For the 8th episode of our Monday Morning Healthcare IT Podcast Series, Tom sits down with HCI's Senior Vice President of Delivery, Jason Huckabay. In this episode, Tom and Jason will discussing EMR training, going over areas such as its importance, best practices, how to deal with common issues, and how these different topics can lead to increased levels of adoption.
In case you missed it, make sure to check out our episode from last week, where Kelly Dungee went over the role of leadership during an EHR Implementation.
EMR Training in Healthcare Organizations
Hello and welcome, everyone. My name is Tom Letro of the HCI Group, and today I am joined by Jason Huckabay, our Senior Vice President of Delivery here at The HCI Group.Jason has worked as a program manager, training manager, and executive advisor, and today we will be discussing various topics related to training during an EMR implementation – such as what can make a training project successful, what organizations should look for when selecting trainers, and why it is beneficial to have the same vendor partner from training through to your Go-Live.Now Jason, why exactly is training so important to healthcare organizations?
So training is important because in order to give proper return on investment and utilization of the system, your staff has to know what they are doing. The training effort is often overlooked because it is not considered an asset to the project plan, it’s usually considered a liability, but there is a lot of expense, and it doesn’t actually focus on the configuration of the system, or tie into any of the ancillary systems, and it is not actually go-live, which is helping patients. So it’s kind of forgotten, but it is critical, because if the end users aren’t trained well, then they aren’t going to know how to use the system come go-live, and then your ability to help patients is going to be diminished, and your wait times are going to go up, and then overall user satisfaction is going to be poor, and it won’t matter how well the system was configured, so training is extremely important.
Communication in the EMR Training Process
Ok, and how does communication play into this? What makes communication so important during your training process?
Well, it’s important to make sure everyone’s aware that training is coming and to get them in the right mindset. Think of it as a new movie coming out. You see ads for the movie months in advance, people get excited around the new movie coming, you generate buzz, and then what happens is you have large attendance when the movie finally makes its way to the movie theatres. Well we want to do the same thing with training, we want it to generate buzz, we want to generate excitement. We want people to look forward to it, this is their first chance of getting into the system, see how it operates. And then hopefully the return is, whenever training classes are open and available, you’ll have full classes instead of having partially full classes, and then you have to worry about will you be able to get your population through training by go-live.
And how do you go about doing that? You used the example of a movie, and for movies obviously you’ll have previews, you’ll have trailers, you’ll have movie posters, and so on and so forth.What would be your movie poster during this process?
Well I think our movie poster starts at the leadership level. You want to communicate with the leaders in your organization, make sure they are on board for the project, make sure they understand the importance of all of their staff being trained, we want them to carry that message forward to staff meetings, we want to do regular communication such as newsletters or interorganizational podcasts, which is something that more clients have started doing. Anything that we can do to put the information into the hand of the end user, and let them know it’s coming, and tell them why they should care. What is this going to do for that, how is this going to improve their lives. What new neat features will it have that they don’t currently have within the organization. We just want to generate that buzz and excitement.
Barriers to Achieving End-User Adoption
Ok, and obviously generating that buzz and excitement will help you achieve adoption, but are there ever any barriers to achieving adoption? Or maybe, some objections that your physicians will have to it?
Typically, the objections come from the lack of knowledge, right? People don’t like change, people don’t like something new, maybe they’re being asked to do something they haven’t done previously, or do it in a way they haven’t done it previously, and so it’s not that the adoption itself is bad, it’s really more the personal reaction of the end user. And to cope with that, what we do is obviously give them lots of reasons why this is a good thing. And it takes time, which is why the communication plan is so important. If you’re just engaging your physicians a week or two before training starts, you haven’t given them the proper notice to get their mind around what’s going to happen and what their new future state is going to look like, and so you are going to start to lose adoption. But if you do that months in advance, by the time training shows up, they’ve already gone through the five stages of grief, right, of leaving their old system behind and heading into this new one, and they’re hopefully in that acceptance phase when training starts, and they are less resistant, they are more willing to learn, and that willingness to learn is where you’re going to get your adoption.
EMR Training Plan Curriculum
And I feel like having a well thought out training plan or curriculum as well would definitely help during your training project.
What are some differences between a well thought out training program versus one that hasn’t been very well thought out?
I think some examples would be the scheduling, their utilization of the LMS, you know, is the LMS going to work for the end user, is the schedule going to allow enough opportunities for everybody to come to class that needs to come to class? Was their communication plan started early enough that you’re going to have high adoption, and that people are looking forward to coming to class versus the alternative, which is your, you know, begging and pleading people to come to class and you’re worried that you’re not going to get everybody through the training program, but by the end, a well thought out training program has a little bit of reserves that aren’t necessarily published, that’s one of the best strategies that I’ve seen, where folks don’t actually have classes on the schedule the week before go-live, and they do that because they know that some users, even though you tell them months in advance, even though they’ve heard about it in staff meetings, even though their directors or managers are telling them to go to training, they just won’t.
They won’t find the time, or they’ll find other things that they feel are more important, and then what happens is a week or two before go-live they’ll have this light bulb moment where they go “oh wow, I really do have to get trained” and they won’t have any availability in the schedule to do that.
So really, well thought out training programs have that contingency plan for end users that last week right before go-live, because you do want to make sure that everyone has that opportunity to be trained even if they are a little resilient or difficult.
Skills of Effective EMR Trainers
Right, and I feel like something that can help out with that resiliency would be having good trainers, trainers who know exactly what they are doing and can be effective.
So what goes into being a good, effective trainer?
You know that’s a good question, and I think that is something that a lot of organizations don’t put enough thought into. I can’t tell you how many senior leaders I’ve spoken with who have the impression that anyone can train. And that is just not a correct statement, I believe anyone can know the material, I think anyone can learn the system, and even learn the curriculum, but to be a trainer, means that you have the ability to connect with end users, to share the information in a way that is engaging, not condescending, not threatening, and that you have the ability to answer questions and manage a classroom at the same time. These are a lot of soft skills and interpersonal skills that not everybody possesses.
And you have to be an extremely positive, high-stamina individual. A class lasts four hours, sometimes two four-hour classes back-to-back. You’re talking about being on your feet for eight hours straight, talking the entire time, being on. Having your mind mentally in the on stage and being positive and engaging, interacting, and it’s definitely a skill. Knowing the system, learning the application, knowing the curriculum, those are all extremely important skills that every trainer must have, but the really good trainers have all these other intangibles that are oftentimes overlooked by leadership in an organization when they are putting a training team together.
And that is something that we focus on here at HCI, you know, finding those individuals that truly are passionate about training, because that comes out in their classes, and then that turns into higher retention, and higher adoption rates for those end users that attend those classes.
e-Learning in the EMR Training Program
Ok, and obviously you’re looking for great trainers like those, you said you want them to be personable and engaging. But how does e-Learning play into this?
How do you incorporate e-Learning into your program?
So e-Learning is kind of this wildcard that some organizations utilize and some don’t, and the question really becomes around when is it appropriate to use e-Learning? So e-Learning is a computer based training, that would be me going to the computer whether I’m sitting at home, or I’m sitting within the organization walls, and I pull up the video, or it could be a little presentation, and it just walks me through primarily information-based content.
Now, the challenge with e-Learning is e-Learning tends to be expensive, it takes a long time to make those videos or to create those presentations, and so if you’re going to share the information with a small number of end users, then you find out real quickly that it’s not very cost effective. You know, I can’t create an e-Learning and share it with five end users and expect to get a good return on that. Now, if I’m sharing the e-Learning with 5,000 end users, then there is definitely a good return on that. And that is honestly when I have seen e-Learning be most effective. It is typically meant to augment a class, it is not meant to be a replacement for a class, and it is typically used to whet the palette for an end user.
They would learn some basic things about the system, or some basic things about the applications that they will be learning. And then they come to class to solidify those items they saw on e-Learning, and it gives the trainers kind of a launching pad so that they can focus more on the advanced pieces of the application during the classroom time versus spending a portion of the classroom time going over these very basic functionality items.
How to Maximize ROI on Budget
Right, and one of the things you touched on there was the fact that e-Learning can be expensive, and I think that is important to remember, that a lot of organizations going through a training process will be training on a tight budget.
So how do you train on a tight budget? Or, what are some best ways in which to maximize your ROI during a training project?
Well, it’s not a one size fits all, I think the short answer is that you have to do the proper training assessment and really understand what the organizations needs are, and make sure that you are building the training program to match those needs.
Like I said, not every organization can really utilize e-Learning, they won’t get the return that they are wanting. So, you need to do a proper assessment of your organization, how many end users you are going to be touching, how much time you have to touch those end users, what type of facilities do you have at your disposal as far as classroom training is concerned, what kind of skill sets do you have on your training team? If you don’t have anyone that can actually build the e-Learning on your training team you have to go get someone else, and now you are adding cost to your team. So I think it all starts with the planning, and really understanding what your organization needs, because it is not the same from organization to organization.
Common Lessons Learned in Training
Ok, so let’s shift gears here a little bit. Are there any common mistakes that you often see training directors make?
You know, I don’t think I would call them mistakes, they are obviously opportunities to learn and ways to get better, I think some lessons learned that I’ve seen would be maybe bringing in the training team too late, you know, the project may last a year and a half or two years, or whatever the duration is, you definitely want some portion of the training team involved when they are configuring the system, and they are going through the workflow walkthroughs and stuff, because you want the trainers to understand why the system is being set up in the way it is set up. That is going to help them when they are creating the curriculum, that is going to help them to understand what are going to be the sticky points with the workflow and that is going to allow them to create a better classroom environment.
Also with your credentialed trainers, and these are the folks who are typically brought in to do the bulk of teaching the classes, sometimes those folks are brought in too late, and so they haven’t really had a chance to learn the nuances of the organization, and those nuances are really what makes that class personal to the organization, you know if they don’t do that then that information doesn’t make its way to the end user, and then you just have more challenges at go-live.
Timing and Amount of Credentialed Trainers
Right, and you started to touch on credentialed trainers here, and you said a problem that arises is if they are brought in too late.
How do you know if you’ll not only need credentialed trainers, but when you should bring them in?
So you’ll know that you need credentialed trainers based on the schedule that you create. The schedule you create should be done no less than 60 days before the actual training starts, you’ll need to have identified the classrooms that you will have done the training in, the hours of the day that those classrooms will be operational, and then based on that information you’ll quickly surmise how many trainers you’re going to need.
Typically, if you have one lead trainer per application, you can expect to have one or two or five credentialed trainers per application to actually teach the classes, and you’ll be able to have those numbers well in advance of classroom training starting, and you’ll want to bring those folks in. You know I’ve seen people do it as early as a week before classes start, I think that is a good strategy if the expectation is that they are not teaching first day, you know, maybe they are sitting second chair and they are watching principal trainers teach the first day. If you want them to teach day one, you probably want to bring them in a couple weeks in advance.
The credentialed trainers, they’ve done this before, so it’s not as if they are learning the system for the first time. What it is, is they are learning the specific nuances of the new system, and they are learning the specific curriculum that that organization has built.
Common Underestimations in Training
Ok, and one thing that I’ve always wondered is what part of your training program is often most underestimated? Is there anything you ever hear that organizations that going in, maybe they would say “oh no, (about a certain topic) that is not a big deal, we have that covered,” but commonly turns out to be an issue for them?
Oh, the most common underestimation would be resources, and I’m referring to the number of people needed, the number of rooms needed, and the cost. Those are almost always underestimated. And I think that starts with the overall project planning phase.
Typically, the folks planning the project, they don’t have a training background, and so it is easy for them to plan how much the build team is going to cost, and it is easy for them to plan how long testing is going to last, and it’s easy to look at the number of end users and get a rough idea for go-live support; but when it comes to training, that’s a little bit harder. You have to really dive in and do an assessment to get to that cost, and that usually isn’t done at the very, very beginning, and so they’ll throw a number down, and they’ll say “well we think that this is what training is going to cost” and a lot of times that number is short, and I think the only way to avoid that would be having your training manager engaged in the very beginning, and having them do that training assessment, which takes a considerable amount of time and effort to get right, but having them do that training effort in the planning phase before you set what the budget for training is going to be.
Benefits of Using the Same Vendor Partner for Training and Go-Live
Ok, and last question here Jason. Are there any benefits to having the same vendor partner from training through to your go-live?
Jason: I think there are. I think those benefits are going to come through the communication and through knowledge transfer. So oftentimes, organizations will use different vendors for different parts of the project, and what happens is they don’t account for the transition between one organization and the next organization. You know, if I have been doing the training for this organization for the past six months, and I know all the workflow nuances, and I know all the departments that are going to be a challenge, and I have this wealth of knowledge from living it, you know, it is very hard to properly transfer all that knowledge, all those experiences, all my interactions with key staff to someone new. You know, I can create a document, I can give them copies of the curriculum, but there is just an intangible amount of information that the new organization won’t know or won’t have, and it’s not because someone is trying to keep something from them, it’s just that if you haven’t lived it, there’s only so much I can tell you about it.
And so, if you keep the same vendor through both, well then you are not losing that information, it is going to stay with the organization that is also doing the support. It also means that that organization will most likely be able to get their hands on training curriculum, and get it into the feet on the floor staff quicker.
It also means that the feet on the floor staff, when they have questions or challenges, the folks being able to answer those questions will have greater insight as to where that answer may lie. You know, if there are 15 curriculum documents, and someone on the floor asks a question like “where’s x”? Well, we’ll have to look through 15 documents because we probably won’t have them memorized, whereas someone who has worked with those 15 documents for 6 months will quickly be able to tell you where in those 15 documents to find the answer. You just can’t discount that experience.
Ok, so obviously it sounds like planning and making sure everyone is engaged and trained on time is going to go a long way in a successful training project, but thank you Jason, we appreciate your time here today.
Ok, thank you again, Jason. For more information on EHR Training, make sure to follow us on social media, and to subscribe to our blog and our podcast. Also, make sure to comment below with anything that you think we may have missed during our discussion on EHR training, so that we can keep the conversation going.
For Jason Huckabay, this has been Tom Letro of The HCI Group. The HCI Group, offering a smarter approach to healthcare IT.