The I(T) in the team

While software firms would have you believe all EMR implementations proceed smoothly on schedule, the truth is that many sink without trace in their first year of use. MT learns how IT training can dictate whether you survive or succumb to digital care.

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By  James McCarthy Published  May 8, 2008

While software firms would have you believe all EMR implementations proceed smoothly on schedule, the truth is that many sink without trace in their first year of use. MT learns how IT training can dictate whether you survive or succumb to digital care.

For hospitals making the switch to electronic medical records (EMR), installing the system is the easy part. The real skill, says Ferhad Patel, regional business manager at Intel, is talking an often-reluctant bank of clinical and administrative staff into embracing a new style of working.

"Any errors, and they want to drop the whole IT solution and go back to the manual way of doing things," he sighs. "Expect problems from the outset."

Training staff on the [EMR] system is about changing behaviours and attitudes about their own work process.

IT training, experts agree, can make or break an EMR implementation. Too little, and staff are too intimidated to use the system. Too complicated, and they struggle to keep workflows moving. So how can facilities get the balance right?

Going on the record

The first step is coaching staff to accept the inevitable. Foteh Tleel, marketing manager at the American Hospital Dubai (AHD) advocates treating implementation as a team decision. August sees the first phase of AHD's multi-million dirham IT overhaul, and managers have been quick to rope in employees to smooth the transition. "We had staff involved from the start," says Tleel.

"When we screened the software, the physicians, nurses and administrators had input, so they understand it."

Still, prising IT-phobic staff away from their charts can be a challenge, even at the screening stage. Physicians in particular can be reluctant to drop paper records, so Patel advises presenting the EMR system in terms of its clinical benefits rather than its technology.

For example, for doctors that offer diabetes or obesity counselling, plug EMR systems as a fast route to better preventive care. "If everything is automated, including the patient's history, you can see and predict clinical trends," he explains.

Pamela Paulk, vice president of human resources at the US-based Johns Hopkins Hospital, goes one step further and advises recruiting a string of employees to champion the advantages of online care to other staff. At least one of these employees, she says, should train as a 'super user' on the new system, to support other, and future, staff members using the new system.

"The reason that is so important in IT is because when people need an answer, they need it right now," she explains. "They can't wait until the next training class to know how to do it."

Timing is everything...

The question of when to train is as important as how to train. Most software vendors will provide in-house lessons before an EMR system goes live. However, the daily routines of practice can wreak havoc with teaching sessions.

Between patients, phones and physicians, staff can find it tough to pick up new skills. Where possible, Paulk advises squeezing in sessions outside hours, or during shift-changes for minimal disruption.

"It is always better to try to train people in increments and to have more training over a longer period of time, rather than try to get everybody in a room for eight hours," she explains. "Anything that we can do in small increments, we just do at shift change."

One way of ensuring sessions are as quick and effective as possible, is by tackling computer illiterates before teaching starts. Patel explains: "Everyone should have at least proficiency in Microsoft Office. It is nearly impossible to train a class where one user is totally proficient and another hasn't touched a PC in their life."

Even after training, staffs are likely to have very different levels of IT proficiency. James Hildebrand, a senior consultant with InterHealth Canada, recommends managers focus less on competency and more on confidence.

"Some staff may function very well with just enough understanding of the system to do their jobs, while others require a higher level of competency," he says. "It's important that each person knows their part of the system, and is able to use it with confidence."

For ongoing training needs, Patel is a fan of using web-based learning to keep skills fresh. "IT training shouldn't just be in a classroom environment, especially when staff are already busy," he explains. "With web-based training, staff can learn at their own pace and it allows you to monitor their progress."

Regardless of the training schedule you choose, says Hildebrand, encouragement goes a long way towards keeping staff on side and happy. "Training staff on the system is about changing behaviours and attitudes about their own work process," he explains.

"Much work needs to go into communicating to staff about the changes to workflow, dealing with resistance to change, and creating a collaborative environment that fosters communication between IT and clinical team members."

Happy EMR-after

Even with training under their belt, some employees will be less than enthusiastic about giving up paper records. When gentle encouragement fails, Paulk recommends a more hardline approach.

"There are a lot of people who don't want to give up their paper, and unless you make them they never will," she argues. "Sometimes you just have to set a deadline and say; After this deadline you can't get a prescription unless you enter it into the computer."

Finally, notes Paulk, expect a slow start from staff. By pouring a percentage of the budget into ongoing training, eventually all but the most resistant staff will be ready to accept the change.

"Training should not be considered an expense, it should be considered as investment," she explains. "People say; ‘We can't afford to do that.' My response would be; 'You can't afford not to.'

"The more you invest in your staff, the more committed they will be."

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