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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.

My Least Favorite EMR Vendor Sales Line

Written by: John Lynn

A feature of every EMR vendor is a whole multitude of sales lines. If you’ve ever talked to a EMR sales person, you know what I’m talking about. This isn’t really unique to EMR sales. The same can be said of most software that’s trying to solve complex problems.

Well, there’s one EMR vendor sales line that gets on my nerves more than any other line. Let’s take a demo of an EMR vendor’s templates. Now here’s the line that I absolutely abhor:

“You can make it do whatever you want.”

Hearing this is like hearing fingernails on a chalkboard for me. Certainly, the intent of their comment is that the EMR template creation is really flexible (and it very well might be). However, the superlative “whatever” is just wrong. Every software system has limitations and I can guarantee you that if you really start using an EMR system you’re going to bump into those limitations.

I guess my problem is using superlatives like whatever, any, all, always, etc. is just misleading and leads to what I call EMR sales miscommunication. Anytime you hear one of those things during an EMR demo (or even during an EMR training) you better start asking lots of questions.

Of course, these superlatives do a lot better job selling EMR software. I guess that’s why I’ll never be an EMR salesperson. Maybe it’s also why people seem to like reading my EMR blog posts.

Sink or Swim After EMR Purchase

Written by: John Lynn

I find it really disturbing the number of stories I read about doctors who have purchased an EMR basically being left to ‘sink or swim’ once the EMR purchase and training process is complete. This is not always the case. Some EMR companies really take a vested interest in those who purchase their EMR software. That’s my biggest compliment of the EMR company I work with on a daily basis is that they really did care about us having a successful EMR implementation. I know a number of others who are just as vested in a clinic’s success.

Unfortunately, far too many EMR vendors don’t take a vested interest in a practice and after the purchase and initial training, the practice is basically left to finish the EHR implementation on their own. Let’s take a look at a common example of what happens:
-Clinic purchases EMR software
-Clinic spends a few days training on EMR software
-Clinic sends support request which goes unanswered
-Clinic gets answer to support request a week later

It should also be noted that the few days spent with the trainer is often untargeted and aptly described as a firehouse which mostly leaves those being trained with a huge migraine. Also, it’s worth mentioning that the clinic ends up floundering along for that week they waited to get their support request answered.

Certainly supporting a new EMR implementation is a significant challenge. Many popular EMR vendors have oversold and just don’t have the trained, skilled staff that are needed to support the number of clinics they’re bringing online. That’s not an excuse for the EMR vendor. They should still be held accountable. However, it’s helpful to understand the challenges an EMR vendor faces so you can possibly avoid them.

Like I said previously, not all EMR vendors have this challenge. This being the case, it highlights the need to talk to users of any EMR software you’re considering. Ask them about the type, speed and quality of the support they receive from the company as a current user and what support they received when implementing that EMR vendor. Also, try to talk to someone who recently implemented that EMR software. Much like a new mother forgets the pains of child birth, EMR implementation pains disappear from memory (see my previous post on EMR and Pregnancy). Plus, in most EMR companies the support and training changes over time as employees come and go. The more recent the support experience the better.

At the end of the day, an EHR implementation does require a determination to ‘sink or swim.’ However, it’s much easier to swim when you have someone throwing you a line along the way.

Beware of Errors on Test or Demo EMR System

Written by: John Lynn

I’m sure that many of my readers have experienced the awkwardness of an error happening during the demo or training of an EMR system. I’ve been on both sides of the fence (watching or doing a demo) and let’s just say it’s really uncomfortable for both sides. Those that have experienced it know that the most common explanation for the error is “This is the demo system and so we haven’t finished setting everything up.” Or in the case of the training system, “This is the training system and so with all of the people training on this system it has some errors from those training on it.”

In some cases, this is completely true. When I’m training my staff for an update to our EMR software, there has been a number of occasions where I was just too lazy to set something up on our test database and it doesn’t work quite right. So, it does happen.

The difference between myself (most of the time) and those demoing and training you on an EMR system is that I’ll make note of the problem and make sure that indeed it was something I could easily fix. If I can’t, then I escalate it to our EMR vendor for resolution before we proceed with the upgrade. Those showing you the demo or training you might do the same. However, if you’re training on the system, there’s little chance the fixes they request will be implemented before you implement the system.

Even more to the point is that far too often it’s not something to do with the test or demo system, but is often an error in the program itself. It’s a good idea to evaluate the error you saw. This can be a real challenge since the trainer is often going to blow by the error as quickly as possible. However, don’t be afraid to call them out on the error. This is going to be the heart of your practice. Make sure you really know if those errors were temporary or chronic. Nothing’s more of a pain than regular errors from your EMR software.

5 Reasons Your EHR Implementation Will Succeed

Written by: John Lynn

I recently read a really interesting and informative article called “Five Reasons Why EHR Implementations Fail.” My only problem with this post is that it focuses too much on the negative. Too many doctors (and all clinical staff) are looking for reasons to have their EHR fail and not enough of them are looking at the reasons why an EHR implementation will succeed.

Therefore, here’s my 5 reasons why your EHR implementation will succeed.

Amazing Trainers
There are amazing trainers out there that have gone through hundreds of successful EHR implementations. Make the time for staff to utilize one of these trainers and you’ll see amazing results in implementing an EHR. Soon after implementing your EHR you’ll wonder how you practiced medicine without an EHR.

Realistic Implementation Schedule
Create a realistic implementation schedule and stick to it. Be open to modifying the schedule as needed, but don’t let excuses get in the way of your plans. Everyone is always busy. Staying on schedule is more about making the EHR implementation a priority. Make it a priority and you’ll have no problem staying on schedule. Also, remember that you don’t have to bite everything off at once. Take it in stages and celebrate the milestones you achieve.

Succeed Despite Challenges
Tons of unrealistic expectations exist around the benefits of EHR implementations. One clear expectation is that every EHR implementation has unique challenges. However, thousands of doctors have faced these challenges and successfully implemented an EHR despite the challenges. There’s no reason you can’t overcome your own unique challenges as well.

Forget About Timing
Certainly there are some times that are better than others for implementing an EHR. You know your practice and should schedule your EHR implementation during a slower time for the practice. However, once you’ve made the decision to implement don’t dwell on the timing, but instead focus on ways you’ll overcome whatever challenges happen because of timing. Reminds me of a common phrase said about marriage, “Before marriage keep both eyes open. After marriage keep both eyes closed.” Apply the same conviction to implementing an EHR and you’ll be amazed by the results.

Create Clinical Buy-In
Each situation is unique, but don’t be surprised if some of your most ardent opponents turn out to be some of your most powerful users. The person complaining about an EHR implementation are probably the same people that are complaining about finding paper charts and illegible charting. An EHR does amazing things to solve these problems. Focus on these types of benefits and it’s very likely that you’ll have more clinical buy-in than you’d have every expected.

Summary
We too often focus on the challenges of an EHR implementation that people easily ignore some of the many reasons why your EHR implementation will succeed. I guess my point is that the glass is half full if you want it to be.

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EMR Implementation Training and Computer Training

My Least Favorite EMR Vendor Sales Line

Sink or Swim After EMR Purchase

Beware of Errors on Test or Demo EMR System

5 Reasons Your EHR Implementation Will Succeed

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