Developing an Effective Clinical Applications Education Department Elizabeth Fiscella, RN, MS Alexis

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Developing an Effective Clinical Applications
Education DepartmentElizabeth Fiscella, RN,
MSAlexis Keeler, BSBerkshire Health
SystemsPittsfield, MassachusettsMEDITECH's
Annual Nurse Informatics WorkshopMay 21st 2009
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True teaching is only achieved by example.
Plato
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Objectives

• Identify potential actual barriers to the
  clinical applications education process
• Discuss the process of developing groundwork for
  effective MT education
• Identify ways to improve future clinical
  applications learning

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The White House is working to improve the
adoption of health information technology In
2004, President Bush launched an initiative to
make electronic health records available to most
Americans within the next 10 years. Health IT
systems can give citizens better access to their
health information, resulting in informed
decisions about their care and a better
understanding of the quality of the care they are
receiving.  In 2006, President Bush directed
Federal agencies to use improved health IT
systems to facilitate the rapid exchange of
health information. In February 2009, President
Obama signs historic bill that focuses, in part,
on improving the electronic health record.
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BHS Transition to a Fully Integrated Electronic
Record

• Identify workflow changes
• Identify effects on productivity
• Education for all clinical staff
  (initial and on-going)

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Barriers
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Background of BHS Clinical Applications Education

• Inconsistency in training methodologies
• Poor communication of IS system updates between
  departments
• No single division/department responsible for
  training and education for all users of the eCARE
  system
• Equipment/training rooms constantly moved based
  on needs of organization

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Inconsistent Training Methodologies

• New implementation trainings were completed by IS
  analysts, taking them from essential build duties
• Orientation training was completed through a
  centralized corporate education department
• Each department also developed delivered
  individualized dept-specific IS training

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Poor Communication of IS Updates

• No consistent method of communicating updates
  between departments
• IS initiated the communication, but there was no
  means of ensuring that consistent information
  reached the end-user
• No consistent follow-up support to new staff to
  evaluate their use of the system and answer their
  questions

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IS Training Equipment Rooms

• Low on overall corporate priorities, so
  classrooms were frequently moved to meet the
  needs of the organization
• Connectivity was greatly varied based on the
  network and equipment being used, resulting in
  classroom disruptions
• Training areas were not always conducive to
  learning

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BEFORE
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AFTER
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Why a Clinical Applications-specific Education
Department?

• Vital for quality improvement
• Education experts required to lead the department
• Need for a conceptual framework curriculum

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Joint Commission Sentinel Event Alert Safely
Implementing Health IT

• Establish a training program for all types of
  clinicians and operations staff who are using the
  technology and provide frequent refresher
  courses.
• Training should be appropriately designed for the
  local staff.
• Focus training on how technology will benefit
  patients and staff (that is, less inefficiency,
  fewer delays, and less repeated work).
• Do not allow long delays between orientation and
  system implementation.

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Its like trying to build a plane while its
flying.
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Leading the charge

• A Seasoned Clinician/Nursing Professor
• AND
• A Tech-savvy Software Educator

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Education vs. Training

• Utilizing adult learning theory (WIIFM)
• Student focused, not teacher focused
• For many adults, learning computers is like
  learning a new language
• Teaching an old dog new tricks

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Strapping new technologies on old processes
doesnt necessarily propel you in the right
direction
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Knowledge comes, but wisdom
lingers. Alfred Lord Tennyson
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Developing a Conceptual Framework

• Must be grounded in the IS customer service
  philosophy
• Requires overall programmatic objectives that are
  specific to clinical applications
• A logical sequence of courses with objectives
  (KSAs) at each level
• Determine which courses require actual hands-on
  training vs. communication
• A process for evaluation at each level

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BHS IS Customer Service Mission

• Our core mission is to actively engage support
  all current and potential users of our systems
  and services in support of their work.
• Further, we strive to develop relationships
  between IS and all user entities which facilitate
  the use of our tools the valuable data we
  house.
• We will be a proactive, high quality, customer
  focused team which works together to provide the
  best possible experience to our users.

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Our Goals

• Assess overall educational needs/tests, evaluates
  and deliver training programs for new and current
  systems
• Audit EMR to track and trend utilization and
  competency
• Deliver programs to all users of eCARE
• Offer multiple options for training while
  maintaining curriculum requirements (CBTs)

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Private Practices (Interface)
Clinical Research
Clinical Applications Education
Performance Improvement
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The Target Audience

• 750 Berkshire Medical Center Nurses
• 25 Fairview Hospital Nurses
• 16 Physician Practices (including MAs)
• Quality Staff (BMC, FVH, BFS)
• Medical Records Staff (Centralized)
• Physicians.

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Target Audience (cont.)
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• Visionary nursing leaders use informatics as a
  tool to guide influence improvements in patient
  safety, satisfaction and outcomes with nursing
  recruitment, recognition and retention efforts.
  (Sapnas 2007)

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Nursing Informatics Schematic

• Technical-
• Psychomotor skills
• Utility-
• Critical thinking
• Leadership-
• Ethical considerations
• Quality Assurance

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Moving from Minimal Competence in the Classroom

• Knowledge, Skills, Abilities for
  User-level
• Keyboarding
• Understands basic computer applications
• Navigate patient care systems/EMR
• Patient data entry to help manage care

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to Proficiency at the Bedside

• Knowledge, Skills, Abilities for
  Modifier-level
• Synthesizes data
• Track and trend data
• Participates in policy and procedural development
• Participates in quality initiatives

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and Beyond!

• Knowledge, Skills, Abilities for Innovator-level
• Recognizes societal and technological trends and
  issues
• Initiates research and development of new
  clinical applications

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Improving the Overall Clinical Apps Education
Results in

• Improved interdepartmental collaboration/communica
  tion
• Improved efficiencies
• Improved patient safety
• Clinical excellence resulting in increased
  nursing job satisfaction!
  Happy nurseshappy patients!

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Developing the KISS Approach to Clinical Apps
Education
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A Comprehensive Needs Assessment Tool

• Provides a mechanism for identifying educational
  needs
• Hands-on classroom training vs. simulation CBTs
  vs. simple verbal/written communication
• Places the responsibility on the department to
  communicate completely with us, ensuring
  consistency throughout the continuum

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Defining the Processand Utilizing Available
Tools and Resources
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Ensuring Education is Part of the
Project/Go-LIVE PlanClinical Applications
Education Workflow Defined
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The Clinical Applications Education Needs
Assessment
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WORKFLOW!!!
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Completed for Each User Group
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Using Simulation through Computer-Based Education
Utilizing a Learning Management System (LMS)
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Computers are incredibly fast, accurate and
stupid. Human beings are incredibly slow,
inaccurate and brilliant. Together they are
powerful beyond imagination.
Albert Einstein
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• Government policy
• US recovery package has 19 billion for health IT
• DENVER, Colo. On February 17, U.S.
  President Barack Obama (pictured) signed into law
  a US787 billion economic stimulus package that
  includes more than 19 billion for healthcare IT.
  At the signing ceremony, President Obama said
  that digitizing U.S. residents health records
  was long overdue and would help eliminate
  duplication and save billions of dollars.Of the
  19 billion for healthcare IT, about 17 billion
  will be delivered through the Medicare and
  Medicaid programs to those who use Electronic
  Health Records and report quality data to the
  government. However, those programs are not
  expected to begin until 2011.

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Closing Remarks by President ObamaFrom the
Health Care Summit3645 3756
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How wonderful it is that nobody need wait a
single moment before starting to improve the
world. Anne Frank
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Questions ?