Enhancing Electronic Health Record Training. Peggy Krimbel, BSN, EdM Sonia Pofelski Susan Johnson, RN, MS

Transcription

1 Enhancing Electronic Health Record Training Peggy Krimbel, BSN, EdM Sonia Pofelski Susan Johnson, RN, MS

2 None of the planners or presenters of this activity have disclosed any relevant financial relationships with any commercial interests. Following the ISMS & IACME Planners Workshop, this presentation will be posted online at the IACME website:

3 The Many Faces of E.H.R. Training Implications for CME Peggy Krimbel, BSN, EdM

4 Is Accrediting for E.H.R. Any Different? Not so much Depends on the type of training & how it is delivered Same criterion though sometimes have to be a bit creative in meeting them

5 Two Stories to Tell I. Implementation of new product across multiple Provena Medical Group clinics II. Upgrade of a current product in a single hospital

6 Strategies/Aids Know your resources use them Get involved in the process early on Develop an Action Plan with deadlines & update periodically Request a lesson plan Partner with those who will do what needs to be done and work with you identify a single contact person For large projects, keep a BIG notebook and tab it to organize materials Apply A Rule of Reason

7 #1- What Did The Organization Want? Implementation of new software in all PMG clinics Proficiency training for all those who would be using it, including physicians And of course CME credits for all physicians who would be participating across the system

8 Description of Training Full day training in a computer lab at a central location. Attendance mandatory Multiple training sessions over a year 7 available computer-based learning modules. Completion of any or all modules optional and at the discretion of the learner

9 Challenges & Tactics 1. What type of program: Course? Lecture? Enduring materials? Course: length; lab ; demonstration of competency; performance expectations during presentation 2. Identifying what was needed to maintain ACCME compliance All the same criteria; used same program worksheet; process & content more extensive only because of repeated sessions & joint sponsorship 3. Defining who was accountable for what task Use Action Plan

10 4. Tracking what had been submitted or not Use detailed Action Plan or checklist 5. Awarding credits Need lesson plan with allotted times from trainer Category 2 paperwork provided for optional CBLs Awarded for 13 months 6. Disclosures Challenges & Tactics Define for others so they can determine who needs to submit 7. Marketing/CME Statement/Logo Done by announcement on LMS Referenced class handouts with CME statement & logo

11 Challenges & Tactics 8. Needs Assessment/Practice Gap/Objectives Developed collaboratively 9. Evaluations Provided forms for standardization same as for any other CME +++ Completed competencies 10. Follow up Looking at data gathered from submitted heat logs Feedback on training led to format change to process flow delivery; revised materials provided to CME unit

12 Challenges & Tactics 11. Linking to all criteria Ask LOTS of questions related to each Plan questions in advance to get the needed information Start with C1-15 as basics Then C16-22 to get full picture Check in frequently Materials, process/delivery change as participant feedback generates improvements; trainers can change over long time period

13 #2 What Did The Organization Want? Implementation of upgrade to current software to standardize across the system Training for all those who would be using it, including physicians And of course CME credits for all physicians who participate

14 Description of Training One hour lecture in central location Attendance strongly encouraged Multiple training sessions over 2 months provided high level information on changes 1:1 IT support and training with practitioners throughout training period

15 Challenges & Tactics 1. What type of program: Course? Lecture? Enduring materials? Multiple lectures, same topic 2. Identifying what was needed to maintain compliance All the same criteria; used same program worksheet; treated each as a separate CME session 3. Defining who was accountable for what task Could be more casual Action Plan as needed

16 Challenges & Tactics 4. Tracking what had been submitted or not Program Worksheet Use Action Plan 5. Awarding credits One hour per session Did not award credits for 1:1 sessions with IT 6. Marketing/CME Statement/Logo Done by usual channels, HOWEVER Other departments wanted to support so also put out info: Save The Date 7. Disclosures Clearly define

17 8. Needs Assessment/Practice Gap/Objectives Developed collaboratively 9. Evaluations Provided forms for standardization same as for any other CME Provided feedback that improved delivery of content 10. Follow up Challenges & Tactics Impact on / Transfer to Practice

18 Challenges & Tactics 11. Linking to all criteria Ask LOTS of questions related to each Plan questions in advance to get the needed information Start with C1-15 as basics Then C16-22 to get full picture to get the full picture Check in frequently Materials, process/delivery change as participant feedback generates improvements

19 Sonia Pofelski

20 IMPLEMENTATION OF EHR Goal of OSF Healthcare: Enhance physician clinical performance Reduce medial errors, improve patient safety Comply with The Centers for Medicare & Medicaid Services (CMS) requirements

21 What was the identified practice gap? Electronic Health Records (EHR) was coming and was new (unknown) technology feared by many!

22 What was the desired results? To facilitate change in physician EHR competency and performance thereby enhancing clinical performance

23 And of course accomplish this training and provide CME to all physicians

24 HOW WERE THESE GOALS ACCOMPLISHED?

25 PRIOR TO TRAINING 2 intermittent Grand Rounds were provided

26 TRAINING 4-hour mandatory e-learning was required prior to in-seat training to familiarize physicians with basic principles and system layout

27 TRAINING Mandatory computer lab in-seat training was provided Length of in-seat training dependent on their specialty

28 Upon completion of training: Physicians demonstrated their EHR skills to credentialed trainers A written test was given A course evaluation was filled out

29 ONCE TRAINING WAS COMPLETE! Access to the sandbox (patient chart simulations) Log-on information

30 HOW WAS THIS ACCOMPLISHED?

31 STRATEGIES / AIDS Define CME expectations to all involved Get to know all who share this endeavor Set a generous timeline

32 STRATEGIES / AIDS Follow a detailed process Communicate the process with all involved long before training begins

33 THE CHALLENGES

34 CHALLENGES Design of the activity: Type Length Demonstration of competency

35 CHALLENGES Modify training to compensate for variable computer skills extreme novice ultimate techie!

36 The Biggest Challenge of All!

37 Physicians are asked to change their culture of medicine.

38 LESSONS LEARNED Be included in on-going meetings with key departments to identify EHR issues (QI, Pharmacy, Radiology, Lab, ED, etc.)

39 LESSONS LEARNED Utilize multiple non-educational adjunct strategies ( current tips of the week, the practice sandbox, posters, blasts, etc.) and

40 Identify & Engage Physician Champions

41 An EHR physician champion ideally utilizes: Good communication skills Strong listening skills Strong computer skills And is a recognized physician leader

42 The appointed physician champions were good the self-appointed physician champions were great!

43 Self-appointed champions endured EHR challenges and struggles, but when they got it they saw value to their practice and their patients.

44 OUR FOLLOW-UP Ongoing meetings with QI, Radiology, Pharmacy, ED and Lab continue to identify knowledge gaps to identify needs for additional physician education

45 OUR FOLLOW UP A 2-hour evening computer lab activity was offered with Pharmacy, Radiology and Lab identifying commonly seen problem areas, case scenarios, and answering questions

46 OUR FOLLOW UP A post go-live Grand Rounds was offered to identify common EHR issues and tips

47 OUR FOLLOW UP An RSS for on-going EHR training of new physicians is offered for up to 7 AMA PRA Category 1 Credits Length of training varies Training is reviewed on a yearly basis

48 Using a Quality Improvement Method To Train E.H.R. Susan Johnson, RN, MS

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50 P.D.C.A. First step is PLAN Timeline: From one year before until training begins Prioritize training Identify the training resources Structure the plan Communicate the plan

51 P.D.C.A. Cont. First step is PLAN CME Planning application Disclosures of all trainers/planners Education design for live activity Pre-requisite education, Can this be enduring material? Special needs of learners

52 P.D.C.A. Second step is DO Timeline: From 4 months prior to training, until training begins Designate global objectives for training plan Validate the in-class time to equal the credits to be awarded Develop workbook/class materials Develop communication page for designation statements, how many and how will physicians receive credit

53 P.D.C.A. Cont. Second step is DO Tracking plan for training schedule, scoring competency test and awarding credit Managing certificates for mid-levels Develop an evaluation based on meeting the training global objectives

54 P.D.C.A. Third step is Study Timeline: From time training class is finished through the go-live period Optimization and Support Provide times to practice and problem-solve in computer lab Pair resources with individuals that are struggling Super-users available where documentation is occurring for go-live

55 P.D.C.A. Cont. Third step is Study Evaluation tracking process Tracking for PARS and individual credit award Expect the unexpected Be responsive to questions and requests Define measures of successful EHR Training

56 P.D.C.A. Fourth step is Act Timeline : From evaluation return until after go-live Live and learn Assess evaluations for anything that may need immediate attention Have a plan to correct and communicate misconceptions or unanticipated training development

57 P.D.C.A. Cont. Fourth step is Act Score evaluations and provide feedback to training team Meaningful electronic capture of data--such as CPOE usage

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59 Questions?

60 Questions? Contact information: Peggy Krimbel: Sonia Pofelski: Susan Johnson: