Electronic medical record (EMR) implementations are expensive endeavors, and cost overruns can cripple the hospitals that experience them and cause havoc for the people who work there.
In the case of Lahey Health, training costs related to their Epic implementation were cited as one of the specific reasons they laid off 130 people in May of last year.
Training is often an overlooked and under-prioritized aspect of an implementation, but it can have vast ramifications—both for the project budget as well as for the successful long-term use of the EMR. Three areas in which hospitals should focus to leverage their budget and increase their success are staffing, training timelines, and the methodology of the training itself. As a former training manager who has worked on 14 EMR implementations (10 in a leadership role), I want to share my experience on how you can optimize these key aspects and best practices to reduce the financial risk profile of your implementation.
Staffing
Determining the best staffing option for your implementation training project can be difficult. There are a few key questions to consider:
- Are you hiring full-time employees or consultants?
- How many people will you need?
- How long will it take them to get on board?
- How do these elements impact your budget and timeline?
Before you can even begin to answer these questions, you need to start with one even more basic: when do you need your team to begin, and how long do you need them? The answer to this question can make the other decisions obvious. If you need a full team (or even just a couple of additions) in a matter of days or weeks, then hiring contractors is an easy choice. If you don't need your team for another year, then it may make more sense to post full time positions, and go through the process of recruiting, interviewing, hiring and training.
Unfortunately, your decision-making experience is unlikely to be that cut and dried.
A portion of your team will need to be on-boarded early enough to be involved with exploration, build, and the creation of the training materials. These individuals will be your leads for the trainers brought in later. Trainers will need to be on-site early enough for them to learn their own material, and ideally they will have time to job shadow the roles they'll be training.
Next, you'll need to determine how many people are needed to train the end users. Count the end users carefully and ask yourself: Who needs to be trained, and when? What about your fellow project team, executive team, and vendors? All of those groups need to count toward your total end user needs. The total number of end users will drive your total number of staff needed.
Now you're ready to identify how many rooms you will be training in and the total length of time you'll be training. When teaching a class, trainers need one hour of prep time at the beginning and one hour of wrap time at the end of each class session. That means if I have classes running in 26 classrooms in four hour blocks, three times a day, I'm going to need 52 trainers.
Once you know how many trainers you need, it's time to determine if you'll hire full time or contract staff. While it's true that full-time employees are less expensive than consultants, that comparison only takes salary into consideration—not the time and resources spent on recruiting, reviewing resumes, interviewing candidates over the phone and in person, training new hires so they're up to speed, and paying the premiums for the various benefits your hospital offers. Odds are high that during this training project, there will also be a period of peak need for trainers before it begins to dwindle. With these probabilities in mind, many health systems decide to utilize a blended approach, hiring a mix of full time employees and consultants for the project.
Timelines
After an approach to staffing has been decided, it's time to address training timelines. This is an area that is often poorly planned—not because there aren't smart people involved with planning (there are), but because they often don't fully understand how their portion of the project fits into the overall big picture.
For example, lesson plan deadlines are often due months before a build is complete. Think about that: how can a trainer effectively build a lesson plan—and then utilize it to train end users—when the object of the lesson hasn't even been completed?
Another route that some vendors recommend is using pre-made lesson plans, but these are even less customized for your organization and build. While these may take less time and cost less to use, please keep in mind how time-consuming and expensive it will be if your end users do not understand the new EMR by the end of the training program.
Another area of confusion about timelines revolves around the go-live date. The training manager's go-live date is not the same go-live date the rest of the project team is working from—it's 6-12 weeks earlier.
The training manager's go-live date marks the kick-off of a "train the trainer" program, which means that all lesson plans must be complete, the training environment must be built, classrooms must be set up, materials sent to the printer, wayfinding set up in the classroom, call center or help desk established, and logins published. When planning the project timelines, you will need to reverse engineer these outcomes to determine when they must be set into motion.
Methodology of Training
While planning out your training program, it may be tempting to think that incorporating eLearning will cut down unnecessary costs. It's true, this method can be cost effective, in addition to its ease of delivery and tracking. But what many don't realize is that to create a single hour of eLearning, it typically takes 40 hours of work (yes, really). This means that if your organization has tight training deadlines, the lesson may be out-of-date before it's even assigned. If your team is not concerned with material becoming outdated, there are still a few other questions to consider before utilizing an eLearning methodology:
- How much eLearning is appropriate and effective? 5 minutes? An hour? More?
- Where will the eLearning material be viewed? Do users need special workstations with speakers? If yes, how many of these workstations would be needed?
- How can your organization track eLearning completion?
- Can the eLearning material be accessed outside the hospital walls for exempt employees and providers who may want to view at home?
- Will these sessions be required as a pre-requisite to a classroom, and will they be turned away if they arrive at class without completion?
Every health system's needs are different, so answers to these questions differ. However, it's wise to keep in mind some best practices if using eLearning:
- Use eLearning to address areas that all users will need to know
- Keep sessions short
- Make eLearning interactive when possible
- Readdress eLearning material in other settings, such as classroom training
Effective eLearning requires a lot of preparation, but so does classroom instruction. It helps to be familiar with adult learning best practices:
- Limit classroom sessions into easily digestible amounts of time
- Make sure your material is organized to follow a workflow as performed on the job—this makes it more relatable
- Be aware of the different learning styles in your group, and address them with varied teaching methods such as group discussion, exercises, partner activities, etc.
- Provide materials post-training to ensure end users have something to reference in the future when they're on their own
In many cases eLearning can be used to enhance classroom learning, but live trainers are vital during an initial implementation training program. However, if the EMR was already built and stable and end users had at least a baseline knowledge about how to use it, eLearning could be an extremely effective way to continue to improve their understanding and efficiency.
Because every EMR implementation is different, every training project will be, too. No one will have all the right answers, but now you have many of the right questions to ask to ensure your hospital can plan an effective, successful training program.
Chris Cooley is a former Training Manager with experience on 14 EMR implementations, with 10 of them in a leadership capacity. She is now Greythorn's Training Advisor for their LIVESite Training & Consulting Practice.
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