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Electronic Health Records

E-learning supports EHR implementations

In addition to meaningful use, we need to defi ne meaningful training. By Andres Jimenez, M.D.


ow do we train hundreds of thousands of doc- tors to become meaningful users in a year or two in time for full stimulus incentives? With technology, that’s how.

Meaningful use of a certifi ed EHR was recently

defi ned by the Health Technology for Economic and Clinical Health (HITECH) Act enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009. Signed into law by President Obama, HITECH provides a benchmark for the attainment of federal incentive bonuses initiated to help drive the adoption of health information technology (HIT) across the na- tion. Over the next fi ve years, hundreds of thousands of doctors will be trading their pens or dictaphones for template-driven computer applications promising to not only store charts, but transmit prescriptions electroni- cally, provide up-to-date decision support on the delivery of patient care and cut down on administrative waste by electronically submitting visit charges to payers. Advanced technology, such as the Allscripts Enter- prise EHR, already delivers on much of this functional- ity, aiding in achieving certifi cation and helping doctors transform healthcare. However, for hospitals and physician practices to fully adopt these highly sophisti- cated EHRs and qualify for HITECH Act incentives by demonstrating meaningful use, they must incorporate computer-based training technology.

Physician participation and motivation is critical Most HIT leaders would agree that training is one of the most important aspects of implementing new technology – especially certifi ed EHRs with advanced functionality. However, the challenge many encounter with any type of training strategy is getting the doctors to participate and maintain a high level of attention to ensure meaningful learning. Many HIMSS Nicholas E. Davies Award of Excel- lence recipients have achieved excellence through sig- nifi cant investments in training. This award recognizes excellence in implementation and attaining value from

22 November 2010

HIT with a special emphasis on EHRs. One award re- cipient, Multicare Health System, amended its medical staff bylaws to require EHR training and competency in order for staff to maintain privileges. As one can imagine, this is a very powerful motivating factor, especially when combined with awarding CME credit for participating in training. Unfortunately, many obstacles exist that can hamper training efforts.

One HIMSS Nicholas E. Davies

Award of Excellence recipient amended its medical staff bylaws to require EHR training and competency in order for staff to maintain privileges.

EHR implementations are plagued with failure rates as high as 50 percent, depending on how suc- cess is defi ned. One commonly cited failure involves a large hospital system in southern California that failed implementation of computerized physician order entry (CPOE). Despite signifi cant resources, strong leadership and experience in informatics, the CPOE system had to be uninstalled because of confi guration challenges and lack of physician support.

Several studies have looked at physician age and adoption of HIT, such as an EHR. Soumerai and col- leagues (1998) found that older physicians are less likely to change their practice of medicine even when presented with evidence that alternative approaches yield improved outcomes. Burt and Sisk (2005) found that physicians older than 60 were less likely to adopt than younger physicians, but they thought this might be related to these doctors being less comfortable with computers. Examining how this might tie into practice characteristics, it turns out that older physicians are less likely to work in large practice settings. Physicians


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