It is a well-established fact that adequate training is essential for a successful EHR implementation. In my experience, the term “training” is often used to describe a range of activities, each of which is essential for success.   The amount of training and the type of training are equally important when implementing an EHR.

Types of Training
Over the years, I have found it is very helpful to divide EHR training into three categories: computer literacy, software features/function, and workflow alteration.

Computer Literacy
Equating computer use with computer literacy is a common mistake that often occurs during EHR implementation planning.  For the last eight years, I have taught a one-day seminar on bibliographic searching and information management tools.  Interestingly, I find that are still a number of Windows users who do not know useful keyboard short cuts–common CRTL sequences; F1 is the help key;  or right-clicking the mouse provides a context-sensitive menu.

Graphical user interfaces (GUIs) have been very successful in promoting computer usage.  However,  they also may convey a false impression of a user’s actual computer skill level. For common applications such as sending an e-mail or updating on Facebook, the user interface is often simple enough to figure out by trial and error. However, EHRs are more complex and offer more features.   Depending on the product, proficient EHR use may require facility with common keyboard shortcuts that are standard for Microsoft Windows.   If this knowledge is lacking, EHR training may not be productive.  With this in mind, consider adding computer literacy assessment to your EHR implementation plans.

EHR Features/Functions
Standard EHR training usually consists of a 3-5 day classroom experience.  Commonly, this is an introduction to the EHR’s menuing system and use of key features/functions. Through repetition, trainees become familiar with the user interface and EHR navigation.  While this type of training is effective in introducing trainees to the capabilities of the EHR, it fails to do so in the context of their everyday jobs.  In my experience, it also seems to be more effective for non-clinical staff.

Workflow Alteration
Moving from paper to an electronic system requires not only learning to use a software product, but also learning how to perform familiar tasks in a new way.  This forces EHR users to undergo a fundamental change in their work habits, and classroom training is not the ideal way to prepare those affected.   The transition to new workflows is less jarring when training is folded into actual patient care encounters.

In particular, getting clinicians up-to-speed seems to happen more quickly when they are provided limited classroom training (1-2 days instead of 3-5) followed by direct assistance while seeing patients.   This approach likely arises informally in practices where super users are available to assist clinicians as they adjust their work habits to the EHR.  I wonder if the drop in productivity often seen with EHR implementation would be ameliorated if this approach were formalized and used as a standard implementation practice.  It certainly worked at the 1917 Clinic.

Training: Round Two
There is a limit to what one can absorb during classroom training before the law of diminishing returns takes over.   After using an EHR for four weeks or so, staff will have a better idea of  their problem areas, and another round of training will often prove useful in accelerating proficiency.  This second training round should address those specific issues identified by the trainee.  It should not be a repeat of the initial classroom experience.  Depending on the vendor, a simple way to provide a second round of training is via the Internet or a training EHR set-up located at the practice site.  Both scenarios work well for small practices.

Job Descriptions, Policies & Procedures
A final, and often overlooked, aspect of training involves planning for future staffing needs.   Policies and procedures should be rewritten to address the training of new hires so that software and job training are properly aligned.   Computer literacy assessment should be included as a condition for employment unless literacy training is offered as a standard component of new employee training.

Proper training is essential for a successful implementation.  Understanding the different types of training experiences allows for better planning and less frustration on the part of practice staff.


Microsoft offers computer literacy assessment and training.  You may access the materials at Microsoft Digital Literacy. The site works best with Internet Explorer.



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