CNEA Question #5, End User Training

Training for providers and the care team

RCHC, not the vendor, does all the training. We divide the trainings into three parts: System Builders, Super Users and "everyone else." We added "System Builders" after we learned from our pilot site that in order to create optimal post-EHR workflows and trainings, key staff (one or two per each staff type, e.g. provider, MA, etc.) in the health centers needed to know the basics about the product. The System Builders customize the product. Thus, the new workflows are based on the functionalities of the product and the product trainings are tailored to the specific workflows of the health center. The System Builders are trained starting approximately one month prior to Go-Live, and the Super Users soon thereafter. Training for everyone else begins a week to two weeks prior to Go-Live for their role. System Builders and Super Users participate in all trainings again in their respective work role groups.

All training sessions are from 3-4 hours. The number of training sessions that each role attends varies with the complexity and the responsibilities of the role, at the discretion of the health center. Generally, providers receive the most training, from 3-5 training sessions. MAs generally receive 2-4 sessions. Staffing coverage and the cost of the training is born by the facility, so they have the last word on who is trained and how much training they get. RCHC provides recommendations based on our experience.

Providers and MAs are trained separately because although both roles do clinical work, and work in the same area of the software, the job descriptions are very different. It is much easier to hold trainees' attention in a training session if their job description is being trained to at all times. At our pilot health center, we tried training MAs and providers on the software together, and it didn't work out very well, mostly because the two roles perform such different functions and have such different responsibilities.

The Provider/MA teams are so used to working together pre-implementation that if the MAs are trained to do their job and the Providers are trained to their job, training the two roles to function together in terms of the software isn't necessary. The MAs train and support each other post Go-Live, and the Providers train and support each other post Go-Live, and the electronic aspect of the interface between the two roles is fine tuned at Go-Live.

The trainings take place in a designated training space provided by the facility. There is a computer terminal for each user and the space is as spacious and comfortable as the facility can manage. The trainer demonstrates and uses a LCD projector to project the trainer's desktop onto a wall or screen. Users are encouraged to watch the demonstration and then time and instructions are given for trainees to practice what they have seen.

The intensity of the trainings doesn't vary that much. We establish a friendly but business-like atmosphere. Trainees should be convinced of the seriousness of the project, but not be too anxious. Excess anxiety is counterproductive to learning. Because of all the workflow design and other preparatory work, our experience is that staff are more excited to learn than anxious.

The RCHC training team creates session agendas based on input of site-specific needs from the individual System Builders and Super Users. Participants in the sessions are given hands-on experience both following along and with some exercises. Post training evaluations give the training team immediate feedback after the class. Flip charts are readily available for 'parking lot' questions that are either held until later in the class or referred back to the training team.

The training assistant makes sure that all trainees have the necessary log-ins, coordinates the training calendars and attendance with sites, assists trainees who need additional help during the training, writes down 'parking lot' questions/concerns and directs them to appropriate people, assists with time management and aggregates the evaluations for quick feedback.

Process Training and Functional Training

In general, all aspects of the product are taught within the context of workflows. The System Builder develops a workflow, in conjunction with a RCHC representative, and furnishes it to the trainer prior to the training session. The trainer steps through the workflow, relating it to the software during the training. Training is more effective if users can understand the use of the software in the context of their specific tasks and duties.