Training providers: beyond the basics of electronic health records

Background

Electronic Health Record (EHR) training can affect EHR usability and provider willingness. This article evaluates the effect of post-implementation training on specific EHR activities (problem list and medication list management).

Methods

The study was conducted at Kaiser Permanente, Mid-Atlantic States (KPMAS), using a mixed methods approach (1:4 match case-control), where the usage rate of problem list and medication list management components of EHR were measured 6 months pre-training and 6 months post-training. A comparative analysis was done using the Wilcoxon sign rank test.

Training included two classes with 20–40 minutes lecture/demonstration format, specific hands-on exercises, and supplemental materials for post-class learning (refer to the appendix section). The first class focused on problem list management, medication list management, patient history, and efficient chart review. While the second class focused on documentation, efficiency tool, order entry, and preference list.

Results

Training evaluation was done on 36 participants and 144 non-participants based on use of problem list and medication list management using the Wilcoxon sign rank test. An increase in the likeliness of participants to use the problem list ((p = 0.06) and medication list (p < 0.05) 6 month post-training was noted. However, the increase in problem list use was not as significant as that of the medication list. The use of problem list increased from 22% of visits to 24% of visits, while use of the medication list increased from 41% of visits to 45% of visits. With these finding, class materials used in this training program have been incorporated into the training program at KPMAS.

Discussion

This study targeted EHR components such as problem lists and medication lists, which are criteria for EHR meaningful use. The training developed, improved the workflow of providers by improving EHR skills, and increased physicians, nurse practitioners, and nurses interest in EHR training.

This training program also had limitations, in that, it may not be appropriate to implement in an inpatient setting, as it was “developed for a non-specific outpatient setting including both primary care and specialty care.”

Conclusions

EHR training improved providers willingness to use EHRs and get ongoing additional training, as well as, improved the use of the problem list and medication list management functions of the EHR, which are part of the Meaningful Use criteria.

Appendix

• Contents of the quick reference guide that was distributed to class participants for the first class.
• Example of the keyboard shortcut templates.
• Effect of training on use of problem lists and medication lists.
• Relationship between provider characteristics and outcome measures.

My Comments

This is an interesting article because it evaluates the impact of post-implementation training, as most EHR training are done post implementation. The length of post-training evaluation (6 month) was also interesting because it determines the learnability of the EHR and the users ability to remember the training after an extended period of time. The only problem I have with the article, is that the sample size used was small. An larger sample size may have produced a different outcome.

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