Question #5: How did you approach and/or support end user training?

We had several levels of end users that required different levels of training. SuperUsers were designated local resources from each clinic who early on (several months before go live) received early training on the entire application, regardless of their actual job responsibility (ie they were trained in front office, back office and provider roles). A subset of the SuperUsers, known as Champion SuperUsers, chosen for their level of motivation and commitment to the EHR implementation, were given additional training so they could provide troubleshooting capabilities for some basic technical application problems.

Members of the Clinical Standards Committee are provider representatives of each major clinical department in the Medical Center; out of these were designated providers that could build templates for their own departments. These builder providers received special training specifically in the area of building templates.

Finally, the rank and file users (all outpatient clinic staff) were provided with EHR training specific to their role in the 1-2 week period just prior to the go live at their clinics. Training duration lastsed 12 hours for physicians and for nurses who run their own clinics, and 8 hours for nurses and office staff.

An attempt at process training during functional training was attempted, since there was close coordination between the vendor provided trainer and the Medical Center on integrating standardized workflow principles into end user training. The Medical Center worked with the vendor during pre-implementation planning to develop a standardized workflow that was optimal for the Medical Center's practice patterns. Before the vendor started the documentation process, we collected paper forms and any other information from each clinic to learn more about the workflow. We also ensured that we had collected and scanned their paper forms into the application. Despite our efforts at pre go live functional training, it had limited effectiveness, as end users seemed to learn the most by being guided through functional processes during the course of their actual clinical practice with patients.

Because on the job training was crucial, breakout sessions twice a day during the first 2 weeks of go live at each clinic were held to discuss pitfalls of the current workflow practices and make any changes as necessary. During the go live, clinics were also given the option to write down their questions and concerns, and those questions were addressed at the end of the day or week by the core implementation.

The only skills assessment activity we performed was to assess the computer literacy of clinical staff via a survey instrument. The survey was delivered through a web based application called Survey Monkey and the content was provided by the vendor. We are unable to provide the survey, as it is the property of the vendor. The results of the survey indicated that most of the respondents had adequate computer competency to use the EHR application. Unfortunately, the survey automatically had favorable bias towards users comfortable with computers, as it was administered on a computer. Although a small number of users were identified as needing more training, and basic computer training courses were offered, no one took advantage of this opportunity. Luckily, basic computer questions didn't represent a significant number of the support calls. During go live training, to help those users who lacked adequate computer literacy, the eCW system administrator and one IT analyst were always present and assisted with their basic computer questions/problems so that the eCW trainer didn’t have to slow down the entire group.