Physician, Train Thyself. Or Not. It’s Up to You, Really. You Tell Me.

I’m a smart aleck. Maybe you’ve figured this out already. Maybe you have another descriptive name for me. Whatever. Back in the day when I was practicing primary care pediatrics 24/7/365, I got to know a lot of my patients’ parents (who am I kidding? – moms) very well. This happens when you practice with only one other physician for many years. It’s a good thing. Often a mom would describe a child with upper respiratory infection (URI) symptoms, and after I heard the history, I’d snidely comment: “Listen, I’m such a good doctor that I’ve already narrowed this down to only two things. It’s either something, or it’s nothing.”

See what I did there? While sarcastic, my statement is basically valid. The vast majority of young children brought to me with URI signs and symptoms either had an ear infection or a simple URI. Before you family docs and pediatricians start tsk tsking me, I acknowledge the outliers. There were kids with wheezing and bronchiolitis; there were patients with the occasional sinusitis or pneumonia. But most children either had an otitis media (which I might treat with antibiotics) or a viral URI (which I would never treat with antibiotics). Based purely on non-scientific, totally made up numbers, I’d say it was 40/40/20 (40% ear infection, 40% viral URI, 20% other).

How do any of these ideas relate to training physicians as they use technology such as the electronic health record (EHR)? In my experience, conversations I have with information technology (IT) experts and clinicians seem to end up in a similar outcome. I can narrow down the perfect EHR training regimen to only a few options. Either doctors should have lots of training up front. Or pretty much no training. Or something in between. Helpful? No need to thank me. I’m here to serve.

When it comes to the debate about how best to train physicians to use the EHR, there are some basic camps:

• All doctors get 8-16 hours of training when using a new EHR. No exceptions. Sometimes these sessions involve specialty-specific workflows; sometimes they’re the same for all docs with follow-up later for specialty workflows.
• Doctors who are new to an organization but have used the same EHR earlier in their career have an abbreviated training session and/or the option to “test out” of training.
• Other options (e-learning with or without classroom training; small group training; one-on-one training with a peer physician, etc.)

Much like my made-up numbers for pediatric sick visits, I’d say we’re looking at 40/40/20 in my experience and travels.

Gradually, some groups are helping us move from opinions and experience to fact-based research. I’m most excited about the KLAS Arch Collaborative. KLAS is a company that has been researching and reporting on healthcare IT technology for many years. Recently, they’ve started surveying end user doctors and nurses about their opinions on the tech tools they use (EHRs mostly). This new methodology helps highlight the fact that some organizations have doctors who love EHR Vendor A, while other organizations have doctors who hate the very same vendor. How can that be? That’s an easy one; see my post and, more specifically, myth #5 here.)

The Arch Collaborative is starting to compare physicians’ own opinions about the EHRs they use (aka subjective data) with efficiency and proficiency data from within the very same EHR (aka objective data). They’ve come to some interesting conclusions. One that I want to highlight here is that physicians who have well-defined, rigorous onboarding EHR training with quick (1-2 weeks) in-person follow-up are much more likely to positively rate their training experience, positively rate their EHRs, and be efficient users of their technology. That’s a bunch of big wins for a relatively small price, yet it’s a price that most doctors say they don’t want to pay.

It’s difficult to force physicians to take time out of their schedules for IT training, especially if they believe they don’t need any training, or they believe that the tech should be so obvious that training should never be necessary. I’m all in favor of EHRs that work like Google, but until they are out in the public domain, training is an inherent part of using a complicated EHR. While we see data that suggest that docs who have more training are better on multiple fronts, the vast majority of docs don’t want that training when offered to them. It’s a paradox that we deal with regularly, and there’s no obvious answer.

Have you figured this out? And if so, have you figured out how to get kids to eat their veggies? Reach out to me with either solution; I’ll be forever in your debt.