EMR Implementation Training and Computer Training

When someone comes to my clinic to see our EMR implementation, they always ask “what lessons did you learn during your EMR implementation?” It’s inevitable, and obviously a good question. One of the answers I give the most is that I was surprised at how much of the initial training was on basic computers skills and not actual EMR software training.

On that note, I got an email from Michael Archuleta of ArcSys Inc. that described some of the challenges of training before an EMR implementation including training on some of the new technologies (see tablet, convertible, laptop and EMR discussion) that might be implemented with an EMR.

First, no two medical professionals are alike. They have been taught differently and see things through different lens.

Second, people have different computer skills. Some are very adept at tackling new technology, and others are easily intimidated.

Third, the flow of work or processes differs markedly from one group to another.

Regarding observation #1: People are best trained one-on-one. Each has their own terminology and it is best to talk the same “language” of medicine.

Regarding observation #2: The doctors and medical staff are best trained on desktop computers. They are, for the most part, familiar with the keyboard, mouse, and monitor. The hand-eye coordination is a known entity. In particular, knowing how to page up or down from the keyboard. Or, how to move the cursor back and forth across a line using the arrow keys. The monitors are large and they are accustomed to how things look. They are familiar with the location of icons on the desktop. They know how to start up applications and how to close down the pc. Thus, it becomes a really good idea to understand how the application works on hardware that you know. Once you are comfortable with the application, then you can advance to new hardware.

Now, contrast this with a tablet pc. The keyboard is smaller and this usually results in hunting for the location of familiar edit keys like page up, page down, arrows, end, and home. If you are trying to learn a new application and a new keyboard layout, your frustration will skyrocket.

The monitor is smaller. You are going to be spending more time squinting. It may be time to invest some time with the eye doctor and get some new corrective lenses. Again, if you are familiar with the application, you will not be visually hunting for tiny icons.

When using a laptop you will have to use either the touchpad, eraser head, or pen for your mouse. All three require an amazing amount of finger dexterity. If you can recall your initial learning curve with the mouse, multiply that by 10 and you will have an idea of what it will be like to re-learn your mousing skills with this new technology. My recommendation would be to get a regular mouse and plug it in the USB port. It is messy with an extra cord, but is one less thing to learn. Better yet, get a wireless mouse. But, then that is also one more piece of technology…

The desktop of the tablet pc will have different icons. It is a good idea to eliminate as many as reasonable. The hard part of any laptop is knowing how to configure it. A laptop is designed to work off of batteries and thus needs to conserve energy. It will go to “dim mode” when it senses the batteries are losing their charge. It will go to “blank mode” when it decides that you haven’t touched the keyboard in a long time. What you need to know is how to bring it back to life in these (and other) circumstances. Because of these types of quirks, if you are not familiar with the application, you will become extremely frustrated and discouraged.

Regarding observation #3: Baby steps. Implement only one automated procedure at a time. Don’t flood everyone with all the bells and whistles. Make certain that everyone understands a new automated procedure before launching the next one.