Coupling Provider-led EHR Training and Agile Optimization for Individual and Clinical Team Proficiency, Efficiency and Satisfaction

Background: Challenges with electronic health records (EHRs) represent a leading source of professional discontent among healthcare professionals. Organizational investment in end-user EHR training improves individual EHR experience. However interventions focused on individuals are unlikely to produce meaningful advances in the shared EHR experience of clinical teams. A more comprehensive strategy for resolving challenges with the EHR would combine individual-oriented interventions with group-oriented microsystem interventions to re-engineer ineffective shared electronic workflows, balance workload and strengthen collaboration and handoff. This study sought to couple provider-led peer-to-peer EHR training with specialty cohort Agile optimization to increase user proficiency, efficiency, and satisfaction with EHR specialty-specific tools.

Methods: Clinical Informatics physician and nurse practitioner peer trainers designed and delivered individualized at-elbow advanced EHR education to ambulatory providers throughout the medical center. Once 80% of providers in a clinical specialty completed advanced training, the group was offered a 3-week Agile EHR optimization sprint activity. We report on the 51 providers representing the first 5 specialties in our organization to participate in the sequential training and Agile experience. End user system activity logs and survey data were collected at baseline, at 1 and 3 months post training and 1 month post optimization. Comparative analyses were performed on baseline and interval proficiency, efficiency, and satisfaction metrics, using paired T-tests.

Results: Brief personalized one-on-one training was associated with improved provider EHR proficiency, efficiency and satisfaction. Ambulatory providers saved an average of 5.6 minutes of documentation time per appointment by 3 months post-training. After-hours EHR usage declined modestly, an average of 3 minutes reduction per day, and was not statistically significant. Participating providers' EHR proficiency attenuated but EHR efficiency made additional gains from 1 month to 3 months. Providers of clinical divisions participating in Agile optimization overwhelmingly endorsed its benefits: 86% agreed with the statement “ this EHR has functionality for my specific specialty or clinical care focus” at the conclusion of the sprint and over 90% agreed that the sprint had been partly or wholly responsible for delivering their specialty's needed EHR tools.

Conclusion: Personalized EHR training coupled with specialty-specific Agile optimization increases individual provider proficiency, efficiency, and satisfaction and produces valued team functionality, which is expected to reduce the risk of health IT-related technostress.