Training EndUsers for optimal EHR usage

Ask any doctor, nurse, or advanced practice provider (APP) what gets in their way of providing good patient care and you’ll likely hear “The electronic health record (EHR).”  Many studies show that the EHR, despite its beneficial role in the revenue cycle, data collection for payor incentive programs and tracking quality outcomes, has a negative impact on work in healthcare settings.  This negative impact contributes to burnout and poor communication among the healthcare team.  It also extends to patients; surveys reveal they feel ignored during an office visit or find it difficult to access their health information.

Despite these downsides, EHRs have the potential to offer many benefits to healthcare systems, healthcare providers and patients.  The key to unlocking these benefits is twofold: design an intuitive system and providing good training.

One of the leading organizations that measures EHR satisfaction among healthcare providers is the KLAS Arch Collaborative.  They have surveyed hundreds of organizations across the globe and provide vital information on what drives a higher EHR satisfaction score (aka Net Provider Score or NPS).  The number one variable affecting NPS is how much training an organization extends to providers in customizing the EHR tools to accommodate their particular workflows.  The number one variable for predicting a highly efficient provider (and lower burnout scores) is termed “chart closure rate.’  This refers to the percent of visits that are closed on the same day of service and there is an inverse relationship between these two variables.  The more charts a provider closes on the day of service, the lower their burnout scores, even if they have more after-hours work (coined PJ time).

At The Guthrie Clinic, we embarked on a journey to improve our physician, nurse and APP NPS. 

We began by focusing on our onboarding training, making sure that we provided extra training on how to customize the EHR for end-users.  We then added an EHR rounding program where trainers were assigned to a practice and provided both scheduled and on-demand training.  The scheduled training followed a curriculum but also included individualized training based on a tool called Signal that provides information about how an end-user is performing in four key areas: reviewing the medical record, placing orders, documentation and, working the in basket.

Given the ongoing EHR improvement and changing regulatory requirements, we incorporated our EHR vendor’s training, called Thrive.  This consists of quarterly 60 minute classes focusing on each of the above areas for both inpatient and ambulatory settings.  We conduct these in a virtual format and offer them at different times of the day to accommodate a variety of schedules.  They are also recorded for on-demand viewing (or review).

We incorporated an adjunct program called “Stay interviews.”  These were developed and administered by our provider retention department and consist of questions that allow evaluation of how a new employee is integrating into the organization, their department and, how their spouse and family are integrating to the community.  This is an additional opportunity for the interviewer to identify any gaps in EHR training, IT support or other areas that need to be addressed.  The combination of all the above has dramatically improved our voluntary turnover (non-retirement) rate.