White Paper Five Things Correctional Facilities Must Know About EMR Implementation and Training NextGen Healthcare Information Systems, Inc. www.nextgen.com
Table of Contents Executive Summary... 3 Introduction.... 4 Ensuring the best possible training via well crafted proposal requests....4 Buyer s Quick Reference Guide......5 Guidelines for implementation.5 Adopting a two-pronged training plan for maximum results...5 Customizing training for specific user groups...6 Example: Why a Rapid EMR Rollout is Critical....6 Ensuring a rapid EMR rollout.7 EMR Implementation Warnings..8 Ongoing training is vital...8 Implementation Do s and Don ts.....9 Conclusion..9 For more information..10 2
Executive Summary As your correctional facility considers an electronic medical record (EMR) solution, it is important to focus on more than just the technical or functional aspects of the technology it is critical to consider your EMR training requirements. Without the right training and coaching, your staff will not be able to properly utilize your EMR solution. This will decrease its effectiveness, impact the quality of patient care, lower your productivity, lead to lower acceptance rates among staff and administrators, and prevent a timely return on your investment. In this white paper, we will help you determine the full scope of your corrections-specific EMR training needs. By defining your requirements up front you can be very specific when you request proposals from potential vendors. You can also more intelligently assess whether proposals accurately and comprehensively address your training needs. Finally, we ll offer guidelines regarding the five things you must know about EMR implementation and training in order to create a results-driven, customized training plan that facilitates a rapid EMR rollout. 3
Introduction Adoption of electronic medical record (EMR) technology in corrections facilities is growing at an ever-increasing pace. Administrative and clinical leadership recognize that EMRs enhance the quality of care, while ensuring that all healthcare services are documented according to regulatory requirements. This technology also allows staff to work more efficiently to streamline processes associated with care delivery. However, as correctional facilities begin shopping for EMRs they often overlook one important consideration: training. Many buyers relegate training to afterthought status, instead focusing solely on the technical and functional aspects of the EMR. If corrections staff members do not receive comprehensive training and coaching, however, they will not be able to properly utilize the technology. This in turn will decrease its effectiveness, impact quality of care, lower productivity, and prevent a timely return on investment. The combination of these problems also leads to a much lower acceptance rate among healthcare staff and administrators. In this white paper, we will help you determine the full scope of your corrections-specific EMR training needs. By defining your requirements up front you can be very specific when you request proposals from potential vendors. And, you can more intelligently assess whether proposals accurately and comprehensively address your training needs. We ll also offer guidelines for creating a results-driven, customized training plan that facilitates a rapid EMR rollout. As the title of this paper suggests, our guidelines are framed around the five things you must know about EMR implementation and training, which are: How to make sure that your proposal requests reflect the full spectrum of your training needs and why this is critical How adopting a two-pronged training plan ensures maximum EMR implementation results How and why to customize training for specific user groups How to ensure a rapid EMR rollout and why it is critical to do so in a corrections environment Why continuous training is vital and how to make sure your facility obtains the proper tools to facilitate ongoing training Ensuring the best possible training via well crafted proposal requests A request for proposal (RFP) is a standardized list of questions and requirements submitted to all vendors competing for your business. The goal is to acquire all the information you need to make apples-to-apples comparisons of the costs and capabilities of the EMRs you re considering. Once you select a vendor, its RFP answers should become an objective list of deliverables that are incorporated into the contract you sign. 4
Training needs to play a central role during the earliest stages of the EMR selection process. Detailed specifications that address training goals and expectations for instance, which staff members need to be prepared to use the technology, or what sort of training program will best support the facility s implementation schedule should be included in the purchaser s RFP. Neglecting to include this level of specificity can interfere with your ability to objectively compare proposals. If left to their own devices, most vendors will likely include a minimal training plan, which may not be comparable to other candidates proposals, nor adequately meet your needs. When this occurs, buyers are forced to go back to the selected vendor after the contract has been signed and request a revised training proposal. This almost guarantees an increase in the contracted price due to significantly greater labor needs. In addition, an after-the-fact training plan may be less successful, resulting in an ineffective EMR implementation that may affect staff acceptance and, ultimately, quality of care or productivity. It also impacts a site s ability to schedule staff for training and to backfill those roles to ensure continued care during training sessions. This typically results in delayed technology rollout or prolonged training activities. Guidelines for implementation EMR training must be designed to meet the unique needs of the corrections industry. While physician practices and healthcare facilities often employ a train-the-trainer approach to technology implementation, this is generally not a viable option for correctional facilities. Simply put, correctional facilities do not have staff available who can dedicate sufficient amounts of their time to providing instruction for all users and who are qualified to do so effectively. Buyer s Quick Reference Guide When choosing an EMR solution, address the following training-related questions during the request for proposal (RFP) process: What type of implementation support, training, and on-site coaching is available? Is there a clear vision of the type of training program that will best support your facility s implementation schedule? Can the vendor point to experience training numerous correctional facilities? Does this vendor employ a train the trainer approach? Which of your staff members need to be prepared to use the technology? Does the vendor have existing training materials to provide to you? Adopting a two-pronged training plan for maximum results Correctional facilities must ensure that EMR users can competently use all features and functionality. To accomplish this, facilities need a two-pronged training plan: 1) All users must attend comprehensive classroom training 2) The vendor must be required to provide coaching staff on-site at each facility. This support should be available for no fewer than 48 hours to support clinical staff when the EMR is launched 5
These two tactics will help ensure that go-live is as smooth as possible. The classroom training will introduce staff to the EMR and provide realistic practice scenarios. But even after the best preparatory instruction, documenting real-time encounters with actual patients is challenging. Without exception, new users will come across an unusual situation that wasn t covered in the training, or will forget how to accomplish a specific task. Vendor coaching on-site means the end user doesn t have to interrupt the encounter, call a remote technical help desk, explain their need, and ask a customer service representative to walk through the process. Instead, the on-site trainer can simply step in and provide immediate instruction so the encounter progresses in an efficient manner. This not only increases productivity during these critical initial first days, but it also builds the user s confidence in his or her ability to make it through their shift using the EMR. Customizing training for specific user groups When classroom training is being developed, correctional facilities must consider two important factors: 1) The curriculum must be structured to provide basic information as well as specific content relevant to each user s responsibilities 2) Training must be scheduled so that all users are trained in a timely manner and the EMR can be rolled out in rapid succession at all correctional facilities within a regional or statewide system Classroom training is typically scheduled two to four weeks prior to technology go-live. Vendors experienced in the corrections field will typically divide the training into two four-hour sessions, with overall training spanning two or more days. It is critical that all training occur in as little time as possible, such that the lag between the first group completing training and the EMR going live is as short as possible. If this gap is too wide the training provided to the initial groups of users will have greatly diminished value, and these users will have difficulty leveraging what they learned and effectively using the system. Typically, at least 25% of the user base will not feel comfortable operating a computer, so in many cases, the first meeting is dedicated to covering the basics through rudimentary training. Topics covered will progress from fundamental computer training to an introduction to the overall functionality of and navigation within the EMR. Example: Why a Rapid EMR Rollout is Critical Inmate Smith may be housed at Site A, which uses an EMR, in April and May. He is then transferred to Site B, which relies on paper charts, from June to November. Site A must print out Smith s record and forward to Site B to be filed with other data. In December, however, Inmate Smith is transferred to Site C, which has also made the transition to EMR. The electronic record is now out of date, because any care given to Inmate Smith at Site B is missing. Site C will need to rely upon the paper record until and if staff members have the time to input information about recent care. 6
The second session should be customized for various user roles. Nurses, for instance, would be trained on intake, sick call, and placing verbal orders. Physicians would learn about documenting the physical exam, ordering medications, and approving verbal orders. Dental and mental health professionals would be introduced to menus and screens applicable to their specialties. Ensuring a rapid EMR rollout Training must support a rapid rollout: When rolling out an EMR in a correctional system with multiple sites, it is imperative to schedule training in such a way to allow all sites to begin using the technology within a very narrow time frame. The reason is simple: Inmates are transferred frequently. If some facilities within a multi-site system have adopted an EMR while others lag and continue working with paper-based charts, it becomes nearly impossible to maintain a comprehensive record for individual patients. The bottom line is this: Correctional systems that don t roll out the EMR at all sites within a short period of time are forced to maintain both paper and electronic processes. This redundancy is not only inefficient but costly, and it interferes with the effective delivery of care. Vendors with expertise in the corrections industry recognize the importance of timely training and devise a schedule, in conjunction with site administrators, to support rapid rollout. For example, to provide effective training in one Midwestern state with 32 sites, a vendor divided the state into four regions. Sessions were scheduled at a central location within each. Training was provided in all four regions simultaneously, and all sites within a region sent staff to the nearest training sessions on a rotating schedule Facility A was trained over the first few days, Facility B the next few days, etc. As soon as all of Facility A s staff were trained, its EMR was launched, with vendor staff providing on-site coaching for two days. This occurred just two weeks after system-wide training commenced. Facility B went live immediately afterward and so on, until all sites were fully operational. This same pattern repeated simultaneously in all regions. Continuous training is critical, especially as nationwide turnover rates have soared to the highest levels in a decade, with 58% of [correctional] organizations reporting difficulty retaining employees. Envisioning the Future: Proactive Leadership through Data-Driven Decision-Making. Jeanne B. Stinchcomb, Corrections Today, August 2006. Using this approach, the corrections system completed training for all 32 sites within two months a quarter of the time a serial training approach would have taken. All facilities were using all areas of the EMR medical, behavioral health, OB/GYN, and dental to complete encounters including intake, labs, off-site referrals, etc. for all inmates receiving care. Inmate movement became a minimal issue due to the experience of the statewide rollout. In order for this to succeed, however, administration must make a commitment to support training. Each facility must require that staff attend scheduled training, and plan ahead often a month or two in advance to backfill during these staff absences. Money must be set aside in the 7
implementation budget to cover not only direct training costs but also for expenses related to interim staff. When the date of training arrives, administration must likewise be consistent in the emphasis it places on attendance. Individual sites may suddenly decide they can t spare certain personnel and balk at letting them participate in training. If this is allowed to occur, the training schedule becomes protracted and implementation is delayed. The ramifications can be great. One system, for example, failed to get management support at several facilities, and attendance at training was abysmal. Ultimately, user acceptance of the EMR hovered at only 20%, rendering the technology virtually useless. Ongoing training is vital High staff turnover within corrections estimated as high as 58% in some areas of the country likewise necessitates a plan for ongoing training. Many facilities with successful EMR implementations found a three-stage approach to be most effective: 1) Identify a focal point or power user. Often, one or more users at a facility display an extraordinary interest in, and aptitude for, the EMR. For example, one employee in a Southern state had never touched a computer before being trained on the EMR. Within weeks, she was highly proficient, and co-workers began to rely on her when they had questions or problems. Individuals displaying these EMR Implementation Warnings Correctional facilities will experience an initial and temporary drop in productivity when an EMR is implemented. No matter how positive a change is, it represents a different workflow and will slow staff down until they ve made the adjustment to the new process. On-site coaching minimizes the early downturn, lessening its duration and impact. One state recently implemented an EMR and reported a 20% reduction in productivity during sick call in just the first few weeks of use. The system relied upon outside vendor support for two days, however, and reported they were back to nearly 100% productivity within a month. Another site opted against onsite training and suffered a 40% drop in productivity. The rate gradually improved, but it took months for staff to regain even 90% productivity. Further, consider this example: Facility A sees 30 inmates during an average three-hour sick call. With an EMR designed specifically to accommodate the corrections environment, coupled with proper training and sufficient coaching staff on-site during the go-live period, Facility A can complete 27-29 encounters in three hours. If staff members are struggling with the EMR, and were not adequately coached by vendor representatives, however, only 15-18 inmates may be seen during the same sick call. This drop in productivity may last for many weeks and can be costly in terms of quality of care delivered, salaries paid to clinical staff, and inmate movement costs. It can also trigger great dissatisfaction among clinical personnel and lessen their motivation to utilize the EMR. skills should be given responsibility for serving as the go-to resource for day-to-day questions from staff, and should be tasked with providing in-house training to new hires. 8
The staffer s job description should be rewritten and a certain number of hours per week allocated for performance of these duties. The EMR vendor s training and coaching staff can help identify these individuals through implementation activities. 2) Include training on the EMR as a formal part of new employee orientation. Rather than expecting incoming personnel to learn the EMR on the job by trial and error, classes should be offered that cover specific tasks the employee will be expected to complete. The training should be scenario-based, so the new employee becomes familiar with how the EMR is used during bona fide encounters. The power user can serve as a mentor to guide and offer additional explanations where needed. The EMR vendor should have existing materials it can provide to you regarding these on-going activities. 3) Take advantage of e-learning opportunities. Best-of-class vendors provide content specifically for corrections. Either the vendor or correctional facility can host this online curriculum. Typically, these courses provide test patient scenarios that allow the trainee to progress through routine encounters. Implementation Do s and Don ts Do Don t make templates simple underestimate the enough for employees to importance of training it use should be addressed in the RFP stage introduce the easiest turn on an EMR function functions first schedule comprehensive classroom training in conjunction with an on-site go-live trainer tailor training content by user group and include scenario-based training deliver timely training for a faster EMR roll-out deliver ongoing training to keep up with high staff turnover without testing it beforehand expect everybody to use the EMR in the exact same way at first expect staff to adjust to the new process immediately you should plan for a slight dip in productivity in the first few weeks of use stagger your EMR rollout it must occur system-wide in order to maintain comprehensive records during frequent inmate transfers and to avoid redundancies forget to plan for the ongoing training needs of new staff; make it part of your new-hire orientation Conclusion In short, successful adoption of an EMR is dependent upon how well staff members are trained to use the technology. The transition from paper-based charting to electronic is significant, and requires dramatic changes in workflow processes. The combination of classroom training and on-site coaching drives user acceptance, increases quality of care, enhances productivity, and results in greater ROI. 9
For more information With over 130 facilities running its EMR product, NextGen Healthcare is a recognized industry leader with a comprehensive corrections-specific solution covering all clinical areas within corrections. Please contact Gary Steiner, NextGen Healthcare s Director of Correctional Healthcare Products, at 215-657-7010 or at gsteiner@nextgen.com for more information or to set up a demonstration. 2008 NextGen Healthcare Information Systems, Inc. All rights reserved. NextGen is a registered trademark and a service mark of NextGen Healthcare Information Systems, Inc. All other marks are the property of their respective owners. Nothing herein is, or is intended to constitute, legal or other professional advice or to substitute for legal or other advice you obtain from professionals you retain. Any claim or grievance against any correctional authority should be discussed with its respective legal representatives. 10