Tech Training for Staff and Patients

From iPhone applications that enable remote access to electronic health records to tablet PCs with voice recognition software to Web-based portals that let patients check-in, schedule appointments, and get lab results online, medical practices these days have become high-tech operations. Implemented properly, of course, new software can enhance both productivity and the patient experience. But done poorly, it can be tens of thousands of dollars down the drain - not to mention a hassle factor of epic proportions.

Indeed, practices looking to reap the benefit of their investment in medical technology must be willing to commit the time, money, and resources to train their team on its use, says Derek Kosiorek, a technology consultant with the MGMA Health Care Consulting Group. "Your success with technology has a lot to do with the amount of time you put into it, which can be difficult because physicians often see the amount of training required as adversely effecting productivity," he says. "But we see a lot of complaints about a lot of systems being used in practices and anytime there's an issue it's more often than not the vendor's fault in the mind of the user - when really it usually could have been avoided by better training."

Here is an overview of "best practice" training methods for bringing the end users in your office - doctors, staff, and patients - up to speed.

Skills assessment

The first step to implementing new technology, be it EHR, mobile medical apps, or practice management software, is to assess the computer literacy of your team, says Peter Polack, an ophthalmologist with Ocala Eye in Ocala, Fla., and founder of emedikon.com, a practice management consulting firm. "You have to assess your employees' basic computer skills and bring them to a certain level of competency before they can even begin training on a new program," he says. "You can start by setting up a couple of computers in a spare room, designing a simple test, and rotating a few people in at a time." Ask them to create a Word document and save it into a specific folder, print something to a default printer in a different part of the building, and log on and log off successfully using secure passwords, Polack suggests. You can also create a questionnaire about basic computer terminology and ask your staff what programs they've used before. Younger employees and physicians are generally the most tech savvy, notes Polack, while older workers with less computer experience may need more hand holding.

During the skills assessment phase, be sensitive to the fact that some employees may get flustered by computer jargon or fear their job will become redundant after the new system goes live. It's your job to reassure, says Jeffery Daigrepont, a senior vice president with the healthcare consulting firm The Coker Group in Atlanta. "We think that best practices for training staff is to do everything in phases and stages," he says. "In some smaller practices that have not yet modernized a lot of times the staff just doesn't trust technology, so getting them some tools that are a little more mobile, and encouraging them to use e-mail and verify eligibility on the Internet can help get them acclimated."

Tailor your training

Next, establish a training plan, including the appointment of an in-house project manager, a realistic timeframe for implementation, and a customized set of goals for each end user, says Sue Zumwalt, administrator of the 8-provider Pediatric Associates of Stockton, in Stockton, Calif., and a columnist for the Professional Association of Health Care Office Management. Before going paperless in 2006, Zumwalt sent her 25 employees to six one-hour online training sessions (more if they requested it) on their new EHR and tablet PCs. "Before the new system even arrived, we had them go into a quiet room one at a time, which we called the 'university,' to complete a training program that helped them become familiar with the screens and how the EHR was set up to their specific job needs," she says. "The front desk person had a different training module than the back office person."

That's good strategy, says Eric Fishman, owner of emrconsultant.com in Palm Beach Gardens, Fla., adding one of the biggest pitfalls of tech training is overwhelming your staff with material they don't need. While everyone should know how to perform basic functions using your new system, such as scheduling appointments and updating charts, don't force your back office personnel to learn the digital ropes of processing claims if that's not part of their job description. Instead, provide a basic orientation for everyone and then rotate in different departments for more tailored skill building, he says.

Fishman notes, too, that the most effective learning takes place when end users aren't preoccupied with their work, which is especially significant when implementing a complex system like an EHR. "I would strongly recommend closing the office for a day or two to get your staff trained," he says. "The initial introduction of the system should happen when there are zero patients in the office." Or, you can also ask your employees to come in early or stay late to complete their training, but that will cost you extra in overtime. If you must hold sessions when the office is open, consider blocking or reducing schedules that day, says Fishman.

While all staff members should be proficient on the ins and outs of new technology in your practice, Polack says it's important to designate one or two of your more tech savvy employees to become "superusers," providing them additional training at a higher level. "If you're a smaller practice you may not have a full-time IT person, so you need to have some people in your office with a higher level of expertise who can assist your other employees and troubleshoot if there are any problems with the equipment," says Polack. Those same superusers should also train any future hires and handle the inevitable support calls to the vendor, he says.

Go for launch

After your training phase is complete, it's time for a mock launch. Either before or after hours, have someone in your practice pretend to be a patient and test run the system for both a sick and well visit. "The front desk should be able to put them in as a patient, the medical assistants should be able to get demographic information entered into the system, and the physician should be able to see them and generate a report," says Fishman. "Was that patient able to be seen in an appropriate fashion?" If not, determine where the hang-ups lie and get them fixed before you go live.

When you flip the switch for good, it's critical that you have outside trainers on hand, says Zumwalt, who had five full-time trainers in her office during their first week of EHR implementation. She reduced to one and a half trainers for the beginning of the second week and eventually moved to none. "That's huge," she says. "You need to have a live person on site for all those little questions and glitches that come up. We had people there holding our hand and that was huge." One word of caution, though: Be sure you screen the trainers that your software vendors provide. "You're spending a lot of money to bring someone out and you don't want them learning on your nickel," says Daigrepont, who is also a faculty member of the American Academy of Medical Management. "They may have just started last week. If they're not as experienced as you would like, the unintended consequence is that they could deliver bad advice or they could set the system up poorly. You want to screen that person and check references. "The best software vendors not only have a knowledgeable stable of trainers," he says, "but provide user manuals embedded within their software, which automatically update as necessary and allow your staff to help themselves as new questions arise."

Just for patients

It's not all about your staff, however. Many of the latest technologies being unveiled for healthcare practices are targeted to the patients themselves. Waiting room kiosks enable patients to check in, verify insurance information, fill out forms, and pay copays and past due amounts with the swipe of a card. Patient portals, meanwhile, allow patients to make and change appointments, check lab results, request prescription refills, confirm their profile information, and interact with providers via e-visits in a secure online setting.

Most software vendors strive for ease of use, creating intuitive programs that are self-explanatory and mitigate the need for patient education. But some are better than others. "The amount of training you'll need to give your patients is largely predicated on whether the solution you select has prompts built in that instruct the consumer or patient as they interact with the software," says Daigrepont. "Generally, resetting their password is the biggest thing you need to worry about, but most systems can automatically reset them."

Either way, be sure your staff is prepared to answer the most frequently asked questions about your patient-centric technology, and include your practice phone number on your Web portal so patients can contact your front desk if they hit a snag. The more challenging IT questions, of course, can be directed to the vendor, says Fishman. For many practices, e-mail communication, which can be used to disseminate written follow-up information and educational material, is a good point of entry for patients who may not feel comfortable using kiosks or portals, he notes.

In its "Guidelines for Physician-Patient Electronic Communications," however, the American Medical Association suggests your staff explain to patients that their messages should be concise; they should use the auto-reply feature to acknowledge reading a clinician's message; they should put their name and identification number in the body of the e-mail; and they should include the category of transaction on the subject line of the e-mail, e.g., prescription, appointment, medical advice, billing question, etc. Be sure, too, that your staff instructs patients to never use e-mail or messaging for emergencies, the AMA notes. (Likewise, instruct your staff never to use such tools for time sensitive issues such as conveying bad news or sending group e-mail where recipients' names are visible to each other.) Finally, the AMA recommends practices develop a patient-clinician agreement of informed consent for the use of e-mail correspondence. "This should be discussed with and signed by the patient and documented in the medical record," it notes, adding patients, in turn, should be given a copy of the agreement.

When it comes to implementing new technology, the amount of training you provide your employees can make or break its long-term success - and help you stay the course during those first few weeks that are filled with inevitable setbacks. "Implementing a new system [or] technology will always feel more difficult at first and there is even the temptation to go back to old ways," says Daigrepont. "This is where training can help by getting the staff prepared in advance so these challenges are minimized."

In Summary

Practices that are looking to reap the benefit of expensive investments in medical technology must be willing to commit the necessary time, money, and resources to train their team to be efficient end users. If done poorly, it can be tens of thousands of dollars down the drain. Here are some of the basics:

• Start with an initial assessment of staff skill level
• Begin with basic training for all staff, and then focus on more specialized skill development based on individual users
• Train "superusers" who can assist your staff and troubleshoot problems
• Schedule a mock launch before you fully implement a new system

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the July/August 2011 issue of Physicians Practice.