With the ICD-10 cutover behind us and the holiday season at our doorstep, I’ve found myself in a nice little lull where I can reflect on some of the engagements I’ve tackled this year.  One of the discussions that struck a chord with me involved applying adult learning theory to training EHR end users.

In 1984, Malcom Knowles detailed his four principles of adult learning theory which state:

1. Adults need to be involved in the planning and evaluation of their instruction
2. Experience (including mistakes) provides the basis for the learning activities
3. Adults are most interested in learning subjects that have immediate relevance and impact to their job or personal life
4. Adult learning is problem-centered rather than content-oriented [i]

When given some thought, these are all very valid (and almost obvious) principles that organizations should consider when designing EHR training courses.  The point which really resonated with me however, was the third principle, which says the content must be relevant to the audience for the learning to be effective, or else we risk losing their attention.

Putting this into context of EHRs, some organizations have started training providers in their Production EHR environments instead of a Training environment to make the experience more relevant.  Rather than going through the motions of recording blood pressure and documenting hypertension (I10) on an “ABC TEST” dummy patient, the providers are being trained on their own patients (with super user supervision, of course), which has been found to increase education retention tremendously.  I’ve worked at organizations where training in Production is taboo, however I definitely see the value of this strategy, as long as the trainer:provider ratio is kept at a manageable level.

This setup doesn’t come without risk, and cannot be accommodated in all situations, but it could be adroitly implemented on a smaller, incremental go-live schedule, such as acquisitions where new providers are being brought into a practice, or optimizations where best practice workflow reinforcement is being rolled out.  This by no means replaces the need for a Training environment, as these are imperative to any successful upgrade effort where training on new functionality must be disseminated beforehand, but it does present an opportunity to improve knowledge retention.

The onslaught of changes with HIT reform is unending, but given the slight dip in requirements (we’ve sailed past the ICD-10 cutover, and MU3 is another year away), now might be a good time for some introspection and optimization.  Yes, there are numerous payment reform initiatives, however with the growing rate of acquisitions and merges, training and onboarding may be an opportunity for improvement!

Resources:

[i] THEORY NAME: Andragogy http://web.cortland.edu/frieda/id/IDtheories/42.html