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Training New EHR Users

Posted on March 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Todd Stansfield has a really great guest blog post over on EMR and HIPAA where he writes about “Learning by Doing.” While this principle applies to a lot of parts of life, I agree with Todd that it’s absolutely valuable when doing EHR training.

I was particularly intrigued by the process that Todd and The Breakaway Group use to train on EHR. I know they have a bunch of researchers at The Breakaway Group that have worked hard to understand the right way to train. However, what struck me is that I found exactly the same thing in my experience training users on EHR.

When I was working my full time job managing, implementing, upgrading, etc the EHR, I was also assigned to train any new staff that got hired by our clinic. Because of our clinic’s relationship with the local medical school and some general staff turnover, I got quite good at training new users on the EHR.

My process was really simple. I would first train the users on the workflow through the EHR. Then, to reinforce what I taught, I would have them go through the same workflow (ie. learning by doing). After I’d shown them what to do, they usually had to stumble through what I’d just taught them. However, once they stumbled through the second time and actually did it themselves, I can’t remember them ever asking me how to do it again. It was really quite amazing to watch. The questions I would get later were more about why, how, or advanced functionality.

Trust me, this is not an easy thing to do. When I was in the second phase of EHR training where I let them do it directly on the EHR, I had to really control my urge to just show them the solution. Sometimes I would literally stand up and walk away from the computer to prevent myself from just showing them how to do it. It’s almost irresistible to step in and do it. However, I had to resist that urge and let them fail and explore a little bit for them to really understand how it worked.

Of course, there’s a point where you might need to step in, because they just flat out don’t remember. That’s fine, but then that often means they’ll need to do that same step again so they don’t forget.

I saw first hand the concept of learning by doing. It’s a powerful one and more EHR vendors should employ it in their EHR training.

Driving Towards Quality Outcomes

Posted on September 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most compelling talks at the Healthcare Forum was from Jennifer Brull, MD Physician Owner and CEO at Prairie Star Family Practice.  Dr. Brull practices in a small town of 1900 souls in Kansas and so she provided a unique perspective on quality outcomes in healthcare.  As Dr. Brull said, “Quality improvement for me is some about my ego and making sure that I’m a good doctor, but a lot about taking care of my friends who also happen to be my patients.”  However, the methods Dr. Brull used to improve outcomes can be applied to any size practice.

In fact, Dr. Brull uses the national Meaningful Use Outcome Priorities as a framework for her practice:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Engage patients and families in their healthcare
  • Improve care coordination
  • Ensure adequate privacy and security protections for personal health information
  • Improve population and public health

Dr. Brull noted that improving quality was first on her list because of its importance, but acknowledged how difficult it can be to measure.  We love to talk about big data and small data in healthcare, but sometimes there is no data.  As EHR use increases, the data captured provides valuable insight into opportunities to improve the care process.    If the data doesn’t match the provider’s perception of the care being provider, it can be scary.  Lots of times doctors get put on a pedestal, but Dr. Brull humbly shared how she fell off her pedestal and how awakening to the fact that she could benefit from the data in her EHRhelped save the lives of her patients.

One of the barriers to improving quality outcomes is convincing other members of the staff to participate.  Most people equate quality outcomes with more time per patient, which then translates to seeing fewer patients or more hours working.  Neither option is tenable long term.  Dr. Brull offered a much better alternative, “By making the right thing to do easy, you actually get more time to do quality improvement and you become more efficient in your processes.”

“If you measure it, you will improve it!” is Dr. Brull’s simple approach to quality improvement.  However, seeing the data before you will often illicit the reaction that “This data is not right!”  Dr. Brull has learned a simple lesson: “Trust your data, it’s probably right.”  Plus, measuring the data and graphing it will let you know if you are improving or not.  She shared, “Graphs help point out critical flaws.  They help motivate your staff.  They help direct your quality improvement cycles.  They show the effect of change over time.”

Dr. Brull offered a number of methods she used to improve the quality outcomes in her office.  The first is education.  She noted, “We don’t hide our poor performance results.  We talk about them.”  This education on the clinic’s performance can be a great motivator to improve.  Alerts in the EHR also proved effective.  Dr. Brull tried sending letters to patients, but found they were “A high dollar investment for a low dollar return.”

When trying to improve breast cancer screening, they found that sending a mammogram order directly to radiology proved effective at getting more patients screened.  The nurses prompted the doctor to screen for colon cancer by simply placing the Hemoccult kit on the counter.  Just by streamlining the referral process they often saw better results.  For example, Dr. Brull developed a patient information handout which the nurses gave patients before they were seen by the doctor.  This dramatically decreased the amount of time the doctor had to spend educating patients on why they should be screened.  These simple changes made doing the right thing easy.

One of Dr. Brull’s lessons learned was to “Never take your eyes off the data, because when you do you start to slip and sometimes you slip really big.”  The ultimate goal of EHR adoption is to improve the quality of care.  Most clinicians would be shocked to learn how they are performing on some of the standard quality measures.  Those who have the courage to use data to drive improvement will create the future of care.

Dr. Brull closed her remarks saying, “My enthusiasm around quality improvement has a lot to do with seeing those graphs.  My passion about quality improvement is because of Marilyn [a patient whose life was saved] and because of all the patients that I know every time I improve the care I take of them I make them live longer and healthier lives.”

I recommend watching the full Dr. Brull Healthcare Forum presentation (embedded below) to see and hear firsthand how she improved the quality outcomes in her clinic:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

The Patient Portal Conundrum

Posted on July 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare has two major challenges hanging over its head.  The first is how to handle newly empowered and engaged patients.  The second is how to lower the skyrocketing costs of healthcare.  At the Healthcare Forum, Ashwin Ram, PhD, looked at how both of these issues are impacted by the patient portal.

Dr. Ram pointed out that the internet is by far the leading source of health and wellness information.  However, patients aren’t looking to their doctors’ patient portal for this information.  Instead they’re looking to Facebook, Wikipedia, Twitter, and online patient communities.  Dr. Ram pointedly describes this shift:

The patient is the CEO of their health.  This stuff is happening.  It’s actually not a choice that we are going to make.  It’s already occurring and if we, the healthcare provider system and all the facets of it don’t drive this change, then some 20 year old kid in a Google garage will drive it for us and then we’ll wonder what happened.

Is healthcare going to drive this change?  Can patient portals be part of providers’ response to this change?

Dr. Ram suggested that “patient portals are great…if we can get people to use them.”  Therein lies the patient portal conundrum.  He offered a simple plan where EHR software gathers the information, patient portals garner patient engagement and then we see improved health as patients’ behaviors change.

Government regulations are pushing providers to engage with their patient through a patient portal.  Meaningful use requires organizations to not only make a patient’s health information available through a portal, but 5% of patients must view, download, or transmit their health information as well.   It is clear that providers need to not simply implement a patient portal, but also need to consider how they engage with healthcare consumers.  This will become even more important as we continue the shift away from fee–for-service to value based care.

Many people believe that most patients are passive consumers of healthcare, but a study by the CDC found that 68% of adults are actively trying to prevent at least one major chronic illness.   Dr. Ram described that we are “moving from this quick fix, reactive, I’ll see you when I’m sick mindset to a wellness oriented, proactive, let’s fix the problem before it occurs mindset. ”  Where are the patient portals that facilitate this kind of interaction?

People are not worried about sharing their health information online if they see value.  We know this because we see them using online patient communities every day.  However, we need to understand the user and their specific health needs so that we can provide information, coaching and resources highly tailored to that patient.  This highly tailored health experience is what could make regular patient portal use the norm and leads us down the road to behavior change.

To create engaged patient portals that drive behavior change, Dr. Ram asserted that, “It’s got to be mobile.  It’s got to be social.  You’re not going to change behavior without social pressure.”  Behavior change is social and that does not mean one person or a million people.  We need a small handful of people who care enough to be engaged in your life.  The technology that enables this is what will make the difference.

Furthermore, social pressures don’t all have to be human.  We can let the simple nudges happen automatically while we leave the higher value, more difficult things to humans.  This philosophy understands the value of automation while still embracing the value of human touch that doctors and friends provide.  Social rewards from both humans and computers matter more to the next generation of patients than money.

Healthcare is going through a fundamental software-based transformation.  Part of this has been driven through government regulation, but the more dramatic change will be driven by the empowered patient and the need to drive down healthcare costs.  The patient portal can play a key role in that transformation if healthcare providers use it to engage patients and leverage social pressures to effect behavior change.

Check out the full Healthcare Forum presentation by Ashwin Ram, PhD embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

Balancing EHR Change vs Train

Posted on May 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was talking with Heather Haugen from The Breakaway Group (A Xerox company) today and in our discussion she used the word “train”, but I heard the word “change”. I always love a good play on words and so it was interesting for me to consider the difference between change and train in an EHR implementation.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.