A Better Training System

Groups using the Allscripts Enterprise EHR (formerly TouchWorks EHR) that I’ve worked with have always yearned for a better training system. Issues with the current training system run the gambit, starting with the majority of groups using their Test or Production/Live system for training purposes. The groups that do have a training system often have a number of very reasonable requests.
Let me outline the ones I’ve always seen:

– The training system build / configuration isn’t close to production,
– Or it isn’t close to the test/development environment where new versions or new build work is available.
– The patient data isn’t realistic.
– The “test” patients become “cluttered”, e.g. 100 problems, 500 notes, 300 medications, etc, etc.
– The patients in the training system are real patients.
– The information is out of date. For example: tasks are months or years overdue or there are no appointments on providers’ schedules.
– If any of these are accomplished (for example, Galen has worked with a handful of groups to add some of the smaller, items such as de-identifying real patients, updating schedules and task lists), the physician group finds that changes are difficult, such as training both new users on the current version, and preparing to train users on a new version that they are upgrading to soon.

There are some serious technical hurdles to overcome to have a training system that avoids the above pitfalls and any others I failed to mention. The biggest hurdles come in combining an EHR “build” (menus, Note definitions, tasking work flows, etc) with patient data. If you can do that successfully, there may be other hurdles – for example, I talked to a large group about a training system several months back. We were able to design it in such a way that we overcame all of the above issues, but it required the client to purchase another server and work through some serious red-tape with their IT group, especially as it related to copying their production system. They would have been interested in the solution, if it were reasonably feasible to get a system that could do everything outlined above, but was completely remote – e.g. I would pick up their build (say from their prod or test system), upload it to a TouchWorks environment that we hosted, then play in the clinical / content information, such as patients, their charts, tasks, appointments, etc.

I’m curious to hear what folks think about training environments, what’s missing and what could be done without. Ideas?

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  1. 1
    Cynthia Gerson

    As a tangent from the technical aspect of the training environment, an important focus is on the application training program. The who, what, when and how are areas that need to be determined in order to facilitate a thorough education for the organization. Following these simple guidelines will have a positive

    Defining the roles and knowing the skill levels of users prior to training assists the trainer in developing the program and preparing for anticipated questions.

    The objectives of each training session must be clearly defined.

    Provide educational materials that correlate to the workflow demonstrated during training.

    Training sessions that are flexible and short have proven to work best. This allows clinical staff working different shifts to choose timeslots that fit their own schedules. This limits time spent away from current job duties and the user does not get overloaded from a long day of new information. I always receive positive feedback from both physicians and nurses, expressing their appreciation for taking their schedules into consideration. Remember, these folks are in a situation where they feel a loss of control & overwhelmed because of all the changes demanded of them for an EHR implementation. A little understanding goes a long way.

    Offering training sessions close to go-live seem to work best with regard to retaining information. There is a clear advantage if a user has the ability to apply new knowledge in a live environment soon after training.

    One thing that is often overlooked is evaluating a new user’s knowledge once the official training sessions are completed. A competency test is not only a great tool to make sure training was successful, but it can also be used by the organization for employee performance evaluations and as a tool for the restructuring of job descriptions that result from EHR implementation workflow changes.

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