mis-EHR-y (misery): the current state of EHR training

mis-EHR-y noun (prononunced “misery”): The current state of EHR training.

As the Physician Lead for EHR (Electronic Health Record) training at my medical group, I both design AND advocate for physician’s EHR training. As our systems get more complicated and more advanced, it is more and more difficult for a busy working doctor to keep up with it all. There is a big discrepancy both regionally and organizationally towards how or even if EHR training is addressed. The reality is that most doctors get no continued routine EHR training at all (just some basic training when they start a new job). We know that EHR training and EHR personalization is linked to greater physician satisfaction and less burnout. BUT, it’s hard to put a dollar value organizationally on less burnout (at least right now). However, burnout is correlated to patient safety concerns. Doctors experiencing burnout leave medicine, and the cost of replacing doctors is high. Additionally, it’s important to point out that this is more than a just a paper chart – the company/organization has heavily invested in a very expensive, multi-discipline, transforming business software. Training the employees to use the tool makes sense on every level.

“Formal protected EHR training should be a standard part of mainstream continuing medical education requirements”

Let’s face it- there are always patients to be seen, and that’s how health systems make money. So, the business case to not see patients and take computer training is a tough sell. Organizations probably think that we as physicians are smart and hard working; we will just figure it out, right? If not, can’t we just work longer hours? I propose: Better competence and control of the EHR by a physician would produce desirable downstream effects for an organization, including less burnout, more efficiency, better population health, better patient safety, better chart accuracy, and improved patient satisfaction. I know personally that the more control I have of the EHR, the better ability I feel to get the patient what they need faster, safer, and in a more satisfying manner. I would challenge the healthcare system that going forward, formal protected EHR training should be a standard part of mainstream continuing medical education requirements. Medical Informatics should be leading the design and requirements of this training.

“…the more control I have of the EHR, the better ability I feel to get the patient what they need faster, safer, and in a more satisfying manner”

What about pilots? Pilots use technology to fly planes. They must adapt to switching jobs, changing planes, and having new software upgrades. Are they only trained in basic flying when they begin their careers, or are they regularly trained for the specific technology of the planes that they fly?

How Are Major Airlines Pilots Trained? “Commercial pilots have to go back to the training center for recurrent training every nine or 12 months. They’ll be given oral and practical exams in the simulator to ensure that they’ve maintained their proficiency, and will be brought up to speed on changes that are coming to the airline and fleet. These recurrent training events are jeopardy events that, if not passed, could result in remedial instruction or, in some cases, termination. There are also frequent additional training opportunities that the pilot must accomplish… to stay up to date on policy, procedures and changes to their aircraft and the airline.”

-ThePointsGuy

Reading about the Boeing 737 Max software feels very similar to a modern EHR. The same software designed to improve flying also makes the system more complicated, which requires new training. This seems similar to the EHR with hard stops, substitutions, clinical decision making, Best Practice Advisories: all tools designed to help our patients, our populations, and our companies’ finances. After all, aren’t AI and these tools a well-intentioned EHR “autopilot.” I know as I write this, its easy to think that we should blame the software, but maybe we just are lopsided in our commitment of resources to supporting the technology advancement while not the supporting adequate necessary training. We still need a doctor with knowledge of the medicine and the patient to “fly the plane” that is the EHR, but we just need to modernize our approach to accept the technological reality of modern medicine. Always changing, always adapting – technology is here to stay. We need to be designing, supporting, and standardizing physician technology education. We need to lead the effort for normalizing this approach to training physicians on technology now and for the future. If we don’t, I would argue that we are complicit in just waiting for bad outcomes to occur that force some outside agency to regulate our industry (and then force this upon us on their own terms).

My Statement of EMR Training:

  • A provider who is not proficient in the EHR may provide less quality of care and less safe care than a provider who is adequately trained to use the EHR. The more complicated the EHR gets, the more powerful the potential automated benefits are to patient care – but does it all matter if no-one can use the tools?
  • EHR is a not just an electronic paper chart. It is an ever- evolving and sophisticated business software as well as a medical device.
  • Successful use of any other medical device or tool requires regular training and certification for safe use. Thus, I believe that the EHR should be viewed as a medical device or tool that requires continual training and maintenance of skill to safely operate.
  • Studies show 5-6 hours annually of EHR training are correlated with the highest benefit.
  • This training should be fully supported by medicine as a whole AND all of our organizations to help doctors safely and effectively use the EHR. This should not be a cost to the doctor in terms of time or money. This is “in-training” on a business tool. This is an investment for an organization’s doctors, in contrast to optional educational medical CME topics.
  • Conclusion: Physicians should be provided 5-6 hours of annual paid, in-person Physician Informaticist-lead EHR training (in-training) to maintain EHR proficiency for safe effective utilization of the EHR.

http://fortune.com/longform/medical-records/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540432/

https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0039-1688753

https://qz.com/1584233/boeing-737-max-what-happened-when-one-us-pilot-asked-for-more-training/

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