EMR Concern

How Training Impacts EMR Success: A Widespread Concern

When it comes to usability within the EMR, the conversation has grown beyond the borders of America. As the world’s healthcare grows increasingly digital, providers from Nordic countries, the Middle East, Australia, the UK, and Singapore have come to me asking, “How do we maximize the output on this thing?”

“This thing”, of course, is the EHR. It seems that we collectively have this notion of how EHRs should help with patient care. But in many instances, the EHR is viewed as an impediment, a frustration, or even a danger. For many physicians, the EHR stands as a barrier preventing them from doing what they are trained to do: take care of patients.

In these far-flung conversations with IT leadership, I often ask, “Does the EMR strongly enable care? Do physicians agree with your answer?” I get massive disparity in responses. Contrary to what you read, some providers respond, “Yes! Absolutely!” and their clinicians agree! Still, there are plenty more who view the EMR as, and I quote, “the signature disaster of [their] career.”

Why is that? The answer could simply be, “It’s a crappy piece of technology” or even, “You can’t teach old ‘dogtors’ new tricks.” But as I look deeper into the mountain of data that the Arch Collaborative has generated, I think we have less of a technology problem and more a change management problem.

At a recent track meet for my daughter, a physician friend bemoaned the recent go-live of a new system in his practice. He explained, “I am convinced that the successful implementation of this EMR will come on the backs of primary care providers like me. Our organization is spending all this money to implement the system, but at the end of the day, the physicians will have to carry the success of this thing.”

I asked him, “What do you mean?”

He said, “Well, I am seeing fewer patients per day on average then I was before go-live. The organization has an expectation that the EMR will make care easier and more efficient, so, it’s up to me to carry this along.”

I asked him three questions.

Are you a bad physician?

He said, “No—I have been doing this for 25 years. I have seen plenty of patients, but I am seeing fewer with this new EMR.”

Okay well is it that your health system hasn't done a good job rolling out this EMR?

“I don’t know. I mean, I go out to the mandatory training, so I can get my login and so forth, but you know . . .” He shrugged.

Finally, I asked, “Well what about the EMR you’re putting in? Is it a garbage system?

“I don't think so. It was expensive and has functionality out the wazoo.”

If the physicians, rollout, and system itself were satisfactory, then where was the gap for my friend and his organization? I think it comes down to what we are seeing in the Arch Collaborative data: training is key. Whenever I hear that a health system is struggling with their EMR, my thoughts go immediately to the following questions, “How much training did you do? What kind of training was it? How long did you take? Was there a trusted clinician at your elbow who walked you through implementation? How personalized is your EMR experience?”

Imagine someone were to give you a smartphone let you loose with it. Given time, you would probably be able to personalize your experience with that device just fine. Now imagine an experience like the one my friend (an Android user) had recently when he asked his wife (an iPhone user) to add a stop to the Google Maps route on his Android phone mid-drive. She was trying to navigate a system that was neither familiar nor personalized to her. He, as the driver, couldn’t take his eyes off the road or his hands off the wheel.

Time was of the essence as their exit was coming up. Without that additional stop programmed into the route, they wouldn’t know which off-ramp to take. The pressure mounted, and my friend’s wife threatened to hurl the phone onto the interstate, littering fee or not!

Healthcare is much like the second scenario if you multiply the complexity to the nth degree. Patients don’t stop needing their doctors just because a new system goes live. Like my friend, doctors cannot shift their focus from their work, and like my friend’s wife, doctors must often navigate unfamiliar workflows without understanding the new tools given to them.

This creates enormous amounts of stress. If we don’t give clinicians the needed time and space to receive thorough training and personalize their EMR experience, delays, detours, and even breaches of safety will continue to plague our health systems.

Initial training, when viewed through this lens, shapeshifts from a box to be checked off to a make-or-break part of EMR success. We have piles of data now that show that when a health system employs the proper change management, it can have success with just about any go-forward EMR.

The software doesn't have to be the most expensive or the most popular. That is the encouraging thing in all of this: there is opportunity for improvement across the board, regardless of the technology an organization has in place.

The best part? We know who has done this successfully! We’ve begun uncovering those organizations who, with thoughtful planning, skill, and the right priorities, have delivered on training to huge success.

We are beyond excited that participants in the Arch Collaborative have access to their insights and best practices and are eager for many more organization to learn with us by joining the Arch Collaborative. We hope that the Collaborative data will, like a rising tide, raise all the ships in the harbor.