Building a Targeted Training Program for the EHR

At UC Davis Health, we are highly focused on improving the physician experience with the EHR. As the Manager of Clinical Informatics, my team and I have had the privilege of being on the forefront of making a difference in this arena. I’d like to share some of the keys to our success in informatics in the hopes that what we have done can inspire similar organizations.

Personalized Education

First and foremost, UC Davis Health looks to meet physicians at the EHR education level that they are at. This means that we train physicians using highly personalized education in order to customize the content. We want to make sure that we are not training physicians on tools that they already know because that is not a valuable use of their time.

If we provide training for physicians that is duplicative or irrelevant to their specialties, there is real potential to lose our physicians’ faith and trust in our team and our education. To avoid that, my team and I make sure to do our homework first. We work to get an understanding of the tools that our physicians are currently using and which tools they are not aware of. We also look at EHR tools that our physicians may have tried a year or two ago but didn't really like or didn't know how to customize in order to fit the workflow.

While system analysis can provide powerful insights into how physicians utilize the EHR system, it’s crucial to place the data in the context of the physicians’ workflows.

Being on Location

In order to provide the most impact and evaluate physician workflow, my team actually works out of clinic locations. Our team wants to teach the most impactful tools for physicians, especially the tools that can be used within physicians’ workflows. To do this, my team is physically present to observe the workflows firsthand. As we developed our program, my staff members have needed to spend less time shadowing because they have gained an overall understanding of what our ambulatory clinics are like. However, there are still some nuances to different subspecialties that are valuable to watch for.

After the shadowing and system analysis are conducted, we hold one-on-one training sessions for each physician. While our staff members rely heavily on the training plan they’ve developed for each physician based on the system analysis and shadowing, changes can still be made based on what my staff members are seeing. During one-on-one training time, my staff members can see the nuances of a specific physician’s workflow, and they will note whether a physician documents in a different way. My staff members also observe whether a particular subspecialty has unique workflows. They will see that information and quickly tailor the training to make sure that it fits the needs of that physician.

Reinforcing Education

In addition to our one-on-one training for each ambulatory primary care and specialty care physician, my staff members do rounding to reinforce the content that they taught previously. They are in every single ambulatory clinic three times a year. During rounding, my team answers any questions that physicians have about the EHR and shares one critical piece of information. Our rounding content is variable; sometimes it is new content that has been rolled out into the EHR, sometimes it is information from the enterprise level that isn't being adopted very well or that can be re-emphasized, and sometimes it is about a specific workflow.

Although the majority of physicians are open to our one-on-one training and rounding efforts, there are some physicians that are just not interested in the trainers’ help. When that happens, the trainers will sit wherever the physicians are documenting and simply watch. It’s not intrusive; the trainers won't be looking directly over somebody's shoulder, but they'll observe the workflows that the physicians are going through. If one of our trainers identifies a particularly inefficient workflow or is aware that there's another tool that would actually improve the physicians’ experience with the EMR, that trainer will go up to the physicians and say something like, “I noticed that you ordered your labs in this way. Did you know that this tool for quicker ordering exists?” At that point, the trainers gain trust with the physicians because they're able to see where further education can provide value.

Build Enhancements

In addition to training, we implement build enhancements. To complete enhancements with a few weeks of turnaround time, we provide clinics with a build menu. The items on our build menu are a subset of enhancement items that require minimal operational governance to be implemented.

These build changes, combined with personalized education, can significantly improve the physicians’ experience with the EHR system. For example, when my team worked with our ophthalmology department, we first looked at the analytics and noticed that certain physicians were receiving a large number of results messages. In order to validate that the trend we were seeing in the data was accurate, we went back and asked the subject matter experts over the group whether it was necessary for these physicians to receive those messages. As it turned out, physicians were receiving results from ophthalmology exams that they ordered and interpreted on the fly during the office visit. Of course, the physicians knew that the exam was resulted because they were the ones who resulted it, but they were still receiving automated system messages notifying them of a new result.

What we ended up doing was a testament to the great partnerships that we built across our health system with IT, operations, and clinicians. Because of these partnerships, we were able to go to our compliance group and ask whether those messages were legally required. As it turns out, they were not. We were then able to turn off all of those automated result messages with a simple build change. The ophthalmology group saw a decrease of 70% for that message type. For some individual physicians, that meant that they were seeing 50 fewer messages a week.

Sharing Success 

Oftentimes, my team is looking for those types of quick wins like we saw in our ophthalmology group in order to gain trust with physicians and support for our efforts in clinics where we haven’t worked yet. When we have a successful engagement in a clinic, we will frequently ask a physician in that clinic to come with us to a new group to discuss his or her experiences with my team. The physician champions will highlight something that our team implemented or some training that we provided in order to discuss how it’s made an impact. In our experience, physician-to-physician communication can help to break down barriers and negative perceptions of the EHR and those working to try and improve it. This method helps create excitement among new clinics that we haven’t worked with before and gives clinics ideas if they are facing a similar situation. Although the build changes will often need alterations to be appropriate for another subspecialty, many of the EHR tools and solutions can cross over.

Willing to Make a Difference

My background and previous experience are both in politics and project management of EHR implementations; it is not in development of EHR training programs. The irony isn’t lost on me that I have now focused my career on the development of training and optimization programs, but I think that speaks to our unique group. Most of my staff members’ backgrounds are not traditionally in physician or clinical training. While I know that some vendors have touted specialists training specialists as the most impactful method, we've had success by looking for people that just want to make a difference and improve the lives of the physicians. My staff members are always willing and excited to learn and take on just about any challenge. It is our team’s commitment to provide physicians with the best customer service and physician training as possible. While we won’t be able to resolve all of the EHR challenges that physicians are facing, we can make an impact by working with individual physicians to improve their experience and ensure that the EHR technology is supporting their work instead of detracting from it.

 Melissa Jost is Manager of Clinical Informatics at UC Davis Health, and a member of the 2020 Arch Collaborative Faculty.