Our Staff Training Program for EMR
We divide the training process into three steps.
By Peter J. Polack, M.D., F.A.C.S.

Over the past year, I have brought readers along for the ride as our practice makes the transition from paper records to electronic medical records (EMR).

Many colleagues have e-mailed me asking why this has been such a lengthy process. Some articles about conversion to EMR describe this as a "3-to-4-month project." Perhaps for a tech-savvy solo practitioner, using a basic EMR system and working out of a single location, this may be true.

However, for most practices, converting to EMR is a major shift in the culture of a medical practice and it is the approach to staff training that can make or break a project of this expense and magnitude. Here, I will discuss the actual training process for our staff, which can be broken down into three steps.

■ Identifying current skill levels. Most children today are well-versed on computers and the use of the Internet, but many adults are not. By necessity, most physicians have had to keep up with technological advances and probably use computers on a regular basis. However, many non-physician staff members have only had experience with computers at work and may have limited computer skills.

To ascertain an employee's proficiency with computers, we ask which programs the employee has used in the past and what type of tasks were performed in those programs. The vocabulary that an employee is familiar with can also help us to determine that person's computer competency.

■ Bringing all staff up to necessary skill levels. When planning to use an EMR/electronic practice management (EPM) system with a graphic interface, it is obvious that all employees will need to be facile with computer skills, from dragging and dropping objects with a mouse to understanding how files are saved on a computer. However, the specific tasks that may be required will differ depending on an employee's job description. For example, most staff members will need to know how to use the EPM system to look up or make an appointment. Some staff members will need to be able to check in or check out patients, while others will also have to be familiar with claims generating or posting money. Technical staff members may not need to know about the claims process but will have to be well-versed in the EMR process.

■ Designing a training plan for new software. The EMR committee will need to design the training plan with the employees' skills in mind. By using a "building blocks" process, they will need to establish what the common tasks will be for all employees and then add on additional functions in increasing complexity, depending on the specific department and job. All staff members will need to be taught the basics of the entire system. Then, each department will rotate through our training room and be taught the tasks that are necessary for their particular jobs. We wrote a training manual for the EPM software module and a manual is being written for the EMR module.

Improvements to the manual are being made during the training process. OM

Next: Conversion from an existing EPM system

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 140 employees. Dr. Polack can be reached by email at ppolack@ocalaeye.com.

Until now, we have looked at various parts of our EMR implementation project, from installing infrastructure to choosing hardware and software. We now need to bring the parts together to make our paperless office a reality.

Although our IT personnel had begun to plan some critical tasks such as the wiring of satellite offices, we needed an integrated plan that would tie in the technical aspects of the project with the training aspects to maximize efficiency, making the best time-use of our personnel.

Developing the Plan

Key personnel from different departments including administration, clinical, IT and clerical met with Frank Polack of Eviton Consulting, a facilitator in project management, to create a WBS (Work Breakdown Structure) for the EMR implementation project.

We identified the major processes that needed to be addressed and placed them under eight overall headings: Software set-up, Hardware acquisition and set-up, Infrastructure, EMR configuration, Testing, Training Plan, Process Review, and Rollout Phasing. [see the diagram]

Each process was then further broken down into smaller steps which could then be delegated to staff who would "own" that particular sub-process. For example, the major process of configuring the EMR program was divided into specific issues (such as configuration of templates) and further sub-divided into specific tasks (which standard templates to use, which templates to create, who creates them, who will review them and how will they be tested).

For EMR configuration, a workgroup comprised of physicians and IT personnel is now analyzing the existing clinical templates in the EMR program. This workgroup will then make modifications based on the workflow currently used in the practice, in order to have the most transparent effect on the task of patient examinations.

Making the System Work

Particularly for physicians who are less "tech-savvy," it is critical to have a system which is as efficient, if not more so, than the current one they are used to using.

Some changes in the current workflow will probably be required given the hierarchical design of the EMR system. For example, while we currently dictate to a scribe something such as "2+ NS (nuclear sclerosis) and PSC" we may need to say "lens, NS 2+ PSC 2+". While this may seem like a minor difference in the way physicians have been doing things, it can have an impact on workflow efficiency when multiplied by hundreds of patient examinations per day.

The onus is then on the configuration workgroup to come up with a method to marry the way the physicians and staff have previously been working with the way the EMR software works most efficiently.

A separate "test" database of the EMR system can be accessed from home via remote desktop services by any member of the workgroup to make changes to templates and test them. The workgroup can then do a final review before the changes are made to the "working" database. OM