Staff training key to successful use of EHR
Even 'experienced' staff need help learning
Electronic health records aren't new to the staff at St. John Home Health and Hospice in Tulsa, OK. However, when the agency switched from its 11-year-old software to a new program, it was not a simple process, but it was a necessary one.
"We needed software that could communicate with the hospital's electronic health records system, and we needed better reports," says Melody Lahann, MS, MHCA, education coordinator for the agency.
Reports are a key issue for many agencies that are evaluating electronic records systems, says John Lawniczak, managing director of the home care division for Cerner, a Kansas City, MO, health care information technology company. "The right reports help a manager see changes in financial or productivity trends from year to year, which help identify ways to control costs or identify underproductive employees," he says. In addition to reports, more agencies are looking for software that can exchange data with other programs or organizations, he adds.
Before those reports or exchange of information can occur, the new system must be implemented, points out Lahann. The first step of implementation began in hospice because it was easier to introduce, she says. "There are no OASIS [Outcome and Assessment Information Set] requirements, and the staff is smaller," she explains.
Even though staff members were accustomed to electronic record keeping and using laptops, all nurses and therapists attended 20 hours of training, says Lahann. "We split the training into five half-days after we had the first group come in for three full days," she reports. "Full days are just too much to absorb, and we found that the half-day sessions were more effective."
Chaplains and social workers also received training on a smaller scale because they don't use as much of the system, she adds.
Although 20 hours per staff person is a lot of time, the training period should not be shortened, recommends Lahann. "We used contract staff to cover basic visits during the training period so that nurses and therapists would not have unreasonable visit schedules during the training," she adds.
A core group of eight employees at St. John attended an intensive, train-the-trainers course to create an in-house group of experts and educators, says Lahann. These eight trainers conducted the staff training sessions, she explains. The cost of paying clinical staff members for 20 hours of classroom time, paying contract staff to cover some patients, and paying trainers to teach the classes does add up, she admits. "Training at this level is not inexpensive, but it is worth the time and money because you can make sure that staff members can handle a variety of situations," she says.
Before the electronic health records training, Lahann offered a beginning computer class to employees who were not computer-savvy, she says. "They had all been using our previous system but they just learned to push certain buttons," she says. "They never learned how to problem solve."
The half-hour classes were attended by about 15% of her hospice staff, she says. "The class reduced their fear of learning new software and gave them a chance to learn how to operate a system intuitively rather than by memory," she adds.
Another training change Lahann made after implementing the new software was requiring all new staff to attend classes on the system. "Previously, we had the nurses' preceptors teach them how to input information into the system, but we discovered that nurses were passing along bad habits and shortcuts that caused problems," she says. "Now, we know the training is standardized, and everyone learns the right way to use the system at the beginning."
Don't forget hardware needs
When evaluating the cost of the new software, consider the need for new hardware, suggests Lawniczak.
"You don't always have to buy new laptops, but it is often the case," he says. Most laptops that are used daily require replacement every three to four years, so this expense should be part of the ongoing budget, he suggests. "If you are implementing a new electronic records system and your laptops are 2 years old, then you should not have to replace them immediately," he adds.
St. John did purchase all new laptops because of the age of the existing laptops and the lack of memory and speed, says Lahann. "We needed extra memory because we had to run our old software for three months into the implementation of the new software," she says.
The overlap occurred for a combination of reasons, says Lahann. "It was simpler to leave existing patients in the old system rather than re-enter all of their information into the new system, and it saved time and prevented errors that might have occurred as we transferred the information," she says. Another benefit was that the new system was used only for new referrals or recertifications, she says. "This meant that employees eased into the new system a patient or two at a time," she explains. It was much easier to troubleshoot and answer questions on a few patients at a time rather than all patients, she adds.
Even after the initial training, be sure that there are staff members who can act as troubleshooters, suggests Lawniczak. "If you have more than 50 users, have a full-time trainer who can conduct ongoing training as well as problem-solving for nurses in the field," he adds.
The core group of eight trainers served a dual purpose for her hospice, says Lahann. "Not only are they the employees who conduct the staff training, but they also serve as resource staff for our field employees," she explains. Although eight might seem like a lot of "experts," it's important to train more than you think you will need, she says. "Our group of eight is down to four after some people left the hospice," she explains.
Implementation of an electronic records system can be successful if the plan is well thought out and staff members receive ample training, says Lahann. And she has one more tip: "Maintain your sense of humor. Things will go wrong, but they can be fixed."
Electronic health records aren't new to the staff at St. John Home Health and Hospice in Tulsa, OK. However, when the agency switched from its 11-year-old software to a new program, it was not a simple process, but it was a necessary one.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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