Molly Merrill, Associate Editor
Molly Merrill is the Associate Editor of Healthcare IT News. She covers physician practice IT issues and national breaking news.
Study finds docs have 'inadequate' EHR training
WASHINGTON | October 24, 2011
It is recommended that doctors receive three to five days of initial training to adequately use their EHRs, but a new report indicates that this requirement is not being met.
The report, released by AmericanEHR Partners, highlights physicians’ experiences with the usability of EHRs to achieve some meaningful use requirements. The survey data, from more than 2,300 physicians, was collected from April 2010 to July 2011 on satisfaction with their use of EHR systems.
[See also: EHR training at Penn State proves win-win for students, docs]
The survey was conducted collaboratively with the American Academy of Allergy Asthma & Immunology, the American College of Physicians, the American Osteopathic Association of Medical Informatics, the Infectious Disease Society of America and the Renal Physicians Association.
Key findings from the report include:
- Overall satisfaction with an EHR was highly correlated with whether the respondent was involved in the EHR selection process.
- At least three to five days of EHR training was necessary to achieve the highest level of overall satisfaction.
- Nearly half (49.3 percent) of respondents indicated that they received three or fewer days of training.
- Ratings on ease of use for basic EHR functions required for meaningful use continued to improve with more than two weeks of training.
- Ratings on ease of use for specific meaningful use measures varied significantly. More training – at least one week – was correlated with improvement in the reported usability of advanced EHR features (e.g. checking patient formulary, importing medication lists and medication reconciliation).
“This report from AmericanEHR Partners demonstrates the power of collecting standardized user satisfaction ratings across multiple specialties,” said Michael S. Barr, senior vice president for medical practice, professionalism and quality at the American College of Physicians. “We hope the insights gathered from this report will lead to better strategies for initial EHR training and better usability for clinicians working on meaningful use requirements.”
“The AmericanEHR Partners survey data strongly suggest that many physicians may be receiving an inadequate amount of initial training on how to use their EHR,” said Cientis CEO Alan Brookstone. “Our analysis showed a substantial increase in overall EHR satisfaction after three to five days of initial training. Consequently, we recommend this amount of training when implementing an EHR system. Advanced meaningful use features, such as formulary checking, required at least one week of training to show a significant improvement in usability.”
[See also: EHR adoption still a top concern for physician practices]
The full report, "The Correlation of Training Duration With EHR Usability and Satisfaction: Implications For Meaningful Use," can be downloaded here.
Showing 6 Comments
dch say: Light front end
October 31, 2011 | 08:14 AM GMT
In my attempts to standardize handwritten documentation with templates, I vacillated between lumping and splitting.
I came to conclude there are too many variables to capture with a detailed template. Further, such attempts fated my notes to appear cloned. It was difficult to tell one patient from another.
I settled upon broader categories (lumping) with reliance upon free text (handwriting) to capture the essence of the encounters. A happy balance was found. My notes were unique to my patients, I could find the information in my notes under certain headings, and I consistently covered certain critical clinical issues.
I think a similar model may best apply to EHR documentation models. I imagine a clinic's patient database. Certain critical elements should be tagged and the rest free text within broader tags.
There's no way a programmer can chase around after constantly changing details, reasoning and nomenclature within a changing landscape of medical specialties and subspecialties. Internally, just within my own specialty, we've faced the same problem with practice guidelines ... trying to create algorithms for best practice, only to find out these require constant, ongoing attention to rapidly evolving field knowledge. Maintenance work is prodigious and paralyzes the projects downstream.
How to use relatively lumped EHR data? Sophisticated data mining/indexing. I've already seen some mention of this now, and with positive reviews.
I think of a patient database like the WWW ... awash in incredibly complex, varied information that is usable because of data mining tools e.g., Google and Wolfram Alpha.
Make the data input front end lean and light, with less emphasis on standardizing every iota of input. Save the heavy lifting for the back-end data mining.
pjcasey75 say: EHRs require lots of training because...
October 25, 2011 | 10:59 AM GMT
Let me state at the outset that I agree that EHR technology is not mature, is generally not as user friendly as it could/should be, and that users who express frustration about that are expressing valid responses to the current state of the art. The frustration level is enhanced by the fact that the EHR industry has touted these solutions as being easier to use, more cost effective, and providing more short term benefits than have been demonstrated by the vast majority of empirical studies searching for these promised results. So healthcare providers are weary of promises and more than a little skeptical.
However... Practicing medicine is not the same as writing an email. Not the same as searching for a restaurant on Google. As one who has programmed solutions in the defense industry, financial analysis and sales in the IT sector, then architected solutions in banking, transportation, manufacturing, not-for-profit and healthcare, including working on a team transforming a paper based template documentation solution for family practice offices into an EHR, I can say with some experience that creating an EHR that captures what healthcare providers (especially in family practice) do is the most difficult application set I've seen in 30 years of working with computer solutions. Standardizing medical data from where it is today into structured, consistent, accurate, sharable data within a widely available yet highly secure infrastructure is amazingly challenging. Transforming the banking industry wasn't nearly as daunting. We literally landed people on the moon and flew the entire space shuttle program with solutions less sophisticated than what we need for documenting a standard upper respiratory complaint visit with and a flu shot.
Doctors take for granted that their training track to practice medicine is tougher than practically anyone else, except maybe army rangers or navy seals (but some would say that's a tossup). Because they don't write commercial code, they think that writing software tools to assist them should be a piece of cake. Which is it then? Is medicine something you learn in 30 minutes? Then how does it makes sense to compare a commercial grade solution for your incredibly complex job to consumer electronics software required to download Itunes?
The EHR industry will mature the same way other industries have experienced - namely, when a significant critical mass of experienced users provide the direct feedback based on their using the immature, bug prone, workflow challenged products. Those healthcare providers who do not actively participate in this transition remove their valuable input from the process. Lord knows we've heard enough from industry champions who think EHRs are already perfect. We need the skeptics as much as the realistic enthusiasts to participate, not from the sidelines, but in the trenches.
dch say: Rhino in living room
October 24, 2011 | 15:57 PM GMT
There is something fundamentally wrong with the design of an electronic health record if 3 to 5 days of training are required to start using it. (Contrast with 0-5 minutes of training for a paper record.)
This might be a nice revenue generator for the training industry, but is evidence of poor attention to usability.
Computer geeks are accustomed to spending weeks, months, and years learning how to code. That model doesn't work for end-users, who have other things to do, and coders should not extend that expectation to them.
It remains my assertion that HITECH is proof of the non-market ready status of EHR technologies.
Docs are eager technology adopters. Why not EHR technologies? No lust. They haven't had that "Oh ... My God!" quality to them. Steve Jobs understood the need for that quality to get people to part with their money.
So, bureaucrats, politicians, academicians, and administrators foisted this upon us anyway, "for our own good," complete with transient carrots and durable whips.
What we get is stuff not written for busy clinical work flows, and that interferes with normal human interactions, both pretty important parts of what we do.
And if we don't like the product after blowing big bucks on it?
So sad. Too bad.
Try changing to another product. How? Patient data is locked to the product. (Might as well dump it all back to paper.)
When clinicians are free to change EHR products at will, product quality will improve and price will drop, establishing a positive feedback loop of adoption. In this way, the market would accomplish what the government cannot.
Stephen McClure say: EHR Training via HealthStream
October 24, 2011 | 13:36 PM GMT
Some of our customers have begun using self-authored E-Learning courses, delivered via the HealthStream Learning Center, for internal EHR training. This often can occur at doctors' convenience, from any location that has Internet access.
Holly Spring say: EHR Usability
October 24, 2011 | 11:48 AM GMT
Training and EHR-supportive tools are critical. For many clinicians, the EHR introduces a dramatic workflow change, demanding additional time and adding complexity to documentation. In another study, when asked what doctors consider an “incentive to drive national EHR adoption,” 75 percent of the physicians surveyed said they consider “access to tools that would help doctors to better document within an EHR (beyond the keyboard), such as speech recognition” an incentive; where as 69 percent cited “stimulus money.” http://www.nuance.com/healthcare/ehr-meaningful-use-study/default.asp
It's clear the challenge of usability remains. Interesting data.
Kay Gooding say: Use those already trained to facilitate the efforts of MDs
Those best educated to bridge gaps between clinical, business and IT needs of healthcare are from the health information management (HIM) profession as they are fully prepared to serve in roles, connecting clinical, operational, and administrative functions. They are responsible for acquiring, analyzing, and protecting digital/traditional medical information vital to providing quality patient care by affecting the quality of information/patient care at every point in the healthcare delivery cycle. They ensure the right information is on hand when and where needed while maintaining the highest standards of data integrity, confidentiality, and security. They are highly trained in the latest info management/technology applications and the workflow in any provider organization from hospital systems to physician practices. They are vital to the operations management of EHRs because their education includes the disciplines of medicine, management, finance, health care coding (ICD-9, ICD-10, CPT, HCPCS etc.), revenue cycle, information technology, and law. In addition, there are those completing the HITECH workforce program who are cross trained in IT and Healthcare topics.