How to Achieve EHR Mastery
This is an excerpt from a recent Arch Collaborative webinar featuring Adam Gale, President of KLAS Research and Taylor Davis, VP of Business Development and head of the Arch Collaborative.
Together they discuss what the Arch Collaborative has discovered about the impact of organization culture on clinician satisfaction.
Adam Gale:
So let’s talk about mastery. Mastery is one of those that, when I think about it I even twitch. When I think about training people want me to do, I think about how education is expensive and challenging. I think we can all remember a time that we’ve gotten together a group of physicians on a Saturday morning, they come in for half a day and get a mediocre training that creates more frustration than success. So, training, is that really the key? How do we get to EHR mastery and what are we finding in the data that can help us move forward in a real, tangible way?
Taylor Davis:
Training and education are things that we all give lip-service to, but we have incredibly varying degrees in terms of how much we believe it. Let me give you an example; I just want to highlight the variation. We’ve spoken to some organizations that say, “we do 16 to 20 hours of onboarding for a new physician as they come on and join our organization in order to learn the EHR.” That was the high end. The low end included several organizations who said, “we just require you – well, we don’t really require you but we encourage you to take a couple of hours and shadow somebody.”
As we speak to some of these users, they say, “yeah, that’s not working very well.” I actually was on the phone with an organization recently and we talked about how their initial training was lacking. The CMIO told me that when they came into the organization, “I was trained on the EHR that I had used before. By the end of the training, I was doing most of the training and I had very little experience on this EHR. I had only used it for about a year before.”
That’s a stark wake-up call when we talk about training. Let me share with you three statistics that highlight that training is not working in this country right now. And I’m going to move away from training to EHR education because I think it’s a more wholistic term.
If you asked physicians, “hey what describes you as a physician: are you expert, advanced, intermediate or struggling?” Adam what do you think, what percentage would put themselves in the intermediate or struggling category?
Adam Gale:
I hope not my doctor.
Taylor Davis:
That’s exactly right! And I would wager that 90% would put themselves in the expert category. And they should! They’ve gone through an incredible amount of training and education.
Adam Gale:
And they know it. So they’ve done the training and they’re typically very good at the medical profession.
Taylor Davis:
And this is really a miracle of medicine, right? That there are as many good clinicians and physicians as there are out there. What’s interesting is we ask this question about the EHR and this is the feedback we get. Over half put themselves into the struggling or intermediate categories with the EHR. As we’ve talked about, this is painful to do. I don’t like being just kind of mediocre at anything. At the same time, this highlights a disconnect that we have going into the 21st century where, “I can be an expert physician, but I don’t have to be an expert technology user.” And at some point, these two just have to come together, right?
Adam Gale:
And in some ways, it feels like a total reversal, right? Only about 10% would be my guess that would say, “hey I’m not an expert in my field.” But you only have 10% who say they are an expert in the EHR. So, there’s clearly not an expectation that in order to be a great physician you need to be great with the EHR.
Taylor Davis:
Yeah! So we’re encouraging organizations to please use this graphic. Use these types of graphics and say, “is this where we want to be?” And I believe strongly that clinicians and physicians will say overwhelmingly, “no this isn’t where we want to be.” We want to be the most proficient at using technology to improve the care that we’re delivering.
Two more data views here. This was absolutely shocking to us. I actually remember the day that I pulled you into my office and said, “look at this, Adam!”
Adam Gale:
And this absolutely broke one of the expectations that I had going into this which was, over time you become great with you EHR.
Taylor Davis:
We expected organizations who’ve just come live in the last 12 months are going to have lower satisfaction on average than those who’ve been using it for several years because those organizations will have figured it out. We have sliced and diced this data in every way. At an organizational level, at an individual level. Here it is at an organizational level. There is almost never a trend here across an organizational level. There is no trend across organizations. People who have used the EHR for longer are not more satisfied. We’re not getting better over time. And as painful as that is, it’s a huge opportunity.
How many organizations have I shared this with and said, “your users are not getting better over time.” And they respond, “yeah it’s because we put it in and forgot about it.” So this is a huge opportunity as an industry to help you get better every year with the EHR and more and more effective. How many times have we heard folks say you can’t learn everything about the EHR with the first training?
Adam Gale:
And I think about how this maps to my own experience playing the piano, which I know is the exact opposite of yours. I practices the piano for 5 years and never got any better. It was because I never had a target of becoming and expert. It was something that was forced on me that I just had to do. You, Taylor, I know are phenomenal on the piano. But if you didn’t keep up with it, you would lose the skills that you have.
Taylor Davis:
And it’s funny, you can say that the EHR shouldn’t’ be like a piano. It should be easy enough that I can just pick it up and I can use it. However, this is the most complex services industry that the world has ever seen. I use that quote often and I’ve never had anybody challenge me on it. And it’s rapidly changing. So we really can’t expect the EHR to not change or not evolve. So when I went to college I spent several years without playing the piano. And my wife and I, after a few years of marriage, bought one and I went to playing again. I was horrible!
So a lot of this is looking at how much time do we spend in follow up training? And you can see here that over half of physicians report that they do no follow up training at all.
Adam Gale:
Brutal. Absolutely brutal.
Taylor Davis:
This is just a way of setting the table. So, lets talk about what training does work, and Adam I don’t know if this has ever come up before as you have conversations about looking at how many resources we should invest in initial go-live training, or the ongoing training for clinicians. But what we looked at was this correlation that we felt was amazing.
We asked clinicians, “did you initial training prepare you well to use the EHR?” What we looked at was, those who strongly agreed that it does help them use the EHR, have a net experience score of 52.8, those who strongly disagree have a net experience score of -26. Do the quick math, that’s a 78.8 point difference!
Then we started thinking, how long does this effect last? If over time this goes away? After a couple of years, everyone is at the same place even with bad initial training then maybe that initial training is not as big of a deal. But look at this. For those who’ve been live with their EHR for 5+ years, the gap is still over 70 points.
Adam Gale:
So if you didn’t have a good initial experience, you’re in big trouble. So it almost sounds like it’s hard to over-invest in that initial training. It will pay off for years to come.
Taylor Davis:
I think that’s a great word to use. A Scar. I have a few kids. You know they fall down and cut themselves and you go, “Alright, should be butterfly bandage that, or should we do this right?” and the reason why you’d sew it up correctly is you don’t want a scar. And you really don’t get a second chance at that. And a lot of organizations who have gone too light on their initial training – they have a scar that they’re now dealing with.
Adam Gale:
And by the way, can I go back to one thing? So Heidi just made a comment about why people that have been on the EHR for 5 years and longer may not feel like they’re better at the EHR and more successful. I can picture a new physician that’s been on the system for a month or two, they’re clicking on something that the physician has been there for 5 years has no idea even exists. It was part of two upgrades, they haven’t been trained on it! And the same thing happens with my own kids with my iPhone. They come up to me and say, “Dad why are you doing it that way, there’s a much easier way!” And I feel a little bit embarrassed in that moment that I didn’t know that existed. But I think Heidi is right that the assumption of you getting better over time breaks because the EHR product keeps changing literally under you feet. So if you don’t keep up, there’s no way you can feel like an expert.
Taylor Davis:
And there’s comment after comment from physicians saying, “The EHR keeps changing, that’s so frustrating to me.” But I don’t think anyone wants an EHR that stays the same. So at the end of the day I think the only way out of this mess is ongoing training.
Our goal with the Arch Collaborative is to make this a science, more than an art. So here are a few data views as we talk about training.
Adam Gale:
Yeah how much training do you really need? Because I think you can over-train. If I make my doctors do 50 hours of training, that’s going to be a nightmare.
Taylor Davis:
And so we see there’s not a perfect number. But we see a real drop-off if you’re doing less than 6 hours of training for new clinicians. So we’re encouraging organizations to do 6 hours. What’s interesting is that, as we keep updating these numbers, we asked if they require a test or not. Not a big difference between those who do have a test and those who don’t.
Adam Gale:
And why do you think that is, because I would assume that if there was a test you’d be more serious about your training?
Taylor Davis:
Well we need to split out the group that is doing a test into two groups. Because we’ve been asking, “do you have a test?” However, a number of those we’ve asked who have a test, when asked if there is a ramification, very few will say “well if you don’t pass the test, we don’t give you a login.” So it’s our believe that testing is a little bit empty right now.”