Self-Directed eLearning 2023
A New Approach to Educating Clinicians
As Arch Collaborative members recognize the positive impact that robust training and education can have on clinicians’ EHR satisfaction, they are looking for ways to scale their education programs quickly with limited staff and budgets. Organizations are increasingly turning to eLearning—both to scale clinician education efforts with small budgets and to meet the demand of recent graduates from medical and nursing schools, who often prefer this format. This report provides examples of how eLearning can be implemented strategically as a convenient, cost-effective training method that complements traditional instructor-led training.
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Methodology
For the purposes of this report, “eLearning” refers to self-directed electronic learning. “Virtual training” refers to the broader combination of eLearning and instructor-led virtual training. The data in this report comes from four sources†: (1) clinician responses to the EHR Experience Survey, (2) clinician responses to the Trainer Quality Benchmark Survey, (3) responses from healthcare organization leaders to the Executive Survey, and (4) interviews with organizations that receive high marks from clinicians for the helpfulness and effectiveness of tip sheets and self-directed online training.
† About KLAS Arch Collaborative surveys: The EHR Experience Survey asks clinicians approximately 40 questions about their EHR experience and how it relates to their well-being and ability to care for patients. Key metrics from this survey are used to create an overall Net EHR Experience Score and to generate peer benchmarking. The Trainer Quality Benchmark Survey asks clinicians 11 questions about their satisfaction with the EHR training they have received and the trainer who provided it. This data allows organizations to compare their training with that of other organizations and allows them to benchmark satisfaction across individual trainers at their organization. The Executive Survey is designed to provide perspective on EHR governance and utilization and includes approximately 27 questions related to training and education efforts.
eLearning Done Right Can Be Just as Impactful as Other Training Modalities
Many healthcare organizations are deploying eLearning tools that help them successfully scale education, enable clinicians to learn at their own pace, and free up training resources to spend more time both creating valuable specialty- and role-specific materials and interacting with clinicians individually. While past Arch Collaborative research (such as the 2021 Clinician Training report) showed in-person training was significantly more effective than virtual learning, additional data collected in recent years shows that robust eLearning can have an equally meaningful impact on the clinician experience. In-person training, while still associated with the highest satisfaction, is only slightly ahead of eLearning. When eLearning is done well, it doesn’t come with a sacrifice in impact. This trend holds true across clinical backgrounds, organization types, and EHR solutions. And over the last few years, clinician satisfaction with virtual training‡ has increased.
‡ Virtual training includes both instructor-led virtual training (such as webinars or remote classrooms) and self-directed eLearning. The KLAS Arch Collaborative first began measuring virtual training as a single category in 2020 but has recently begun to collect data on the two distinct categories. Future reports will continue to explore the differences between instructor-led virtual training and self-directed eLearning.
Strong eLearning Is Connected to Lower Clinician Burnout and Higher Trust in IT Leaders
Arch Collaborative data shows that increased adoption of virtual training is correlated with a significantly better clinician experience. The quality of training is also vital to maximizing the impact—clinicians who agree virtual EHR education is helpful and effective are less likely to report feeling burned out. These clinicians are also 73 times more likely to report satisfaction with organization and IT leadership around the EHR (compared to those strongly dissatisfied with EHR education). Some of this effect is rooted in inherent benefits of the eLearning method—eLearning is usually easier to access and consume, can be tailored to specific roles, and is often packaged in shorter sessions. eLearning tools are also continuing to evolve and incorporate sophisticated adult learning methods, which may further increase eLearning’s impact on the clinician experience.
Clinicians’ Sense of Value from eLearning Is Trending Upward
While clinicians have historically reported at-the-elbow EHR training is their preferred training type, an increasing number are embracing the advantages of eLearning. Data from the Trainer Quality Benchmark Survey shows the percentage of clinicians who would recommend eLearning courses to a colleague has increased from 67% in 2021 to 83% in 2023. This coincides with an increase in the percentage of clinicians who agree eLearning courses were very valuable—64% in 2021 compared to 80% in 2023. The quality of eLearning programs and platforms has improved, and newer entrants to medical practice are more likely to have used these same types of platforms during their education. All of this means clinicians are more likely to engage with education in an eLearning format. Many clinicians say they enjoy the self-paced and on-demand nature of eLearning tools. Having access to a library of learning modules empowers clinicians to review concepts as needed to reinforce previous learning and learn new workflows that improve their EHR efficiency.
Voice of the Clinician
“I prefer to do virtual self-directed training. I can review whatever I might need to. I like direct contact with a person, but I don’t remember all they say, and then they need to repeat what they have said. I feel it’s not as efficient as when I’m working with the computer on my own.” —Nurse
“Self-directed training gives me autonomy to go through the training at my own speed and really learn what steps I am taking.” —Physician
eLearning Improves Scalability and Reduces Expenses Associated with EHR Education
As healthcare organizations grow, scalability of training programs is a top concern. Frequent updates and changes to the EHR can stretch thin the resources allocated to training and education. One of eLearning’s biggest advantages is scalability—both in content and total number of learners. For example, eLearning modules can be modified or added to at any time, and the most up-to-date materials can be automatically distributed to the relevant clinicians. Another unique characteristic of eLearning is that it provides consistency—content is created at a single point and deployed so that every learner receives the exact same information. This can reduce challenges associated with trainer variation, and it can ensure every clinician receives the highest-quality content possible. eLearning is especially helpful in empowering clinicians to consume education in their own clinic/hospital, without the need for clinicians or trainers to spend precious time traveling. eLearning also enables organizations to quickly customize and distribute highly specialized materials to the right subset of learners.
Learn from Your Peers: Allina Health
Allina Health had a large EHR upgrade that affected the workflows of 9,000 employees in more than 50 roles. Because approximately 80% of the content was the same for all roles, the LCMS (learning content management system) allowed Allina to create one base eLearning and then quickly customize the other 20% of content. This resulted in 11 unique eLearnings, and employees received education that was customized to their role. Without the LCMS, these 11 eLearnings would have taken several months and significant resources to create. Instead, after the initial eLearning was complete, the other eLearnings were complete within two weeks.
Increased utilization of eLearning content can also reduce costs associated with classroom-based training. Due to its web-based, asynchronous nature, eLearning is available to clinicians regardless of where they are located or when they choose to access the content. Increased utilization of eLearning reduces the overall time clinicians spend in the classroom and can generate a significant ROI in time savings. On average, clinicians who participate in self-directed eLearning report they save 90 minutes per week in the EHR for every hour they spend engaged in eLearning. Such time savings are applicable for both onboarding and ongoing training. Some organizations in the Arch Collaborative have said eLearning frees up both trainers and members of the informatics team so they can focus on other training-related tasks—e.g., content creation, at-the-elbow support.
Learn from Your Peers: Baptist Health (Jacksonville)
Baptist Health (Jacksonville) partnered with Divurgent to develop eLearning modules that continued the onboarding training process—successfully reducing the traditional 4-12 hours of classroom training to 1-2 hours of eLearning. Divurgent assisted Baptist Health in developing a series of simulation-based eLearning training modules. These modules were embedded in the learning management system and allowed end users to follow along and interact with the tool to properly document the case. Utilization of these eLearning modules led to a more than 11-point increase in clinicians’ satisfaction with initial training. Baptist Health also estimates these eLearning modules save $37,500 for every 25 newly onboarded physicians, while simultaneously freeing up 0.5 FTEs on the clinical informatics team.
eLearning Best Practices
To better understand how to effectively leverage eLearning content, we identified organizations whose EHR Experience Survey respondents reported high agreement that their organization’s tip sheets and self-directed online trainings are helpful and effective. Education leaders involved with the creation and deployment of eLearning content at four of the top ten highest scoring organizations were interviewed. The following leading practices are used by at least three of the four interviewed organizations. These leading practices are further supported by previously published Arch Collaborative case studies and data collected through Arch Collaborative surveys.
Creating Effective Content
- Create modules that are brief (less than two hours) and interactive
- Carefully curate content to meet specific needs
- When possible, use content from EHR or third-party vendors as your foundation
- Expensive software is not needed to create high-quality eLearning content
Optimizing Deployment
- Increase ease of access by using multiple, on-demand sources
- Provide clinicians with orientation to the eLearning platform to increase engagement, set expectations, and reinforce how to access support
Ensuring Mastery
- Leverage proficiency assessments to track and drive individual EHR mastery
- Supplement eLearning content with in-person/at-the-elbow support to reinforce learning and quickly address unique needs
Creating Effective Content
Create modules that are brief and interactive
All four of the high-performing organizations interviewed for best practices indicate that their individual eLearning modules last roughly one hour. This seems to be a common practice across organizations as 80% of clinicians say the eLearning modules they complete typically last 60 minutes or less. In fact, clinician perceptions of a training’s value decrease as the training extends beyond two hours. Keeping content concise prevents redundancy and keeps clinicians engaged for the duration. In comments from the Collaborative’s EHR Experience Survey, clinicians frequently note appreciation for the ability to easily access needed content without having to sit through lengthy classroom sessions that interfere with clinical responsibilities.
In addition to being brief, eLearning content must be interactive. It is not sufficient to simply record traditional classroom content for clinicians to watch at a later time. Curriculum should be adapted for a digital format and include a hook to grab the learner’s attention, incorporate variety in the presentation, and contain knowledge checks that require the learner to engage with the material. For example, problem-based content encourages clinicians to discover how the content can directly benefit their workflows and proactively empowers them to overcome obstacles to achieving personal EHR efficiency.
Voice of the Clinician
“Self-directed learning is most helpful for me because I do not like adding additional meetings during the day. So being able to fit short learning videos into my schedule when I have time is helpful.” —Physician assistant
“I enjoy being given direction on where to find areas of documentation and being able to click through the EHR to practice while completing training videos at my own pace. I have never felt this level of interactivity in a classroom, and it helps me focus on the content.” —Nurse
Carefully curate content to meet specific needs
Not all eLearning content is intended to serve the same purpose. When developing eLearning materials, identify the specific goals of the training and let those goals guide the content creation. In general, longer-form videos are more effective for initial training, while self-serve tip sheets and resources are more effective for ongoing education and in-the-moment support. For example, several organizations in the Collaborative use initial training videos to help newly hired clinicians familiarize themselves with the basics of accessing and navigating the EHR before their first day on the job so that they are better prepared to learn specialty-specific workflows once they start. Conversely, self-serve tip sheets are an effective option for ensuring clinicians adhere to standard workflows and documentation for infrequent procedures. In all cases, eLearning content should be continuously evaluated and modified based on end-user feedback to ensure it meets specific clinician needs.
Case Study: Aspirus Health
Aspirus Health developed a curriculum review board for all of their education content. This review board included individuals from operations and IT as well as managers and superusers. The review board was tasked with evaluating content and articulating the “why” whenever they moved something to the eLearning system. They also determined whether content would be best delivered as a video, tip sheet, or hands-on experience. By curating their educational content through uPerform, Aspirus was able to increase the effectiveness of their eLearning and drive improved engagement with both eLearning content and hands-on educational experiences.
When possible, use content from EHR or third-party vendors as your foundation
It is not necessary to recreate the wheel when developing eLearning content. All of the organizations interviewed for this report indicate that their EHR vendor provides content for training clinicians on EHR upgrades and workflows. Such content can be used to quickly get clinicians up to speed on EHR changes. Third-party education vendors may also have material that can be used directly or adapted as needed. By building on existing training foundations, organizations can quickly tailor content to meet their specific needs while minimizing development investment.
Get Help Developing eLearning Content
Check out this recent report from the Arch Collaborative for information on vendors and firms that have been validated to assist with the development of eLearning content.
Expensive software is not needed to create high-quality eLearning content
A common misconception is that expensive software is necessary to develop high-quality eLearning content. However, content can be created with common, inexpensive tools such as PowerPoint, Snagit, and Camtasia. As mentioned previously, eLearning modules should be concise and carefully curated. The actual tool used to convey the content is less important than the time invested in creating quality materials. Trainers and informaticists who develop eLearning modules should be trained to create content that is engaging regardless of the tool being used.
Optimizing Deployment
Increase ease of access by using multiple, on-demand sources
All four of the interviewed high-performing organizations give their clinicians at least three different ways to access eLearning content. Common access points include learning management software, information embedded directly in the EHR dashboard, and collaborative platforms, such as Microsoft SharePoint. Having a range of methods to access on-demand eLearning content enables clinicians to both receive quick support in the moment and review longer learning modules at their own pace.
Case Study: Baylor Scott & White Health
Baylor Scott & White Health works together with uPerform to gather feedback from end users and then develop content that is released quarterly with information about upgrades and enhancements. When clinicians are in the middle of a patient encounter, they can use hot keys in Epic to help them understand how to complete tasks and swiftly return to patient care. In this manner, clinicians can easily access resource hubs and learning libraries and search for role-based support in uPerform. As a result of these eLearning tools, uPerform users at Baylor Scott & White Health rate their ongoing EHR training 11 percentage points higher than non-users and achieve Net EHR Experience Scores 12.9 points higher.
Case Study: Franciscan Health
Franciscan Health uses a dashboard to give clinicians access to all upgrade training resources, including tip sheets, PowerPoint presentations, and microlearning videos. Materials are provided by the EHR vendor and supplemented with original material from Franciscan Health. Each user can personalize the dashboard based on how much information they want to see and to show role-specific components. This strategy proactively ensures that educational materials are always conveniently accessible when EHR upgrades and changes are deployed.
Provide clinicians with orientation to the eLearning platform to increase engagement, set expectations, and reinforce how to access support
Organizations say resistance from clinicians who prefer classroom training is one of the biggest challenges to effective eLearning deployment. While it would be hard to completely eliminate this resistance, providing eLearning orientation can reduce the friction clinicians feel when engaging. Clinician respondents to the Arch Collaborative’s EHR Experience Survey are more likely to engage with eLearning if they are shown how to access and use the content. Though it seems simple, providing even a 15-minute orientation to introduce eLearning content, its uses, and the associated expectations can dramatically increase clinician willingness to participate because it provides them with a framework for success. Such orientation may take the form of a video or brief in-person coaching. Additionally, providing contact information for relevant support resources within the eLearning modules can create a positive experience for clinicians who encounter obstacles during training.
Ensuring Mastery
Leverage proficiency assessments to track and drive individual EHR mastery
One difference between eLearning and in-person training is that eLearning often encourages a greater level of interaction and engagement while simultaneously promoting the use of critical thinking. By actively engaging with the EHR through hands-on eLearning modules, clinicians can achieve greater retention. Additionally, organizations can leverage eLearning tools to deliver assessments or quizzes that track EHR proficiency. eLearning can then be used to provide targeted remediation as needed. Through a combination of active engagement and proficiency assessments, eLearning modules can act as powerful drivers of EHR mastery.
Case Study: Providence
Providence partnered with Amplifire to enhance the effectiveness of their eLearning modules. Amplifire shows learners an explanation as many times as is needed to achieve mastery. The adaptive learning modules recognize individual struggle areas and focus on those topics to produce a learning path that leads to true proficiency. Amplifire also offers analytics that are not available in traditional classroom settings, aimed at helping identify individual knowledge gaps so they can be remediated. These tools allow Providence to see what content is resonating with learners and what isn’t so the eLearning modules can be continually evaluated and improved. Providence estimates they have achieved a 25% reduction in total training time by using adaptive learning and analytics, all while improving the quality of training.
Supplement eLearning content with in-person/at-the-elbow support to reinforce learning and quickly address unique needs
All four of the organizations interviewed for this report indicated that while they funnel clinicians primarily to self-serve eLearning modules, they also provide in-person and at-the-elbow support to quickly address unique user needs. One of the organizations notifies their clinical informaticists of all the newly hired clinicians so that the informaticists can proactively round and provide at-the-elbow support during these individuals’ first few weeks on the job. Another approach used is to provide contact information for support hotlines within all self-serve eLearning materials and videos so that clinicians don’t need to wait for an informaticist to come to them before receiving help. Regardless of the specific approach, all of the organizations ensure there are clear lines of communication to support teams. This is a critical element of eLearning because it prevents end users from remaining stuck for extended periods of time. By blending eLearning content with in-person support, clinicians can benefit from both the convenience and flexibility of eLearning materials as well as the knowledge and expertise provided by clinical informaticists and other support individuals. In this way, targeted in-person support can reinforce what is learned through eLearning modules and empower clinicians to improve EHR proficiency.
What Is the KLAS Arch Collaborative?
The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, almost 300 healthcare organizations have surveyed their end users and over 400,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR.
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.