This article looks at items to take into account when implementing health information technology (HIT). After selecting and preparing computerized medical record software, training health care workers to use the new technology remains a critical need. The health care industry must strive to create training that can be delivered with minimal impact on staffing, the flexibility to meet the needs of multiple disciplines, and the effectiveness to decrease the impact on revenue that is commonly seen after the implementation of an electronic medical record (EMR) system.

1. T R A I N I N G C O N S I D E R AT I O N S F O R H E A LT H I N F O R M AT I O N T E C H N O L O G Y

2. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
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3. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
I M P L E M E N T I N G H I T: T H E S E A R C H F O R
E F FE C T I V E A N D F LE X I B LE T R A I N I N G
Executive Summary
The business of healthcare is experiencing change of a magnitude that has
never before been seen. The implementation of health information technology
(HIT) is burgeoning within health care organizations across the United States.
After selecting and preparing computerized medical record software, training
health care workers to use the new technology remains a critical need.
Relatively new to technology, the health care industry must strive to create
training that can be delivered with minimal impact on staffing, the flexibility to
meet the needs of multiple disciplines, and the effectiveness to decrease the
impact on revenue that is commonly seen after the implementation of an
electronic medical record (EMR) system.
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4. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
The New World of Health Information Technology
In light of recent ARRA legislation, healthcare organizations are scrambling to comply with government mandates and implement health information
technology. HIT includes such things as:
 Computerized physician order entry.
 Computerized documentation of patient biometric information.
Resources Devoted to the Implementation of HIT
 Electronic delivery of diagnostic test results.
 Computerized documentation of physician, nursing and allied health
Software Purchase
patient care plans and notes. • >$10,000 per Prescriber
 Evidence-based guidance.
The scope of HIT requires that all health care workers must be trained to use the
Software Implementation
computer system.
• 1.5 X purchase costs
• Technical configuration
Although many resources are focused on defining such things as meaningful use • Additional staff
• Decreased productivity & revenue loss
of health information technology, levels of adoption, and software selection, little
attention has been focused on the training and support of the health care workers Training
• No published cost measures exist
who ultimately use health information technology on a daily basis.
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5. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
The Current State of the Industry
Health care as an industry is a latecomer to the computer age, and many nurses and physicians are novice computer users. They are now faced with
the challenges of learning basic computer operation and the introduction of computer technology into the daily work of patient care. These challenges
precipitate changes in workflow and data entry processes that can impact the delivery of patient care.
Components of Effective Training
It is essential that health care staff are properly trained and prepared to use health information technology, and health care organizations must create
effective and flexible training through a variety of delivery methods such as online courses, instructor-led training and hands-on practice. Training must
also focus on the key concepts and processes, and it should be chunked into flexible learning modules that can be reused to meet the needs of the
many different roles involved in the delivery of patient care.
Example of Chunking Training into Modules for Flexibility and Reusability
Training Modules Learner Roles
Physician Nurse Social Worker Nursing Assistant
How to enter vital signs X X
How to view vital signs X X
How to enter an order X X
How to view an order X X
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6. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
Because EMR software is constantly changing—with upgrades and new functionality—training must keep up
with the change. Learning modules must be designed so they can be quickly and easily updated to reflect
changes in software or processes and can be utilized for ongoing employee training long after the initial
implementation training.
Implementation of effective, successful HIT training requires several components:
 A development team with an in-depth knowledge of the processes and practices associated with the
delivery of patient care and a detailed understanding of computer technology and the possibilities and
limitations of an EMR system
 Expertise in and application of adult learning theory and instructional design principles
 A focus on the end users—the targets of change—and their concerns and needs
 A dedication to creating conditions for success during this time of extreme organizational change
There are few experts within the health care industry who possess this combination of skills to design
effective training.
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7. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
The Clinical Specialist
Historically, training within health care has focused on the validation and advancement of clinical skills—a task most often performed by clinical
experts such as registered nurses trained as clinical nurse specialists. Although clinical nurse specialists are experts in the processes and practices of
the delivery of health care, the training of computer technology is typically not within the scope of expertise for these professionals.
The Information Technology Solution
A new breed of health care professionals has arisen in response to the growing need for HIT implementation expertise. These professionals include
nursing informaticists, medical informaticists, and other licensed health care professionals who focus on the integration of technology with the delivery
of health care. The design and delivery of HIT training is often delegated to the informaticist, who possesses an in-depth knowledge of patient care
delivery processes as well as an understanding of health information technology. Missing from the equation, however, is the expertise in adult
learning, instructional design, and change management.
The Software Vendor Solution
In response to the lack of effective training solutions, many vendors of electronic medical records systems offer prefabricated or customized training to
a health care organization. Although a software vendor is an expert in the functionality and processes associated with their particular EMR system, the
vendor is often unfamiliar with the unique culture and processes of each health care organization. Oftentimes the result is training that teaches health
care staff how the software works, but not how to use the software in their daily work.
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8. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
The Instructional Design Solution
Infrequently seen in health care but utilized by many other industries, the instructional designer is trained to tap the knowledge of subject matter
experts in order to design and deliver effective training. Instructional designers for an initiative as large and complex as EMR implementation typically
work in a team to provide consultation services and training solutions. They can collaborate closely with subject matter experts in all areas to perform
tasks such as:
 Clarify organizational goals and objectives. The Instructional Designer’s Role
 Identify the target training population: their characteristics, current
processes, and needs.
Clinical Nurse
Specialist: Software Vendor:
 Analyze the level of performance to be attained as a result of the training. Patient care Software function
processes and training
 Determine strategies for transferring learned skills into the workplace. and training
Instructional Designer:
 Identify learning objectives for the training program. Utilizes subject matter
experts in all three
 Design and develop a flexible, comprehensive training program that meets the areas to design effective
and efficient training
needs of learners, is instructionally sound, creates conditions for success, and based on adult learning
theory and instructional
design principles
meets the business needs of the health care organization.
 Implement the training solution along with complementary communications to
prepare learners for success. Clinical
Informaticist:
 Evaluate the success of the training program. Software function
and patient care
processes
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9. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
Benefits of an Instructional Design Solution
The delivery of training to patient care staff is a large expense for an organization,
triggering increased payroll costs during the training and implementation period. Although
hiring instructional designers to manage the training is also an investment, it is often
more economical than using the internal resources because:
 The internal resources are usually fully booked with work. Stretching internal
resources can be detrimental to morale, but hiring additional permanent
employees can be expensive and time consuming. Instructional design
consultants are fully engaged in the learning project and feel the urgency of
deadlines.
 Successful instructional design consultants have proven track records, protocols,
methodologies, and efficiencies that reduce development time and money.
 Instructional designers are skilled at learning new technologies and business
processes and can quickly assimilate into the organization’s environment. This
acceleration provides an excellent return on investment.
 Consultants schedule their work around the subject matter experts’
commitments, maximizing their time and reducing their time away from their
other priorities.
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10. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
Conclusion
A critical component in the successful implementation of health
information technology is training. However, very limited attention
and resources have been dedicated toward helping novice users in
the industry gain the necessary skills to be successful with the
technology. HIT process, practice, integration and
functionality experts have historically been tasked with creating
training, but they lack the essential expertise to create
instructionally sound, effective solutions. By completing the
existing team of experts with experienced instructional design
consultants, health care organizations can achieve optimal ROI
and deliver EMR system training that meets the needs of the staff
and the business objectives of the organization.
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11. TRAINING CONS IDERATIONS FOR
HEALT H INFORMAT ION TECHNOLO GY
At Michaels & Associates, we provide consultation services and custom training development for a variety of businesses including the healthcare
industry. We help our clients build an environment for individuals where learning matters and profoundly impacts every person, business and
community. To learn more about how Michaels & Associates can help your organization build effective EMR training, contact us.
Michaels & Associates — where applied learning and your business goals meet.
info@michaelsandassoc.com www.michaelsandassoc.com toll-free: 877-614-8440
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