EHR Implementations: Success Lies Beyond the Build

Rob Drewniak for HealthLeaders Media , April 28, 2009
  • Obtain leadership support for your training strategy. The training mission, vision, and delivery strategy should be reviewed and approved by administrative and physician leadership. It is important to communicate the critical training requirements to physicians, clinical care providers and general staff. For example, training may be optional for some and mandatory for others. Or, access to the new system will be granted only to those passing a competency assessment. My clients have found that a best practice is to tie system access to passing a competency assessment. Executive buy-in is absolutely critical for this to be successful, however. It should also be communicated by executive leadership versus the project team.
  • Staff up. Identify potential trainers early in the process. Look for people with good communication skills at all levels, experience in training environments—preferably with a system implementation, and other characteristics like patience. Don't wait. Identify trainers on staff or hire outside trainers during the initial phases of the project to begin involving them in all activities, including design, build, validation, and any re-engineering processes sessions. Training in and of itself is a significant endeavor.
  • Determine training methodology. There are many questions to be answered, such as: Will there be a dedicated training team? Will a train-the-trainer approach be used? How will the role of super user be defined? Will training be instructor-led or computer-based? How much can a user learn about the process and the software application in a short formal classroom session? Based on my experience, the approach most often used is a blend of instructor-led and computer-based training. Here are some suggestions:
    • Don't rely entirely on computer-based training. Given the number of staff who may not be very computer literate, it will not be the most effective way for them to learn.
    • Combine computer-based training, instructor-led training, hands-on exercises, and practice time. This blended approach should meet most of the diverse end-user characteristics.
    • For end users who need additional training, computer-based training is a good option.
    Create curricula based on the design, build, and validation processes that focus on the specific goals or requirements of the role and the associated workflow that individuals need to know.
  • Cover computer basics. Early in the implementation process, evaluate end users' computer knowledge. The quickest way to frustrate staff is to give them tools that they cannot use or understand. Provide basic skills to those who need them to shorten class time during training. Our experience with clients has shown this strategy should lead to better adoption rates, a clearer understanding of application flow and workflow, and increased use of the system.
  • Communicate changes. In the training communication plan, include a process for distributing updated training materials to staff. This includes specific updates for managers and super users.
  • Set up post-training environment. You will most likely have users with a variety of unique training needs. Therefore, it's important that the communication plan clearly identifies the post-training requirements for all users. For example, a "playground" or test environment is a great way to enable users to practice without worrying about making mistakes.
  • Transfer knowledge. Training is a collaborative process. Trainers will need to work closely with physicians, nurses, technologists, financial staff, and other members of the healthcare organization to successfully develop and deliver training. The objective of training is to transfer knowledge to end users so that they can enhance the quality of patient care. The EHR is one tool to do this. The other tools that are just as important are processes and workflows that complement the technology. Although the initial training sessions will focus on application functions, the actual "learning" and optimization of the applications will come after the training, through use. That is why post-implementation support is so important. Whether it's the training "playground" or additional classes, users will have more questions once they start using the system and living in the new workflows. Processes may need to be fine-tuned; therefore, trainers and technical staff should be readily available post go-live.
  • These three areas: communication, classifying implementation projects, and end-user training can create a foundation for the technology to succeed. Some mistake them as "fluff," but that is a costly mistake.

    Rob Drewniak is a consultant with Hayes Management Consulting in Newton Center, MA, and the former senior vice president of clinical resources at Glendale Memorial Hospital. He can be contacted at or visit for more information.

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