Health Information System Training & User Adoption

Chapter 11 of 11

The dynamic nature of technology requires the adoption of new systems to keep up with the trends. However, training is necessary to sustain the adoption of new technology. To maintain the accuracy of Health Information Systems, modifications of the old system and additions of new systems are key factors. This includes adoption and training of users on new systems. This chapter will provide insights on health information system training and user adoption.

11.1. DEFINITION

User adoption refers to the transfer (conversion) in an organization between an old system and a target system. In this process, users adopt a system that is intended to satisfy a specific need. Users transfer from an old system to adopt a system that provides more work capacity and is more efficient. To ensure that users can use the system properly, training is an important factor in the acceptance and use of 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 system, improving communication, providing optimized access to centralized information, and improving the quality of care.

11.2. PURPOSE

HIS training is crucial to realizing the full potential of an implemented platform. 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 allows users to develop and standardize new procedures.

11.3. HISTORY

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 seminar paper that rejected the ideas of arithmetic-based computing language and advocated the merits of formal and simple hypothetical devices. He pioneered the concept 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.

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. 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).

11.4. UNDERSTANDING KNOWLEDGE MANAGEMENT AND CHANGE MANAGEMENT IN TRAINING AND ADOPTION

Knowledge Management (KM) refers to processes involved in handling, maintaining, and controlling the knowledge available in an organization. An important aspect of KM is the understanding of knowledge which refers to the distinct or elusive skills possessed by an individual. With KM, organizational learning is possible with companies investing in production as well as the knowledge behind the production. Companies committed to organizational learning are concerned with maintaining and building upon internal knowledge at a corporate level. This helps individuals acquire exceptional skills and to ensure that the knowledge gained is utilized throughout the workforce.

The main goal KM, according to a research paper released by Massachusetts Institute of Technology (MIT), is the connection of knowledge nodes. In other words, connecting those with knowledge with those in search of knowledge within an organization. The authors of the paper pointed out four objectives of KM:

  • Capturing of knowledge
  • Increasing knowledge access
  • Enhancing the knowledge environment
  • Management of knowledge as an asset.

KM is an important factor in user training and adoption as it is a unified system of accruing, storing, and sharing knowledge within a team or an organization.

11.4.1. WHO CAN USE KM?

KM can be applied in various public and commercial sectors, including the healthcare sector, but the implementation processes may differ based on factors such as industry and company size. For small organizations, carving out a modest industry market, KM benefits come from codifying and storing internal knowledge from the inception. Meanwhile, large organizations, including those with substantial power in their market, use KM to act quickly in the digital age, where business frequently changes without warning. It would be difficult to react to these market changes without a dependable system to store existing knowledge and accumulate new knowledge.

If you want to implement KM in a certain department, you can also fit the practice to sub-fields. Ultimately, KM is mostly applied in IT/information systems and science, organizational management, business administration, human resources management, content management, or for personal use.

11.4.2. THE BENEFIT OF KM

KM is applied in training and adoption to increase the organization’s efficiency and decision-making. Building knowledge in an organization (amongst employees) helps in making more informed, faster, and profitable decisions. Other benefits include:

  • Enhances teamwork generation of ideas
  • Knowledge sharing culture
  • Protection of intellectual capital
  • Human capital is treated as an asset which makes employees feel valued
  • Captures and retains knowledge for the future workforce

11.4.3. BASIC COMPONENTS AND STRATEGIES OF KM

The rationale of KM is to ensure that the workforce is educated and skillful as possible. This is possible via strengthening organizational learning and this practice ensures that existing knowledge is systematized, stored, and dispersed among other employees for continuous amassment of skills. Below are the three core approaches to KM:

  • People-centric: This approach is focused on people, relationships, and how people create learning communities and other informal ways of sharing knowledge. This method is also recognized as ecological KM theory.
  • Tech-centric: This approach is concerned with technology that enables knowledge storage and transfer it aims to create technology systems that share knowledge.
  • Process-centric: This approach is centered on how the organizational structure and processes hold and encourage knowledge sharing as well as organizational learning. This concept comprises of the production processes, the organizational hierarchy, as well as cultural background.

Choosing any of these approaches depends on how an organization’s functions but all will undoubtedly affect the people, technology, and processes. Keeping all three in mind is best when selecting a KM strategy.

11.4.4. HOW TO IMPROVE KM

KM can still be challenging to execute, even if you are versed in the KM life cycle. Nevertheless, here are some tips to enhance KM.

Understand how knowledge flows in your organization: There are several life cycle models of KM with phases to follow, but they are just blueprints. Know how knowledge is gained, stored, and shared in your organization. Make use of this flow of information to draft the process for your formal KM.

Define your goals clearly and have a definite way of measuring them: A clearly defined goal is easier to evaluate, especially when it comes to measuring your success. You need to pick objectives with a method of measurement before executing KM.

Socialization helps: Transfer of knowledge naturally is best achieved through casual sharing and talking. Allow room for interaction among team members so an in-office relationship can be formed. This will improve the sharing of knowledge and information.

Create new knowledge: KM is not just about the storing of knowledge, but also about the creation of new knowledge with a detailed process on how it’s going to be managed. Demonstrate how new knowledge is treated to your employees and also showing how their knowledge will be viewed as an asset. This will make them more inclined to adopt knowledge.

Embrace technology: In organizing and standardizing the process of KM, technology can simplify things. It’s paramount to remember that technology is in no way KM, it’s just an enhancement tool for your processes.

11.5. CHANGE MANAGEMENT

Over the past few years, change management has advanced with change management plans, processes, and models which made it easier to impact change in an organization. Definitions of Change Management Model, Change Management Process, and Change Management Plan must be understood as well as how they vary.

Change Management Models: These concepts developed over time based on the experiences and research on how to effectively manage change in one’s personal life and in an organization.

Change Management Processes: These processes involve sequential steps or activities that shift a change from conception to delivery.

Change Management Plans: Development of plans supports project transformation. These plans are created during the change management process planning stage.

11.5.2. CHANGE MANAGEMENT IN HEALTHCARE ORGANIZATIONS

The health industry has projections of how digitalization will transform and optimize its procedures and processes. Clinical trials, tests, team onboarding, healthcare credentialing, and clinical openings all require an automated approach that involves management of change. For effective implementation, high-level visibility is needed. Efficiency in the organization of timelines and contracts as well as the storage of confidential information is also paramount. As the demand for more standardized processes is increasing, collaborative, real-time, and visible tools are required.

Smartsheet is a work execution platform beneficial to healthcare companies. It helps to improve the efficiency of work, scale repetitive processes, and store health information securely. Stored health information in compliance with HIPAA’s regulatory requirements can be easily shared. It helps in the streamlining of documents and improvement in communication. Healthcare processes are modified, and top-level data security is enabled.

11.6. COMPONENTS

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

Needs Analysis

  • Identify a clear business goal that the training supports
  • Determine the tasks workers need to perform so the company can reach its goal
  • Determine the training activities that will help workers learn to perform the tasks
  • Determine the learning characteristics of workers to make training more effective
  • Creating a Lesson Plan
  • Once learning objectives are identified, create content that covers the objectives
  • Quizzes, tests, case studies, and/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

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
  • 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
  • Assessments
  • 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.?

11.7. TOOLS AND TECHNIQUES

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 requirements are and how they can be fulfilled
  • Prepare the test phase
  • Run the test phase
  • Evaluate results and determine if 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

11.8. BEST PRACTICES

Several adoption strategies can be used. Each strategy serves to provide user adoption based on specific criteria of ease, speed, and cost of implementation. The three best practices are big bang adoption, parallel adoption, and phased 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 the implementation of the new system. The advantage of this approach is the immediate impact of system adoption, 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. 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 the implementation. As the platform is rolled-out, all questions and issues have been addressed. 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 the transition, the old system and new system are operating parallel for users to gain proficiency with the new system. At the same time, users can still fulfill their duties using the old system, and the implantation of the new platform does not impact organizational workflow. 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. 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 famous as the chance of complete workflow breakdown is minimal due to its cautious approach.

Phased adoption is an incremental process that implements a new platform in several phases. This process ensures that each phase brings 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’ adherence 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.

11.8.1. HEALTH INFORMATION SYSTEM TRAINING STRATEGIES

Role-Based Training is used to achieve an 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 a 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 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, a new system will begin the workflow. Clinical processes such as e-prescribing or triage services would require the participation of several users such as nurses, call center personnel, and others. All 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.

Mock-Clinic Training is used 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 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 has proved to be effective in providing peer-to-peer training and enabling a smooth transition for user adoption.

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. They help the rest of the 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.

11.9. OUTCOMES

HIS training and user adoption 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. 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.

11.10. CITATIONS

  1. Mayer Duggan, C. (2005, June). Designing Effective Training. Journal of AHIMA; 76, no.6: 28-32. Retrieved from http://library.ahima.org/doc?oid=59954#.Wcu3sGhSzIU
  2. HealthIT.gov (2019a) How Should I Train My Staff? Retrieved from https://www.healthit.gov/faq/how-should-i-train-my-staff
  3. Dalto, J. (2014). How to Create an Effective Training Program: 8 Steps to Success. Retrieved from https://www.convergencetraining.com/blog/how-to-create-an-effective-training-program-8-steps-to-success
  4. Turing, A.M. (1937). On Computable Numbers, With an Application to the Entscheidungsproblem. Proceedings of the London Mathematical Society. pp. 230–265.
  5. Letter by Stanley Frankel to Brian Randell, 1972, in Copeland. B.J. (Ed.) (2004). The Essential Turing: Seminal Writings in Computing, Logic, Philosophy, Artificial Intelligence, and Artificial Life plus The Secrets of Enigma. Oxford: Clarendon Press. p22
  6. University of Illinois at Chicago (n.d.). 50+ Years of Complexity: The History of Health Informatics. A Brief History of Health Informatics. [Web log post.] Retrieved from http://healthinformatics.uic.edu/resources/articles/a-brief-history-of-health-informatics/
  7. A Brief History of Computer Based Training
  8. By Natalie Aranda August 31, 2006 http://ezinearticles.com/?A-Brief-History-of-Computer-Based-Training&id=287273
  9. Aranda, N. (2006). A Brief History of Computer Based Training. Retrieved from http://ezinearticles.com/?A-Brief-History-of-Computer-Based-Training&id=287273
  10. Sleight, D.A. (1993). A Developmental History of Training
  11. in the United States and Europe. Michigan State University. Retrieved from https://msu.edu/~sleightd/trainhst.html
  12. Mayer Duggan, C. (2005, June). Designing Effective Training. Journal of AHIMA; 76, no.6: 28-32. Retrieved from http://library.ahima.org/doc?oid=59954#.Wcu3sGhSzIU
  13. HHS.gov. (n.d.). Retrieved September 17, 2015, from https://www.healthit.gov/policy-researchers-implementers/health-it-adoption-programs
  14. Op. Cit. HealthIT.gov (2019a)