy in the OR
N/A
N/A
Outline
•Patient list management
•Chart review
•Problem list maintenance
•Medication reconciliation
•Admission order sets
•History & Physical creation
•Charge capture for notes
•Chart review
•Progress note creation
•Rounding checklist
•Order entry
•Request consultation
•Transfer orders
•Transfer note creation
•Procedure navigator
•Procedure note creation
•Charge capture for procedures
•Discharge prescriptions
•Discharge orders
•Discharge summary creation
•Chart review
•Consult note creation
•Blood order sets
•OR case request
•OR status board
•Procedure navigator
•Inbox management
•Messaging
•Cosigning notes
•Handoff tool
•Log in department
•Patient list configuration
•Note template favorites
•Order set favorites
Case Report
mentation

92
© Schattauer 2015
Table 4 Training Evaluation Results
Question
Organization of presenta-
tion
Instructor’s mastery of sub-
ject
Instructor’s communication
skills
Quality of handouts for
class
Questions answered to
your satisfaction
Adequate time to cover all
topics
Course objectives were
clear
Course objectives were
met
Content of training was
applicable to my role
Please rate your comfort
level using Epic
Excellent
889
923
921
759
830
807
901
873
793
505
Good
150
127
118
224
203
183
138
160
193
373
Fair
8
4
16
29
14
50
13
13
54
168
Poor
1
0
1
1
2
9
0
0
12
24
Total
Answers
1048
1054
1056
1013
1049
1049
1052
1046
1052
1070
Mean
Score
3.8387
3.8719
3.8551
3.7187
3.7741
3.7045
3.8441
3.8222
3.6797
3.2701
Std Dev
0.3953
0.3454
0.3998
0.5151
0.4615
0.5958
0.3954
0.4136
0.6236
0.8036
Case Report
J.L. Pantaleoni et al.: Successful Physician Training Program for Large Scale
EMR Implementation

93
© Schattauer 2015
Table 5 Training Evaluation Comments
Subject matter
Training delivery – (e.g. length of training, tim-
ing of training in respect to go-live, pace of
training, use of materials)
Training setting – (e.g. food, location, parking,
room temperature, breaks,AV)
Training specificity – (e.g. tailored to role, de-
partment, workflow, user needs)
Ongoing training needs
Example comments
“More time assigned for classes”
“Decrease class time – it went way over effective learning
time”
“Content was dense – break up into smaller sessions”
“Move training closer to start date”
“Would be nice to do this online due to limited attention
span”
“Concise, to point, efficiently presented”
“Water bottles in room”
“Thanks for the food!”
“Improve pre-class communication/instructions (email parking
instructions, location of class, etc)”
“Larger projector screens”
“Great venue”
“Personalize to service provider type”
“Faster, more personalized training”
“Separate people with prior experience to Epic.Also separate
based on clinical roles”
“Too broad – stick to division.”
“Thanks for making this specific to psych.”
“Greatly appreciated that [the trainer] adapted content to my
experience level and provided extra tips.”
“Have refreshers once or twice a year”
“I only work at SCH 2x a year so I am worried about additional
support later”
“I need more hands on time”
“I need more practice”
Case Report
mentation

94
© Schattauer 2015
References
1. Anderson LK, Stafford CJ. The „big bang“ implementation: not for the faint of heart. Computers in nurs-
ing 2002; 20(1): 14–20; quiz –2.
2. Ash JS, Bates DW. Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion.
Journal of the American Medical Informatics Association: JAMIA 2005; 12(1): 8–12.
3. Brokel JM, Harrison MI. Redesigning care processes using an electronic health record: a system’s experi-
ence. Joint Commission journal on quality and patient safety / Joint Commission Resources 2009; 35(2):
82–92.
4. Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement elec-
tronic health records (EHR) in small ambulatory practice settings. BMC medical informatics and decision
making 2009; 9: 15.
5. McAlearney AS, Robbins J, Hirsch A, Jorina M, Harrop JP. Perceived efficiency impacts following elec-
tronic health record implementation: an exploratory study of an urban community health center network.
Int J Med Inform 2010; 79(12): 807–816.
6. Terry AL, Thorpe CF, Giles G, Brown JB, Harris SB, Reid GJ, Thind A, Stewart M. Implementing elec-
tronic health records: Key factors in primary care. Canadian family physician Medecin de famille canadien
2008; 54(5): 730–736.
7. Whittaker AA, Aufdenkamp M, Tinley S. Barriers and facilitators to electronic documentation in a rural
hospital. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor
Society of Nursing / Sigma Theta Tau 2009; 41(3): 293–300.
8. Rockswold PD, Finnell VW. Predictors of tool usage in the military health system’s electronic health rec-
ord, the Armed Forces Health Longitudinal Technology Application. Military medicine 2010; 175(5):
313–316.
9. Kushinka SA. Training strategies: EHR deployment techniques. California Healthcare Foundation 2010;
Issue Brief.
10.Edwards G, Kitzmiller RR, Breckenridge-Sproat S. Innovative health information technology training: ex-
ploring blended learning. Computers, informatics, nursing: CIN 2012; 30(2): 104–109.
11.Bredfeldt CE, Awad EB, Joseph K, Snyder MH. Training providers: beyond the basics of electronic health
records. BMC Health Serv Res 2013; 13: 503.
12.Abramson EL, Patel V, Malhotra S, Pfoh ER, Nena Osorio S, Cheriff A, Cole CL, Bunce A, Ash J, Kaushal
R. Physician experiences transitioning between an older versus newer electronic health record for elec-
tronic prescribing. Int J Med Inform 2012; 81(8): 539–548.
13.Longhurst CA, Palma JP, Grisim LM, Widen E, Chan M, Sharek PJ. Using an Evidence-Based Approach to
EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences. Journal of healthcare
information management: JHIM 2013; 27(3): 79–83.
14.Ajami S, Bagheri-Tadi T. Barriers for Adopting Electronic Health Records (EHRs) by Physicians. Acta in-
formatica medica: AIM: journal of the Society for Medical Informatics of Bosnia & Herzegovina: casopis
Drustva za medicinsku informatiku BiH 2013; 21(2): 129–134.
15.Ford EW, Menachemi N, Phillips MT. Predicting the adoption of electronic health records by physicians:
when will health care be paperless? Journal of the American Medical Informatics Association: JAMIA
2006; 13(1): 106–112.
16.Adams ES, Longhurst CA, Pageler N, Widen E, Franzon D, Cornfield DN. Computerized physician order
entry with decision support decreases blood transfusions in children. Pediatrics 2011; 127(5):
e1112–e1119.
17.Bernstein JA, Imler DL, Sharek P, Longhurst CA. Improved physician work flow after integrating sign-out
notes into the electronic medical record. Joint Commission journal on quality and patient safety / Joint
Commission Resources 2010; 36(2): 72–78.
18.Longhurst CA, Parast L, Sandborg CI, Widen E, Sullivan J, Hahn JS, Dawes CG, Sharek PJ. Decrease in
hospital-wide mortality rate after implementation of a commercially sold computerized physician order
entry system. Pediatrics 2010; 126(1): 14–21.
19.Palma JP, Van Eaton EG, Longhurst CA. Neonatal Informatics: Information Technology to Support Hand-
offs in Neonatal Care. NeoReviews 2011; 2011(12).
20.Chi J, Kugler J, Chu IM, Loftus PD, Evans KH, Oskotsky T, Basaviah P, Braddock CH, 3rd. Medical Stu-
dents and the Electronic Health Record: „An Epic Use of Time“. The American journal of medicine 2014.
21.Stevens LA, Pantaleoni JL, Longhurst CA. The value of clinical teachers for EMR implementations and
conversions. Applied Clinical Informatics 2015; 6: 75-79.
Case Report
mentation

95
© Schattauer 2015
22.McAlearney AS, Robbins J, Kowalczyk N, Chisolm DJ, Song PH. The role of cognitive and learning the-
ories in supporting successful EHR system implementation training: a qualitative study. Medical care re-
search and review: MCRR 2012; 69(3): 294–315.
Case Report
mentation

Successful Physician Training Program for Large Scale EHR Implementation

More Related Content

What's hot (19)

Similar to Successful Physician Training Program for Large Scale EHR Implementation (20)

Successful Physician Training Program for Large Scale EHR Implementation