Health Information System Training & User Adoption
User adoption refers to the transfer (conversion) in an organization between an old system and a target system. In this process, users (e.g., clinicians, providers, etc.) adopt a system that is intended to satisfy a specific need. Users transfer from an old system and adopt a system that provides more work capacity and is more comprehensive and efficient.  To ensure that users can use the system properly, training is an important factor in acceptance and use of a new technology. Comprehensive training services provide staff with a solid understanding of the capabilities and functionality of a Health Information System (HIS) platform. HIS training facilitates and advances the adoption and correct use of the system. Additionally, training ensures the optimization of platform use by streamlining workflow, improving communication, providing optimized access to centralized information and improving quality of care. 
HIS training is crucial to realizing the full potential of an implemented platform. Training supports users by transferring specific knowledge and teaching skills to improve individual performance and productivity. HIS training and user adoption provides an individual with the required competencies and allows him or her to learn how to do a job or perform a task to achieve objectives.  Generally, training includes educating employees on organizational goals, objectives, strategies, policies and regulations. HIS training is designed with the objective of teaching employees to perform their duties on the new platform safely and proficiently. Training is designed to help personnel gain the qualifications, knowledge and skills in the new system and affords users the opportunity to develop and standardize new procedures. 
Alan Turing is credited as the first to set out the ideas of modern computing as it is known today. In 1936 he published On Computable Numbers, a seminal paper that rejected the ideas of arithmetic-based computing language and advocated the merits of a formal and simple hypothetical devices.  He pioneered the idea of a ‘Universal Machine’ that would be capable of computing, executing a program, and be programmable.  In the 1950s, the use of computer technology began to rise worldwide. France, Belgium, The Netherlands, and Germany established specialized university departments and began to offer informatics training programs in the 1960s. In the 1970s medical informatics research units appeared in the United States and parts of Europe with the goal of developing high-quality health informatics research, training and organization. Throughout development of health informatics, this field was referred to by many names: medical computing, biomedical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering and medical computer technology. 
As a field of study, Health informatics emerged when computer technology became advanced enough to compute large sets of data. Earlier experimentations in applied health informatics were conducted in the field of dentistry, but it was in the 1960s that health informatics began to emerge as a field within applied sciences. The first standards for healthcare data reporting were established by the American Society for Testing and Materials (ASTM). These practices include standards for “laboratory message exchange, properties for electronic health record systems, data content, and health information system security.” The first electronic medical record appeared soon after and new nomenclature for specific disciplines and services took shape.  The subspecialty of bioinformatics was introduced in the late 1970s, which centers on collating biological data, including DNA. As the importance and prevalence of health informatics began to grow, the training of clinical and medical personnel became focused on individualized instruction through computer-based training (CBT). CBT was developed in the 1970s using mainframe computers when the increasing capability, capacity of computers, and decreasing cost made CBT technologically feasible. 
Components of Training and Instructional Design
Training and Adult Learning Design  must address the needs of an adult user and the principles of training must tailor training for individuals who meet some or all of the following criteria:
- Are self-directed
- Come to training with a lifetime of existing knowledge, experience, and opinions
- Are goal-oriented
- Want training that is relevant to their work (“what’s in it for them”?)
- Want task-oriented training
- Want to be and feel respected
- Identify a clear business goal that the training supports
- Determine the tasks the workers need to perform so the company can reach that goal
- Determine the training activities that will help the workers learn to perform the tasks
- Determine the learning characteristics of the workers that will make the training more effective
Creating a Lesson Plan
- Once learning objectives are identified, create content that covers the objectives
- Quizzes, tests, case studies, or hands-on exercises performed during training to evaluate your worker’s comprehension of the training should assess only the workers’ understanding of the objectives
- Any observation of workers when they return to their jobs to evaluate the effectiveness of the training should also focus on the performance of these objectives
Selecting and Working with Media
- Word, Excel, and similar “Office” programs to create handouts for employees and to create training outlines and notes for the instructor of any instructor-led components
- Materials for hands-on elements and/or role-playing elements of the training
- PowerPoint for in-class projections and/or handouts to deliver to employees
- Flip-charts, posters, transparencies, and/or computer-generated graphics for presenting visual materials during training
- E-learning authoring tools such as Articulate Studio and Storyline or Adobe Captivate for creating computer-based e-learning modules
- Step 1: Reaction – How well did the learners like the learning process?
- Step 2: Learning – What did they learn? (the extent to which the learners gain knowledge and skills)
- Step 3: Behavior – What changes in job performance resulted from the learning process? (capability to perform the newly learned skills while on the job)
- Step 4: Results – What are the tangible results of the learning process in terms of reduced cost, improved quality, increased production, efficiency, etc.?
Tools and Techniques
The User Adoption Process:
- Identify the changes that are to be made.
- Prepare a plan for the user adoption process.
- Identify the requirements that must be fulfilled for the plan to be successful.
- Achieve full agreement on what these requirements are and how they can be fulfilled.
- Prepare the test phase.
- Run the test phase.
- Evaluate results and determine whether the organization is ready for implementation.
- Prepare a final user adoption plan. Ideally, this should be done in collaboration with the users who will be directly affected.
The final adoption plan should include:
- Pre-rollout communications plan
- Post-rollout communications plan
- User training plan.
- Internal marketing plan (if needed)
- Support and troubleshooting to be provided during the rollout
- Reporting lines and reporting requirements
Several adoption strategies are used to implement a system in an organization. Each strategy serves to provide user adoption based on specific criteria of ease, speed, and cost of implementation. The three best practices for adoption strategy are big bang adoption, parallel adoption and phased adoption .
Big Bang Adoption
Big Bang Adoption approach entails the wholesale adoption of a new system on one specific date. This date marks the abandonment of the old system and implementation of the new system. The advantage of this approach is the immediate impact of system adoption as all users start on a new system the same day. All facets and issues of Big Bang adoption are addressed at the same time with all users involved. Everyone in the organization is on the same page working with the new system and the limited timeframe of the implementation provides for near-instant change. Big Bang user adoption relies on effective training and orientation to ensure the success of implementation. Training is conducted before adoption so that users understand the system, the use of software, and the way adoption is going to influence their work. As the platform is rolled-out all questions and issues have been addressed. Big Bang adoption should depend on the type software of the new system. Big Bang adoption works best when the system is user-friendly as complex systems encounter adoption problems due to large amounts of training data.
Parallel Adoption entails the use of two systems that will run simultaneously. During transition, the old system and new system are operating parallel in order for users to gain proficiency with the new system. At the same time the users can still fulfill their duties using the old system and organizational workflow is not impacted by the implantation of the new platform. The advantage of Parallel adoption is that users have time to familiarize themselves with the new system and solve any potential user issues during the training period. At the same time users can conduct their duties by using the old system if they do not fully comprehend the new system or in the case of implementation complications. The obvious drawback of such an adoption method is that, for a period, the organization has to monitor and maintain two systems (old and new) which can put a strain on users and impede workflow. Additionally, when given this option, users tend to employ the old system for as long as possible as it is more familiar. However, Parallel adoption remains popular as the chance of complete workflow breakdown is minimal due to its cautious approach that ensures the safeguards of multiple systems operating in parallel.
Phased adoption is an incremental process that implements a new platform in several phases. This process ensures that each phase bring the organization closer to new system adoption. Organizational management employs small changes over time such as having one specific team start the transition to the new system. If the transition is successful, then the next group is transitioned to the new system until all processes and users are operating on the new platform. Although similar to Parallel adoption, Phased adoption utilized organized transition where users adhere to a strict schedule of adoption and training is completed before implementation. It is considered to be safer than Big Bang adoption as it employs more safeguards and less resistant to change then Parallel adoption.
Health Information System Training Strategies
To achieve effective training process, it is important that training is organized by function, and that users are trained in specific functions related to their job. This ensures that participants are attentive as end-users will be employing these processes on daily basis. Training materials are developed and customized, after system configuration to suit the organization. Computer skills assessment is administered as role-based training involves the use of computers and, therefore, computer literacy needs to be addressed. Capability assessments are administered after role-based training to identify specific training needs, apply organizational standards, and identify trends in training effectiveness.
Process-based training is vital for some organizations because in the process of user adoption of a new system will issues of workflow. Clinical processes such as e-prescribing or triage services would require participation of a number of users such nurses, call center personnel, and others. All involved must understand new processes and their specific role in these processes that also involves interactions with other end-users. Process training affords the opportunity to improve and streamline policies and procedures and to integrate best practices into the end-user training.
To achieve an all-encompassing, comprehensive, and integrated training process, some organizations choose to run a mock-clinic training where the place of performance is closed for a time in order to run simulated exercises. Administrators and leads usually play the role of a typical patient from check-in to check-out. Demonstrating diverse simulations, based on several factors, helps organizations understand how the integrated processes will be changing. Lessons learned sessions are conducted at the end of the mock-clinic to understand which processes end-users are found to be helpful and which processes still need improvement. This type of training has proved to be effective in providing peer-to-peer training and enabling smooth transition for user adoption.
Super User Training
Super user strategy focuses on vendor-provided training to a specific team within the organization called “super users.” Super users are personnel that are understand the functions of the system and are able to navigate the new platform effectively. Super users can help the rest of personnel with directions, techniques, and troubleshooting. This group of super users provide internal training and combine specialized HIS training with customized workflow specific to the needs of their organization.
HIS training and user adaption are tools that help clinics, hospitals, or other organizations to optimize workflow by ensuring that end-users can harness the advanced capabilities of the new system and provide a better level of care due to functional system enhancements. Implementation of a new platform will not have the desired effect if the people using the system are not fully aware of system capabilities and processes. As a result, the training and user adoption processes will have an impact throughout the organization and are not limited to new technology alone. A strategic approach to training can turn organizational and technological changes into opportunities for improvements, and can help the organization to transition to a new system with minimal complications that usually accompany such adoptions. 
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- Turing 1937, pp. 230–265. Online versions: Proceedings of the London Mathematical Society Another version online.
- Letter by Stanley Frankel to Brian Randell, 1972, quoted in Jack Copeland (2004) The Essential Turing, p22.
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