A recent study showed that clinicians spend about 16 minutes per patient using electronic health records (EHRs) for tasks such as chart review, orders and documentation (https://www.acpjournals.org/doi/10.7326/M18-3684). Studies also have shown that EHR use increases physicians’ frustration and can lead to burnout.
One way to reduce administrative burden is to invest time in training clinicians on how to use their EHR, said Kim Whalen R.N. M.S. C.C.R.N., a pediatric intensive care unit clinician and EHR educator. It is important that training is provided by physicians or nurses who use the system and understand the workflow.
EHR training includes three steps: onboarding, classroom training and one-on-one or “elbow support.”
Onboarding is the first step in the training process and varies with institution. Some institutions consider onboarding primarily administrative such as licensure, credentialing, creating a login account and personalizing the EHR interface or tools for the department. At other institutions, EHR onboarding consists of pretests and exercises.
The next step is several hours of hands-on computer classroom training focused on an individual’s clinical role and department. During the classroom experience, clinicians learn how to navigate the EHR efficiently, become familiar with inpatient and/or outpatient charting and flowsheets, focus on writing short, accurate notes geared toward clinical care rather than billing practice, and learn workflow customization.
“Nurses and physicians need training prior to their clinical duties, but it is also important when there are major updates or clinical duty changes,” said Whalen, an affiliate member of the AAP Council on Clinical Information Technology.
The last part of training is one-on-one or elbow support provided by a trainer, in-house training team or a supervisor or clinician in the practice who has received additional training. During this phase, providers are shown how to use the EHR effectively without creating workarounds, which can increase efficiency and decrease frustration.
“A key component is setting up EHR personalization and assuring that clinicians can find critical clinical information,” Whalen said.
Due to the COVID-19 pandemic, EHR training is now being provided online using PowerPoint, online videos and webinar discussions with trainers.
According to Whalen, virtual EHR training has the following advantages:
- Sessions can be scheduled without concerns for classroom capacity.
- Material is consistent, self-paced and easily accessible with reduced downtime for attendees.
- Updates can be communicated throughout a hospital system without requiring staff to attend in-person classes.
- Modules contain hands-on practice sections and quizzes to improve engagement and understanding.
However, when training is self-directed, there are limited ways for participants to ask questions and for trainers to troubleshoot misunderstandings. In addition, there is less one-on-one support.
Despite the downsides, online, self-paced EHR training may be a long-term strategy to support clinicians in continuously improving their skills.
Investing in onboarding, classroom training and one-on-one support can save clinicians time and reduce their frustration with EHRs. Training is one step toward improving physician well-being and resilience.
Dr. Barr is a member of the AAP Council on Clinical Information Technology and chair of the Section on Medicine/Pediatrics Executive Committee.